Risk of death due to heart disease after radiotherapy for esophageal cancer: A SEER study.

Frandsen, Jonathan; Boothe, Dustin; Gaffney, David K.; Wilson, Brent D.; Lloyd, Shane

doi:10.1200/jco.2015.33.15_suppl.4025

Cited by 22 publications

(36 citation statements)

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“…Although the heart was previously considered resistant to irradiation, past studies have found that radiation therapy is associated with cardiac diseases (5,6). Moreover, recent studies have demonstrated that the use of radiation therapy for esophageal cancer leads to an increased risk of cardiac death (7,8). Therefore, long-term survivors who underwent radiation therapy for esophageal cancer should be carefully observed for potential risks of adverse cardiac events.…”

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confidence: 99%

Left Ventricular T1 Mapping during Chemotherapy–Radiation Therapy: Serial Assessment of Participants with Esophageal Cancer

et al. 2018

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Purpose To assess changes in left ventricular function and tissue composition by using MRI after chemotherapy-radiation therapy in participants with esophageal cancer. Materials and Methods Between January 2013 and April 2015, this prospective study enrolled 24 participants (42% women; mean age, 63 years; range, 49-73 years) scheduled for chemotherapy-radiation therapy. 3.0-T MRI examinations were performed before, at 0.5 year, and at 1.5 years after chemotherapy-radiation therapy. Myocardial native T1, postcontrast T1, and extracellular volume were measured in basal septum (as irradiated areas) and apical lateral wall (as nonirradiated areas). Left ventricular function, prevalence of late gadolinium enhancement, and T1 and extracellular volume values were compared over the follow-up period by using Friedman or Cochran Q tests, followed by Dunn test. Results In 14 participants who were followed up for 1.5 years, native T1 and extracellular volume in the septum were elevated at 0.5 year compared with baseline (1183 msec ± 46 [standard deviation] vs 1257 msec ± 35; 26% ± 3 vs 32% ± 3; adjusted P < .01 for both), but not in the lateral wall. Left ventricular stroke volume index and late gadolinium enhancement changed at 1.5 years compared with baseline (41 mL/m ± 11 vs 36 mL/m ± 9; P = .046; 7% [one of 14] vs 78% [11 of 14]; P < .01). Other measures of left ventricular function did not change during the follow-up period (P > .10 for all). Conclusion Native T1 and extracellular volume could detect early changes in myocardium at 0.5 year after chemotherapy-radiation therapy, whereas left ventricular stroke volume index and late gadolinium enhancement showed abnormality at 1.5 years. © RSNA, 2018 Online supplemental material is available for this article.

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confidence: 99%

Left Ventricular T1 Mapping during Chemotherapy–Radiation Therapy: Serial Assessment of Participants with Esophageal Cancer

et al. 2018

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“…We did not find a significant increase in postoperative cardiovascular events risk among those receiving preoperative chemotherapy (SDHR increased myocardial perfusion defects 7 , decreased ejection fraction 8,9 , and clinically significant cardiac toxicity 10,11 . Similarly, a study evaluating patients within SEER found a 2.8% absolute increased risk of death from cardiovascular disease among esophageal cancer patients treated with radiation 12 . Clinical trial data support a cancerspecific survival advantage associated with preoperative radiation in esophageal cancer 3,19 , though our study in conjunction with existing research highlights the potential for increased cardiovascular morbidity and mortality.…”

Section: Resultsmentioning

confidence: 94%

“…Multiple small institutional studies have demonstrated a potential link between radiation and cardiovascular disease in esophageal cancer patients treated with radiotherapy [7][8][9][10][11] . Additionally, a study evaluating patients within the Surveillance Epidemiology and End Results (SEER) cancer registry found increased cardiovascular mortality among esophageal cancer patients receiving radiation 12 . While these older studies demonstrate increased risks associated with radiation, the delivery of radiation in esophageal cancer has evolved over the past several decades 13 .…”

Section: Introductionmentioning

confidence: 99%

Impact of Radiation on Cardiovascular Outcomes in Patients with Resectable Esophageal Cancer

Sarkar

Hatamipour

Panjwani

et al. 2019

Preprint

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Purpose: Preoperative radiation therapy improves outcomes for operable esophageal cancer patients, though the proximity of the heart to the esophagus puts patients at risk of radiation-induced cardiovascular disease. This study characterizes the impact of radiation therapy and different radiation techniques on cardiovascular morbidity among a large cohort of esophageal cancer patients. Methods: We identified 1,125 Medicare beneficiaries diagnosed between 2000 and 2011 with esophageal cancer who received surgery alone, or surgery preceded by either preoperative chemotherapy or preoperative chemoradiation. We used Medicare claims to identify severe adverse cardiovascular events in the perioperative and postoperative periods. Multivariable logistic regression and Fine-Gray models were used to determine the effect of pre-surgery treatment on the risk of perioperative and postoperative cardiovascular disease. Results: Preoperative chemotherapy or preoperative chemoradiation did not significantly increase the risk of perioperative cardiovascular complications compared to surgery alone. Patients treated with preoperative chemoradiation had a 36% increased risk of having a postoperative cardiovascular event compared to patients treated with surgery alone (subdistribution hazard ratio [SDHR] 1.36; p=0.035). There was no significant increase in cardiovascular events among patients treated with preoperative chemotherapy (SDHR 1.18; p=0.40). Among patients treated with preoperative chemoradiation, those receiving intensity modulated radiotherapy (IMRT) had a 68% decreased risk of having a cardiovascular event compared to patients receiving conventional radiation (SDHR 0.32; p=0.007). Conclusions: This study demonstrates an increased risk of cardiovascular complications among operative esophageal cancer patients treated with preoperative chemoradiation, though these risks might be reduced with more cardioprotective radiation techniques such as IMRT.

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“…Clinically, the overall incidence of RACVDs is rare but substantially encountered in irradiated patients with mediastinum lymphoma (8,44,66), head and neck (10,45), esophagus (63), lung (13,61,62), and breast (12,21,56,64) cancers. High-risk features of RACVD development are as follows: left-side breast irradiation (21, 65), combination with anthracycline-based chemotherapy (65), and vulnerable patient populations [e.g., pre-existing cardiac risk factors/heart disease (21, 57) and BRCA1/2 mutation carriers (60)].…”

Section: Clinical Challenges Of Decreasing the Risk Of Racvd In Modermentioning

confidence: 99%

Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care

Lee

Liu

Hung

et al. 2020

Front. Cardiovasc. Med.

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Radiotherapy (RT) is a crucial treatment modality in managing cancer patients. However, irradiation dose sprinkling to tumor-adjacent normal tissues is unavoidable, generating treatment toxicities, such as radiation-associated cardiovascular dysfunction (RACVD), particularly for those patients with combined therapies or pre-existing adverse features/comorbidities. Radiation oncologists implement several efforts to decrease heart dose for reducing the risk of RACVD. Even applying the deep-inspiration breath-hold (DIBH) technique, the risk of RACVD is though reduced but still substantial. Besides, available clinical methods are limited for early detecting and managing RACVD. The present study reviewed emerging challenges of RACVD in modern radiation oncology, in terms of clinical practice, bench investigation, and multidisciplinary care. Several molecules are potential for serving as biomarkers and therapeutic targets. Of these, miRNAs, endogenous small non-coding RNAs that function in regulating gene expression, are of particular interest because low-dose irradiation, i.e., 200 mGy (one-tenth of conventional RT daily dose) induces early changes of pro-RACVD miRNA expression. Moreover, several miRNAs, e.g., miR-15b and miR21, involve in the development of RACVD, further demonstrating the potential bio-application in RACVD. Remarkably, many RACVDs are late RT sequelae, characterizing highly irreversible and progressively worse. Thus, multidisciplinary care from oncologists and cardiologists is crucial. Combined managements with commodities control (such as hypertension, hypercholesterolemia, and diabetes), smoking cessation, and close monitoring are recommended. Some agents show abilities for preventing and managing RACVD, such as statins and angiotensin-converting enzyme inhibitors (ACEIs); however, their real roles should be confirmed by further prospective trials.

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Risk of death due to heart disease after radiotherapy for esophageal cancer: A SEER study.

Cited by 22 publications

References 0 publications

Left Ventricular T1 Mapping during Chemotherapy–Radiation Therapy: Serial Assessment of Participants with Esophageal Cancer

Left Ventricular T1 Mapping during Chemotherapy–Radiation Therapy: Serial Assessment of Participants with Esophageal Cancer

Impact of Radiation on Cardiovascular Outcomes in Patients with Resectable Esophageal Cancer

Emerging Challenges of Radiation-Associated Cardiovascular Dysfunction (RACVD) in Modern Radiation Oncology: Clinical Practice, Bench Investigation, and Multidisciplinary Care

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