Cardiac Toxicity in Operable Esophageal Cancer Patients Treated With or Without Chemoradiation

Area of Science:

• Cardiology
• Oncology
• Radiation Oncology

Background:

• Esophageal cancer treatment often involves neoadjuvant chemoradiotherapy (NA CRT) followed by surgery.
• Assessing cardiac event predictors is crucial for patient management.
• Comparing NA CRT with surgery alone is important for understanding treatment-related risks.

Purpose of the Study:

• To evaluate predictors of cardiac events in esophageal cancer patients.
• To compare cardiac event rates between NA CRT followed by surgery and surgery alone.
• To identify factors influencing cardiac event occurrence post-treatment.

Main Methods:

• Retrospective analysis of 123 esophageal cancer patients (2006-2016).
• Comparison of 70 patients treated with surgery alone versus 53 with NA CRT.
• Cardiac events graded using Common Terminology Criteria for Adverse Events; dosimetric data analyzed.
• Multivariable and competing risk regression analyses performed.

Main Results:

• Grade ≥3 cardiac events occurred in 24.5% of NA CRT patients vs. 10% of surgery-alone patients (P=0.04).
• NA CRT use predicted for grade ≥3 cardiac events (HR: 3.45) and pericardial effusions (HR: 3.70).
• No dosimetric variable predicted cardiac events or survival, but V45Gy predicted pericardial effusions (HR: 1.03).

Conclusions:

• NA CRT significantly increases the risk of major cardiac events compared to surgery alone for esophageal cancer.
• While NA CRT is a predictor of cardiac events, specific radiation dosimetry did not correlate with overall survival.
• Radiation dose V45Gy emerged as a significant predictor for pericardial effusions, suggesting targeted monitoring is warranted.