Key result
During concurrent chemoradiotherapy for esophageal cancer, cardiac volume was significantly reduced by 6.05% at the 20th fraction compared to baseline.
Why the study?
Does concurrent chemoradiotherapy alter cardiac volume and physiological parameters in patients with esophageal cancer?
Observational (n=46)
No
Does concurrent chemoradiotherapy alter cardiac volume and physiological parameters in patients with esophageal cancer?
p-value: p=<0.001
Cardiac volume significantly decreases during the early and middle stages of chemoradiotherapy for esophageal cancer, accompanied by reduced blood pressure and increased heart rate, suggesting early subclinical cardiac impairment.
May indicate early subclinical cardiac impairment during esophageal chemoradiotherapy; hypothesis-generating for prospective monitoring studies.
BACKGROUND: Concurrent chemoradiotherapy is considered curative intent treatment for patients with non-operative esophageal cancer. Radiation-induced heart damage receives much attention. We performed repeated four-dimensional computed tomography (4DCT) to detect changes in cardiac volume during radiotherapy for esophageal cancer patients, and explored potential factors responsible for those changes. METHODS: Forty-six patients with esophageal cancer underwent enhanced 4DCT and three-dimensional (3D) CT scans before radiotherapy and every 10 fractions during treatment. The heart was contoured on 3DCT images, 4DCT end expiratory (EE) images and 4DCT maximum intensity projection (MIP) images by the same radiation oncologist. Heart volumes and other relative parameters were compared by the SPSS software package, version 19.0. RESULTS: Compared with its initial value, heart volume was smaller at the 10th fraction (reduction = 3.27%, 4.45% and 4.52% on 3DCT, EE and MIP images, respectively, p < 0.05) and the 20th fraction (reduction = 6.05%, 5.64% and 4.51% on 3DCT, EE and MIP images, respectively, p < 0.05), but not at the 30th fraction. Systolic and diastolic blood pressures were reduced (by 16.95 ± 16.69 mmHg and 7.14 ± 11.64 mmHg, respectively, both p < 0.05) and the heart rate was elevated by 5.27 ± 6.25 beats/min (p < 0.05) after radiotherapy. None of the potential explanatory variables correlated with heart volume changes. CONCLUSIONS: Cardiac volume reduced significantly from an early treatment stage and maintained the reduction until the middle stage. The heart volume changes observed on 3DCT and 4DCT were consistent during radiotherapy. The changes in heart volume, blood pressure and heart rate may be valuable indicators of cardiac impairment and target dose changes.
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Wang et al. (2018) conducted an observational in Thoracic esophageal squamous cell carcinoma (n=46). Concurrent chemoradiotherapy vs. Baseline (before radiotherapy) was evaluated on Reduction in heart volume at the 20th fraction on 3DCT images for mid-thoracic tumors (p=<0.001). During concurrent chemoradiotherapy for esophageal cancer, cardiac volume was significantly reduced by 6.05% at the 20th fraction compared to baseline.
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