Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands.
Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan.
Radiother Oncol. 2020 Aug;149:222-227. doi: 10.1016/j.radonc.2020.05.033. Epub 2020 May 21.
The aim of this study was to evaluate which clinical and treatment-related factors are associated with heart and lung toxicity in oesophageal cancer patients treated with chemoradiation (CRT). The secondary objective was to analyse whether these toxicities are associated with overall survival (OS).
The study population consisted of a retrospective cohort of 216 oesophageal cancer patients treated with curative CRT. Clinical and treatment related factors were analysed for OS and new pulmonary and cardiac events by multivariable regression analyses. The effect of these toxicities on OS was assessed by Kaplan Meyer analyses.
Multivariable analysis revealed that pulmonary toxicity was best predicted by the mean lung dose. Cardiac complications were diverse; the most frequently occurring complication was pericardial effusion. Several cardiac dose parameters correlated with this endpoint. Patients developing radiation pneumonitis had significantly worse OS than patients without radiation pneumonitis, while no difference was observed in OS between patients with and without pericardial effusion. OS was best predicted by the V45 of the lung and tumour stage. None of the cardiac dose parameters predicted OS in multivariable analyses.
Cardiac dose volume parameters predicted the risk of pericardial effusion and pulmonary dose volume parameters predicted the risk of radiation pneumonitis. However, in this patient cohort, pulmonary DVH parameters (V45) were more important for OS than cardiac DVH parameters. These results suggest that reducing the cardiac dose at the expense of the dose to the lungs might not always be a good strategy in oesophageal cancer patients.
本研究旨在评估哪些临床和治疗相关因素与接受放化疗（CRT）的食管癌患者的心肺毒性相关。次要目的是分析这些毒性是否与总生存期（OS）相关。
研究人群为 216 例接受根治性 CRT 的食管癌患者的回顾性队列。通过多变量回归分析，对 OS 和新的肺部及心脏事件的临床和治疗相关因素进行分析。通过 Kaplan-Meier 分析评估这些毒性对 OS 的影响。
多变量分析显示，平均肺剂量可最佳预测肺部毒性。心脏并发症多种多样，最常见的并发症是心包积液。几个心脏剂量参数与该终点相关。发生放射性肺炎的患者 OS 明显差于未发生放射性肺炎的患者，而有心包积液的患者和无心包积液的患者的 OS 无差异。V45 肺和肿瘤分期可最佳预测 OS。多变量分析中，无任何心脏剂量参数预测 OS。
心脏剂量体积参数预测心包积液的风险，而肺部剂量体积参数预测放射性肺炎的风险。然而，在本患者队列中，肺部剂量体积参数（V45）对 OS 的预测作用比心脏剂量体积参数更重要。这些结果表明，在食管癌患者中，为了降低肺部剂量而牺牲心脏剂量可能并非总是一个好策略。
