University of California San Diego School of Medicine.
Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla.
Am J Clin Oncol. 2021 Jun 1;44(6):275-282. doi: 10.1097/COC.0000000000000815.
Preoperative radiotherapy improves outcomes for operable esophageal cancer patients, though the proximity of the heart to the esophagus puts patients at risk of radiation-induced cardiovascular disease. This study characterizes the impact of radiotherapy and different radiation techniques on cardiovascular morbidity among a cohort of esophageal cancer patients.
We identified 1125 patients aged 65 and older diagnosed between 2000 and 2011 with esophageal cancer who received surgery alone, or surgery preceded by either preoperative chemotherapy or preoperative chemoradiation from the Surveillance Epidemiology and End Results (SEER)-Medicare database. We used Medicare claims to identify severe perioperative and late cardiovascular events. Multivariable logistic regression and Fine-Gray models were used to determine the effect of presurgery treatment on the risk of perioperative and late cardiovascular disease.
Preoperative chemotherapy or chemoradiation did not significantly increase the risk of perioperative cardiovascular complications compared with surgery alone. Patients treated with preoperative chemoradiation had a 36% increased risk of having a late cardiovascular event compared with patients treated with surgery alone (subdistribution hazard ratio [SDHR]: 1.36; P=0.035). There was no significant increase in late cardiovascular events among patients treated with preoperative chemotherapy (SDHR: 1.18; P=0.40). Among patients treated with preoperative chemoradiation, those receiving intensity modulated radiotherapy had a 68% decreased risk of having a late cardiovascular event compared with patients receiving conventional radiation (SDHR: 0.32; P=0.007).
This study demonstrates an increased risk of cardiovascular complications among operative esophageal cancer patients treated with preoperative chemoradiation, though these risks might be reduced with more cardioprotective radiation techniques such as intensity modulated radiotherapy.
术前放疗可改善可手术食管癌患者的预后，但心脏与食管的邻近位置使患者面临放射性心血管疾病的风险。本研究旨在描述放疗及不同放疗技术对食管癌患者队列中心血管发病率的影响。
我们从监测、流行病学和最终结果（SEER）-医疗保险数据库中确定了 1125 名年龄在 65 岁及以上、2000 年至 2011 年间被诊断为食管癌且仅接受手术、术前化疗或术前放化疗的患者。我们使用医疗保险理赔来识别严重围手术期和迟发性心血管事件。多变量逻辑回归和 Fine-Gray 模型用于确定术前治疗对围手术期和迟发性心血管疾病风险的影响。
与单独手术相比，术前化疗或放化疗并未显著增加围手术期心血管并发症的风险。与单独手术相比，接受术前放化疗的患者发生迟发性心血管事件的风险增加 36%（亚分布风险比 [SDHR]：1.36；P=0.035）。接受术前化疗的患者迟发性心血管事件无显著增加（SDHR：1.18；P=0.40）。在接受术前放化疗的患者中，与接受常规放疗的患者相比，接受调强放疗的患者发生迟发性心血管事件的风险降低了 68%（SDHR：0.32；P=0.007）。
本研究表明，接受术前放化疗的手术食管癌患者发生心血管并发症的风险增加，但通过更具心脏保护作用的放疗技术（如调强放疗），这些风险可能会降低。
