Sato Yuta, Umezawa Rei, Yamamoto Takaya, Takahashi Noriyoshi, Suzuki Yu, Kishida Keita, Omata So, Harada Hinako, Seki Yasuhiro, Chiba Nanae, Okuda Shinsaku, Jingu Keiichi
Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-chou, Aoba-ku, Sendai, 980-8574, Japan.
Cardiooncology. 2024 Oct 18;10(1):73. doi: 10.1186/s40959-024-00274-6.
There have been several reports showing that heart-related deaths are common in long-term survivors of esophageal cancer after radiation therapy; however, radiotherapy technology is evolving year by year. This study was carried out using the SEER database to determine whether the frequency of mortality from heart disease after radiotherapy has improved over time in patients with esophageal cancer.
SEER*Stat statistical software version 8.3.9.2 (National Cancer Institute) was used to perform case listing and data extraction. We reviewed causes of death in 8,297 patients who were treated by radiotherapy without surgery between 2004 and 2015 (radiotherapy group). For comparison with this group, we also reviewed causes of death in 5,149 patients who were treated by surgery without radiotherapy (surgery group).
In the radiotherapy group, the cumulative heart-related death rate in patients with carcinoma in the middle to abdominal esophagus, for which it was considered that the heart was irradiated with a higher dose, was significantly higher than that in patients with carcinoma in the cervical to upper thoracic esophagus (p = 0.017). However, in the surgery group, the cumulative heart-related death rate in patients with carcinoma in the middle to abdominal esophagus tended to be lower than that in patients with carcinoma in the cervical to upper thoracic esophagus (p = 0.063). The cumulative heart-related death rate in patients treated in 2010-2015 was significantly lower than that in patients treated in 2004-2009 in the radiotherapy group (p = 0.011), although the cumulative heart-related death rate was not significantly different between patients treated in 2010-2015 and patients treated in 2004-2009 in the surgery group (p = 0.90).
The results suggest that recent advances in radiotherapy have enabled a reduction in radiation-induced heart disease in patients with esophageal cancer.
有几份报告显示，放射治疗后的食管癌长期幸存者中心脏相关死亡很常见；然而，放射治疗技术逐年发展。本研究使用监测、流行病学与最终结果（SEER）数据库来确定食管癌患者放疗后心脏病死亡率随时间推移是否有所改善。
使用SEER*Stat统计软件8.3.9.2版（美国国立癌症研究所）进行病例列表和数据提取。我们回顾了2004年至2015年间接受单纯放疗的8297例患者（放疗组）的死亡原因。为与该组进行比较，我们还回顾了5149例接受单纯手术而非放疗的患者（手术组）的死亡原因。
在放疗组中，中下段食管癌患者的累积心脏相关死亡率显著高于颈段至胸上段食管癌患者，因为认为前者心脏接受的照射剂量更高（p = 0.017）。然而，在手术组中，中下段食管癌患者的累积心脏相关死亡率往往低于颈段至胸上段食管癌患者（p = 0.063）。放疗组中2010 - 2015年接受治疗的患者的累积心脏相关死亡率显著低于2004 - 2009年接受治疗的患者（p = 0.011），尽管手术组中2010 - 2015年接受治疗的患者与2004 - 2009年接受治疗的患者之间的累积心脏相关死亡率无显著差异（p = 0.90）。
结果表明，放疗技术的最新进展已使食管癌患者的放射性心脏病有所减少。
