Dataset Information

Heart and lung doses are independent predictors of overall survival in esophageal cancer after chemoradiotherapy.

ABSTRACT:

Purpose

To analyze associations between heart and lung dose and overall survival (OS) in patients with esophageal cancer who received concurrent chemo-radiotherapy (CCRT) with or without surgery.

Patients and methods

Patients received intensity-modulated radiation therapy (median dose 50.4?Gy) from 2004 through 2016. Cutoff points for continuous variables were calculated using the method of Contal and O'Quigley. Kaplan-Meier method with log-rank tests was used to calculate survival. OS was analyzed with both univariate and multivariable Cox models.

Results

In all, 560 patients were analyzed; median follow-up time was 29.3?months, and 5-year OS rate was 41.7%. Heart V30 >45% and mean lung dose (MLD) >10?Gy were found to be independently associated with worse survival after adjustment for other clinical and dosimetric factors (P?P?45% (P?=?0.046); 18.8% of patients with MLD ?10?Gy had pulmonary complications vs. 27% for MLD >10?Gy (P?=?0.020). Having cardiac complications was associated with worse survival (5-year OS rates 27.6% with vs. 43.2% without, P?=?0.012), and having pulmonary complications was associated with worse survival as well (5-year OS rates 23.1% with vs. 47.4% without, P?ConclusionBoth heart and lung doses independently predicted worse OS in patients with esophageal cancer, even after adjustment for other clinical and dosimetric factors, and were also risk factors for radiation-induced complications. Both irradiated heart and lung doses should be minimized as a whole.

SUBMITTER: Xu C

PROVIDER: S-EPMC6506607 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Publications

Heart and lung doses are independent predictors of overall survival in esophageal cancer after chemoradiotherapy.

Xu Cai C Guo Lanwei L Liao Zhongxing Z Wang Yifan Y Liu Xiyou X Zhao Shuangtao S Wang Jun J Yuan Zhiyong Z Wang Ping P Lin Steven H SH

Clinical and translational radiation oncology 20190424

<h4>Purpose</h4>To analyze associations between heart and lung dose and overall survival (OS) in patients with esophageal cancer who received concurrent chemo-radiotherapy (CCRT) with or without surgery.<h4>Patients and methods</h4>Patients received intensity-modulated radiation therapy (median dose 50.4 Gy) from 2004 through 2016. Cutoff points for continuous variables were calculated using the method of Contal and O'Quigley. Kaplan-Meier method with log-rank tests was used to calculate surviva ...[more]

PMID: 31080898

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Project description:Objectives: The aim of this study was to assess the association between heart dosimetric parameters and cardiac events or overall survival (OS) for patients with stage III esophageal cancer receiving definitive radiotherapy. Materials and Methods: Patients with stage III esophageal cancer receiving definitive radiotherapy at our hospital from 2011 to 2013 were enrolled retrospectively. The primary endpoint was grade ≥ 2 cardiac events, and the second endpoint was 5-year OS. Competing risk analysis and Cox regressions analysis were performed to evaluate the association between heart dose and cardiac events or OS. Results: Three hundred forty-six patients were analyzed. Median follow-up was 30 months. Median prescribed dose was 60 Gy. Seventy-eight patients (22.5%) had 91 grade ≥ 2 cardiac events, at a median of 14 months to first event. Thirty-three patients (9.5%) had 42 grade ≥ 3 cardiac events. Of the 78 patients with grade ≥ 2 cardiac events, 70 (89.7%) had the first cardiac events that occurred within first 3 years after radiotherapy. Multivariable analysis showed that preexisting ischemic heart disease [hazard ratio (HR), 2.26; 95% confidence interval (CI), 1.26-4.06; p = 0.006] and mean heart dose (HR, 1.12; 95% CI, 1.04-1.20; p = 0.002) were significantly associated with increased risk of grade ≥ 2 cardiac events. Disease progression (HR, 2.60; 95% CI, 1.82-3.70; p < 0.001), Eastern Cooperative Oncology Group (ECOG) performance status (HR, 0.71; 95% CI, 0.56-0.91; p = 0.007), heart volume receiving ≥ 5 Gy (V5, HR, 1.01; 95% CI, 1.00-1.03; p = 0.035), and gross tumor volume (GTV; HR, 1.00; 95% CI, 1.00-1.00; p = 0.020) were significant predictors of 5-year OS on multivariable analysis. Conclusion: Higher heart dose was significantly associated with an increased cardiac event rate and a worse OS outcome for patients with stage III esophageal cancer treated with definitive radiotherapy. Most of the first cardiac events occurred within first 3 years after treatment.

Dataset Information

Heart and lung doses are independent predictors of overall survival in esophageal cancer after chemoradiotherapy.

Purpose

Patients and methods

Results

Publications

Heart and lung doses are independent predictors of overall survival in esophageal cancer after chemoradiotherapy.

Similar Datasets

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