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The Impact of Radiation Dose to Heart Substructures on Major Coronary Events and Patient Survival after Chemoradiation Therapy for Esophageal Cancer

SIMPLE SUMMARY: Whether it is necessary to evaluate the radiation exposure of cardiac substructures when making radiotherapy plans is one of the current research hotspots. In this cohort study of 355 patients with esophageal cancer, the radiation dose to key coronary substructures such as the left a...

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Autores principales: Wang, Xin, Palaskas, Nicolas L., Hobbs, Brian P., Abe, Jun-ichi, Nead, Kevin T., Yusuf, Syed Wamique, Hermann, Joerg, Deswal, Anita, Lin, Steven H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8909404/
https://www.ncbi.nlm.nih.gov/pubmed/35267613
http://dx.doi.org/10.3390/cancers14051304
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author Wang, Xin
Palaskas, Nicolas L.
Hobbs, Brian P.
Abe, Jun-ichi
Nead, Kevin T.
Yusuf, Syed Wamique
Hermann, Joerg
Deswal, Anita
Lin, Steven H.
author_facet Wang, Xin
Palaskas, Nicolas L.
Hobbs, Brian P.
Abe, Jun-ichi
Nead, Kevin T.
Yusuf, Syed Wamique
Hermann, Joerg
Deswal, Anita
Lin, Steven H.
author_sort Wang, Xin
collection PubMed
description SIMPLE SUMMARY: Whether it is necessary to evaluate the radiation exposure of cardiac substructures when making radiotherapy plans is one of the current research hotspots. In this cohort study of 355 patients with esophageal cancer, the radiation dose to key coronary substructures such as the left anterior descending artery V30(Gy) and mean left main coronary artery was closely associated with major coronary events and overall patient survival, and showed better predictive value than the mean heart dose or heart V30(Gy) recommended by current guidelines. Our findings suggest that, in addition to the whole heart, key coronary substructures should be contoured as organs at risk during radiotherapy plan optimization. ABSTRACT: Background: There is a paucity of data regarding the association between radiation exposure of heart substructures and the incidence of major coronary events (MCEs) in patients with esophageal cancer (ESOC) undergoing chemoradiation therapy. We studied radiation dosimetric determinants of MCE risk and measured their impact on patient prognosis using a cohort of ESOC patients treated at a single institution. Methods: Between March 2005 and October 2015, 355 ESOC patients treated with concurrent chemoradiotherapy were identified from a prospectively maintained and institutional-regulatory-board-approved clinical database. Dose-distribution parameters of the whole heart, the atria, the ventricles, the left main coronary artery, and three main coronary arteries were extracted for analysis. Results: Within a median follow-up time of 67 months, 14 patients experienced MCEs at a median of 16 months. The incidence of MCEs was significantly associated with the left anterior descending coronary artery (LAD) receiving ≥30 Gy (V30(Gy)) (p = 0.048). Patients receiving LAD V30(Gy) ≥ 10% of volume experienced a higher incidence of MCEs versus the LAD V30(Gy) < 10% group (p = 0.044). The relative rate of death increased with the left main coronary artery (LMA) mean dose (Gy) (p = 0.002). Furthermore, a mutual promotion effect of hyperlipidemia and RT on MCEs was observed. Conclusion: Radiation dose to coronary substructures is associated with MCEs and overall survival in patients with ESOC. In this study, the doses to these substructures appeared to be better predictors of toxicity outcomes than mean heart dose (MHD) or whole-heart V30(Gy). These findings have implications for reducing coronary events through radiation therapy planning.
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spelling pubmed-89094042022-03-11 The Impact of Radiation Dose to Heart Substructures on Major Coronary Events and Patient Survival after Chemoradiation Therapy for Esophageal Cancer Wang, Xin Palaskas, Nicolas L. Hobbs, Brian P. Abe, Jun-ichi Nead, Kevin T. Yusuf, Syed Wamique Hermann, Joerg Deswal, Anita Lin, Steven H. Cancers (Basel) Article SIMPLE SUMMARY: Whether it is necessary to evaluate the radiation exposure of cardiac substructures when making radiotherapy plans is one of the current research hotspots. In this cohort study of 355 patients with esophageal cancer, the radiation dose to key coronary substructures such as the left anterior descending artery V30(Gy) and mean left main coronary artery was closely associated with major coronary events and overall patient survival, and showed better predictive value than the mean heart dose or heart V30(Gy) recommended by current guidelines. Our findings suggest that, in addition to the whole heart, key coronary substructures should be contoured as organs at risk during radiotherapy plan optimization. ABSTRACT: Background: There is a paucity of data regarding the association between radiation exposure of heart substructures and the incidence of major coronary events (MCEs) in patients with esophageal cancer (ESOC) undergoing chemoradiation therapy. We studied radiation dosimetric determinants of MCE risk and measured their impact on patient prognosis using a cohort of ESOC patients treated at a single institution. Methods: Between March 2005 and October 2015, 355 ESOC patients treated with concurrent chemoradiotherapy were identified from a prospectively maintained and institutional-regulatory-board-approved clinical database. Dose-distribution parameters of the whole heart, the atria, the ventricles, the left main coronary artery, and three main coronary arteries were extracted for analysis. Results: Within a median follow-up time of 67 months, 14 patients experienced MCEs at a median of 16 months. The incidence of MCEs was significantly associated with the left anterior descending coronary artery (LAD) receiving ≥30 Gy (V30(Gy)) (p = 0.048). Patients receiving LAD V30(Gy) ≥ 10% of volume experienced a higher incidence of MCEs versus the LAD V30(Gy) < 10% group (p = 0.044). The relative rate of death increased with the left main coronary artery (LMA) mean dose (Gy) (p = 0.002). Furthermore, a mutual promotion effect of hyperlipidemia and RT on MCEs was observed. Conclusion: Radiation dose to coronary substructures is associated with MCEs and overall survival in patients with ESOC. In this study, the doses to these substructures appeared to be better predictors of toxicity outcomes than mean heart dose (MHD) or whole-heart V30(Gy). These findings have implications for reducing coronary events through radiation therapy planning. MDPI 2022-03-03 /pmc/articles/PMC8909404/ /pubmed/35267613 http://dx.doi.org/10.3390/cancers14051304 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Wang, Xin
Palaskas, Nicolas L.
Hobbs, Brian P.
Abe, Jun-ichi
Nead, Kevin T.
Yusuf, Syed Wamique
Hermann, Joerg
Deswal, Anita
Lin, Steven H.
The Impact of Radiation Dose to Heart Substructures on Major Coronary Events and Patient Survival after Chemoradiation Therapy for Esophageal Cancer
title The Impact of Radiation Dose to Heart Substructures on Major Coronary Events and Patient Survival after Chemoradiation Therapy for Esophageal Cancer
title_full The Impact of Radiation Dose to Heart Substructures on Major Coronary Events and Patient Survival after Chemoradiation Therapy for Esophageal Cancer
title_fullStr The Impact of Radiation Dose to Heart Substructures on Major Coronary Events and Patient Survival after Chemoradiation Therapy for Esophageal Cancer
title_full_unstemmed The Impact of Radiation Dose to Heart Substructures on Major Coronary Events and Patient Survival after Chemoradiation Therapy for Esophageal Cancer
title_short The Impact of Radiation Dose to Heart Substructures on Major Coronary Events and Patient Survival after Chemoradiation Therapy for Esophageal Cancer
title_sort impact of radiation dose to heart substructures on major coronary events and patient survival after chemoradiation therapy for esophageal cancer
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8909404/
https://www.ncbi.nlm.nih.gov/pubmed/35267613
http://dx.doi.org/10.3390/cancers14051304
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