Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan, 70456, Taiwan.
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Radiat Oncol. 2020 Sep 22;15(1):221. doi: 10.1186/s13014-020-01664-7.
The prognostic significance of cardiac radiation dose in esophageal cancer after definitive concurrent chemoradiotherapy (CCRT) remains largely unknown. We aimed to investigate the association between cardiac dose-volume parameters and overall survival (OS) in esophageal squamous cell carcinoma (ESCC) after definitive CCRT.
One hundred and twenty-one ESCC patients undergoing definitive CCRT with intensity modulated radiotherapy technique between 2008 and 2018 were reviewed. Cardiac dose-volume parameters were calculated. Survival of patients and cumulative incidence of adverse events were estimated by the Kaplan-Meier method and compared between groups by the log-rank test. The prognostic significance of cardiac dose-volume parameters was determined with multivariate Cox proportional hazards regression analysis.
Median follow-up was 16.2 months (range, 4.3-109.3). Median OS was 18.4 months. Heart V5, V10, and V20 were independent prognostic factors of OS. Median OS was longer for patients with heart V5 ≤ 94.3% (24.7 vs. 16.3 months, p = 0.0025), heart V10 ≤ 86.4% (24.8 vs. 16.9 months, p = 0.0041), and heart V20 ≤ 76.9% (20.0 vs. 17.2 months, p = 0.047). Lower cumulative incidence of symptomatic cardiac adverse events was observed among patients with heart V5 ≤ 94.3% (p = 0.017), heart V10 ≤ 86.4% (p = 0.02), and heart V20 ≤ 76.9% (p = 0.0057). Patients without symptomatic cardiac adverse events had a higher 3-year OS rate (33.8% vs. 0%, p = 0.03).
Cardiac radiation dose inversely correlated with survival in ESCC after definitive CCRT. Radiation dose to the heart should be minimized.
在接受根治性同步放化疗（CCRT）后，食管癌患者心脏接受的放射剂量与预后的关系仍不完全清楚。本研究旨在探讨食管癌根治性 CCRT 后心脏剂量-体积参数与总生存（OS）的关系。
回顾性分析了 2008 年至 2018 年间接受调强放疗技术根治性 CCRT 的 121 例食管鳞癌患者。计算心脏剂量-体积参数。采用 Kaplan-Meier 法估计患者的生存情况和不良事件的累积发生率，并采用对数秩检验比较组间差异。采用多因素 Cox 比例风险回归分析确定心脏剂量-体积参数的预后意义。
中位随访时间为 16.2 个月（范围 4.3-109.3 个月）。中位 OS 为 18.4 个月。心脏 V5、V10 和 V20 是 OS 的独立预后因素。心脏 V5≤94.3%（24.7 个月比 16.3 个月，p=0.0025）、心脏 V10≤86.4%（24.8 个月比 16.9 个月，p=0.0041）和心脏 V20≤76.9%（20.0 个月比 17.2 个月，p=0.047）的患者 OS 更长。心脏 V5≤94.3%（p=0.017）、心脏 V10≤86.4%（p=0.02）和心脏 V20≤76.9%（p=0.0057）的患者发生有症状心脏不良事件的累积发生率较低。无有症状心脏不良事件的患者 3 年 OS 率更高（33.8%比 0%，p=0.03）。
食管癌根治性 CCRT 后心脏接受的放射剂量与生存呈负相关。心脏的放射剂量应尽量减少。
