Key result
Preoperative chemoradiation linked to ~36% more late cardiovascular events versus surgery alone.
Why the study?
Preoperative radiotherapy improves outcomes for operable esophageal cancer, but heart proximity risks radiation-induced cardiovascular disease, prompting evaluation of radiotherapy and techniques on cardiovascular morbidity.
Does preoperative chemoradiation increase the risk of severe perioperative and late cardiovascular events in older patients with operable esophageal cancer compared to surgery alone?
Cohort (n=1,125)
Yes
Does preoperative chemoradiation increase the risk of severe perioperative and late cardiovascular events in older patients with operable esophageal cancer compared to surgery alone?
Effect estimate: SDHR 1.36
p-value: p=0.035
Preoperative chemoradiation in older esophageal cancer patients increases the risk of late cardiovascular events, highlighting the potential benefit of cardioprotective techniques like intensity-modulated radiotherapy.
May warrant enhanced CV surveillance after preoperative chemoradiation in older esophageal cancer patients; leaves open prospective validation of IMRT benefit.
OBJECTIVES: Preoperative radiotherapy 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 radiotherapy and different radiation techniques on cardiovascular morbidity among a cohort of esophageal cancer patients. MATERIALS AND METHODS: We identified 1125 patients aged 65 and older diagnosed between 2000 and 2011 with esophageal cancer who received surgery alone, or surgery preceded by either preoperative chemotherapy or preoperative chemoradiation from the Surveillance Epidemiology and End Results (SEER)-Medicare database. We used Medicare claims to identify severe perioperative and late cardiovascular events. Multivariable logistic regression and Fine-Gray models were used to determine the effect of presurgery treatment on the risk of perioperative and late cardiovascular disease. RESULTS: Preoperative chemotherapy or chemoradiation did not significantly increase the risk of perioperative cardiovascular complications compared with surgery alone. Patients treated with preoperative chemoradiation had a 36% increased risk of having a late cardiovascular event compared with patients treated with surgery alone (subdistribution hazard ratio [SDHR]: 1.36; P=0.035). There was no significant increase in late 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 had a 68% decreased risk of having a late cardiovascular event compared with 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 intensity modulated radiotherapy.
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Sarkar et al. (2021) conducted a cohort in esophageal cancer (n=1,125). Preoperative chemoradiation vs. Surgery alone was evaluated on Late cardiovascular events (SDHR 1.36, p=0.035). Preoperative chemoradiation increased late cardiovascular events compared to surgery alone (SDHR 1.36; P=0.035), though intensity modulated radiotherapy reduced this risk (SDHR 0.32; P=0.007).
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