SCIENCE@home

CHAPTER 23

E. Goldratt

Published 2017 in Seven Million

ABSTRACT

Oesophageal cancer is frequently treated with external-beam radiotherapy (EBRT) in addition to surgery and/or chemotherapy. Oesophageal cancer patients treated with EBRT may be at risk for radiation-induced cardiotoxicity. Oesophageal cancer patients surviving ≥6 months after diagnosis in Surveillance Epidemiology and End Results (SEER) registries from 1973-2014 were queried for irradiation status, cause of death and survival using SEERaBomb. 38,304 oesophageal cancer survivors were identified, of whom 13,206 (34%) received no radiation therapy and 25,098 (66%) received EBRT. Heart disease-related mortality (HDRM) occurred in 1748 oesophageal cancer survivors; 614 after no radiation and 1134 after EBRT. The median time to HDRM after oesophageal cancer diagnosis was 3.0 (interquartile range: 1.3-8.0) years after no radiation and 2.0 (interquartile range: 1.0-5.3) years after EBRT. In multivariate analyses, EBRT was an independent prognostic factor for early HDRM (6 months-5 years after oesophageal cancer diagnosis; hazard ratio [HR], 1.58; 95% confidence interval [CI], 1.34-1.86; P < 0.0001) and late HDRM (>5 years after oesophageal cancer diagnosis; HR, 1.51; 95% CI, 1.31-2.41; P < 0.0001). Whereas the risk of HDRM decreased as a patient was diagnosed and treated for oesophageal cancer more recently, EBRT was still an independent prognostic factor for early HDRM in oesophageal cancer patients diagnosed as recently as 2006-2014 (HR, 1.30; 95% CI, 1.04-1.62; P = 0.02). Oesophageal cancer patients treated with EBRT have an increased risk of HDRM compared with those not treated with EBRT. This may be due to late radiation-induced cardiotoxicity. In view of the increasing number of oesophageal cancer survivors, further efforts to decrease late radiation-induced cardiotoxicity are warranted. Introduction Oesophageal cancer occurs in ~17,000 patients in the US each year617 and with the introduction of multimodality treatment, 5-year survival rates have increased from ~5% for patients diagnosed in the 1970s to ~15% for patients diagnosed in 2009.488 EBRT is given to approximately half of all oesophageal cancer patients either in the neoadjuvant or the adjuvant setting since the 1960s in the US and since the early 2000s in Europe.617 With recent improvements in the survival of oesophageal cancer patients654,655 and the consequent increases in the number of oesophageal cancer survivors, the population that is at risk for late adverse effects of EBRT is also increasing. One of the most serious late complications of EBRT as treatment for thoracic malignancies is the development of cardiomyopathy in a process that is called radiation-induced cardiotoxicity. This has been extensively described for thoracic malignancies such as breast cancer,656,657 lung cancer,658,659 and Hodgkin’s lymphoma,660,661 but less so for oesophageal cancer.662,663 In a systematic review of retrospective studies, the most frequently occurring grade ≥3 adverse events were cardiac ischemia, pleural effusion, pericardial effusion and heart failure and occurred in 6-11% of oesophageal cancer patients treated with radiotherapy.664 Although these adverse events are generally considered to be late toxicity, they occurred relatively soon after treatment, with a median onset of 26-57 months.664 Considering the anatomical proximity of the oesophagus to the heart, we hypothesised that EBRT for oesophageal cancer is associated with increased HDRM in oesophageal cancer patients. In this analysis, we focused on the difference between short-term and long-term HDRM.

PUBLICATION RECORD

CITATION MAP

EXTRACTION MAP

CLAIMS

  • No claims are published for this paper.

CONCEPTS

  • No concepts are published for this paper.

REFERENCES

Showing 1-9 of 9 references · Page 1 of 1

CITED BY

Showing 1-19 of 19 citing papers · Page 1 of 1