Key result
Esophageal cancer RT linked to ~2-point higher LV global ECV vs other thoracic cancers.
Why the study?
Cardiac radiation exposure is higher in esophageal cancer radiotherapy than in other thoracic malignancies, with reported increased cardiac-related mortality risk.
Does radiation therapy for esophageal cancer increase the risk of myocardial perfusion abnormalities and fibrosis compared to non-esophageal thoracic malignancies in post-treatment cardiac imaging?
Cohort (n=20)
No
Does radiation therapy for esophageal cancer increase the risk of myocardial perfusion abnormalities and fibrosis compared to non-esophageal thoracic malignancies in post-treatment cardiac imaging?
Absolute Event Rate: 31.7% vs 29.9%
p-value: p=0.037
Patients receiving thoracic radiation therapy for esophageal cancer show a significantly higher incidence of myocardial fibrosis measured by MRI Global ECV compared to those treated for other thoracic malignancies.
Purpose/Objective(s) In radiation therapy for esophageal cancer, cardiac radiation exposure tends to be higher than in other malignancies, and an increased risk of cardiac-related mortality has been reported. This study aimed to evaluate and compare the incidence of myocardial perfusion abnormalities and fibrosis using post-treatment cardiac CT and MRI in patients who underwent thoracic irradiation at our institution. Materials/Methods We retrospectively analyzed 20 patients with thoracic malignancies who received radiation therapy at our institution between March 2017 and October 2023 and subsequently underwent both cardiac CT and MRI one year after treatment. We assessed the presence of coronary artery stenosis, reduced myocardial perfusion, and myocardial fibrosis. In addition, the left ventricular global extracellular volume fraction (Global ECV) was quantitatively measured using MRI. Global ECV values were compared between the esophageal cancer group and the non-esophageal cancer group using the Mann–Whitney U test. Results The cohort consisted of 8 patients with esophageal cancer, 7 with breast cancer, 4 with malignant lymphoma, and 1 with lung cancer. One year after treatment, reduced myocardial perfusion on cardiac CT was observed in 12 patients (60%), and myocardial fibrosis on cardiac MRI was detected in 5 patients (25%). The overall median (IQR) left ventricular Global ECV was 31.2 (29.4–33.8). The median (IQR) Global ECV values in the esophageal cancer and non-esophageal cancer groups were 31.7 (31.0–35.4) and 29.9 (28.6–32.0), respectively. Global ECV was significantly higher in the esophageal cancer group (p = 0.037). Conclusion Myocardial perfusion abnormalities were frequently observed after thoracic radiation therapy. In particular, patients with esophageal cancer demonstrated a higher risk of developing myocardial fibrosis, underscoring the importance of early evaluation for radiation-induced cardiac injury.
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Takada et al. (2026) conducted a cohort in Thoracic malignancies (n=20). Thoracic radiation therapy for esophageal cancer vs. Thoracic radiation therapy for non-esophageal cancer was evaluated on Left ventricular global extracellular volume fraction (Global ECV) (p=0.037). Thoracic radiation therapy for esophageal cancer was associated with a significantly higher left ventricular Global ECV compared to non-esophageal cancer (median 31.7 vs 29.9, P=0.037).
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