Department of Radiation Oncology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan.
J Radiat Res. 2020 Mar 23;61(2):298-306. doi: 10.1093/jrr/rraa001.
This study aimed to evaluate the relationship between cardiac toxicity after definitive chemoradiotherapy (CRT) for esophageal cancer and the dose-volume histogram (DVH) of organs at risk (OARs) [using biological effective dose (BED)]. We analyzed the data of 83 patients with esophageal cancer treated using definitive CRT between 2001 and 2016. Furthermore, we evaluated pericardial effusion (PE) as a measure of cardiac toxicity. The median total irradiation dose was 60 (50.4-71) Gy. Symptomatic PE was observed in 12 (14%) patients. The heart and pericardium V5-V100-BED were significantly higher in patients with symptomatic PE than in those without symptomatic PE (heart: V5-V95-BED, P < 0.001; V100-BED, P = 0.0053, and pericardium: V5-V40-BED, V55-V95-BED, P < 0.001; V45-50-BED, V100-BED, P < 0.05, respectively). Receiver operating characteristic curve analysis showed that the dose-volume parameter of the pericardium and the heart that was most strongly associated with an adverse cardiac event was V80-BED, and the mean dose and the cut-off value were 27.38% and 61.7 Gy-BED, respectively. Multivariate analysis showed that the pericardium V80-BED and the mean heart dose-BED were risk factors for symptomatic PE (P < 0.001, respectively). We revealed the relationship between the irradiated dose of the OARs and symptomatic PE using a BED-based dose-volume histogram. Pericardium V80-BED and mean heart dose-BED were the most relevant risk factors for symptomatic PE.
本研究旨在评估食管癌根治性放化疗（CRT）后心脏毒性与危及器官（OAR）剂量-体积直方图（DVH）[使用生物有效剂量（BED）]之间的关系。我们分析了 2001 年至 2016 年间接受根治性 CRT 治疗的 83 例食管癌患者的数据。此外，我们评估了心包积液（PE）作为心脏毒性的衡量指标。中位总照射剂量为 60（50.4-71）Gy。12 例（14%）患者出现症状性 PE。与无症状性 PE 患者相比，有症状性 PE 患者的心脏和心包 V5-V100-BED 显著升高（心脏：V5-V95-BED，P<0.001；V100-BED，P=0.0053，心包：V5-V40-BED，V55-V95-BED，P<0.001；V45-50-BED，V100-BED，P<0.05）。受试者工作特征曲线分析显示，与不良心脏事件最相关的 OAR 剂量-体积参数是心包和心脏的 V80-BED，平均剂量和截断值分别为 27.38%和 61.7 Gy-BED。多变量分析显示，心包 V80-BED 和平均心脏剂量-BED 是症状性 PE 的危险因素（P<0.001）。我们使用基于 BED 的剂量-体积直方图揭示了 OAR 照射剂量与症状性 PE 之间的关系。心包 V80-BED 和平均心脏剂量-BED 是症状性 PE 的最相关危险因素。
