21 Review on cardiac toxicity Results The literature search resulted in a total of 38 papers, of which the abstracts were screened first for their relevance to our review. After initial screening, seven papers were considered relevant. After screening the references from these papers, another 6 papers were retrieved and included. An overview of the selection process is shown in figure 1. All selected papers are listed and briefly summarized in Table 1. Table 1. Selected papers on cardiotoxicity in chemoradiotherapy for esophageal cancer.a (Continued) Author N Total dose RT (dose/fr) (Gy) FU (months) Time to event (months) Toxicities (N) Association with dose distribution parameters Morota et al. (2009) 69 60 (2) 26.1 10 6% > grade II: pericardial effusion (n = 1), valve replacement → heart failure (n = 1), cardiac ischemia (n = 1), and pleural effusion (n = 11) Not available Ishikura et al. (2003) 139 60 (2) 53 14 11% > grade II: myocardial infarction → death (n = 2) pericardial effusion (n = 8) → grade V heart failure (n = 2), pleural effusion (n = 8) Not available Kumekawa et al. (2006) 81 60 (2) 57 Mean within 24 11% > grade II: pericardial effusion (n = 3) → grade V heart failure (n = 2), cardiac ischemia (n = 3) → grade V (n = 1), pleural effusion (n = 3) → grade V (in combination with pneumonitis) (n = 1) Not available Martel et al. (1998) 57 37.5–49 (1.5–3.5) 19 8 5% > grade II: pericardial effusion (n = 3) → grade V (n = 1) Mean and max heart dose Wei et al. (2008) 101 45–50.4 (1.8–2) 8.4 5.3 28% any pericardial effusion Pericardial dose > 26.1 Gy; V5–45 pericard Shirai et al. (2011) 43 52–70 (1.8–2) 26.9 4 35% any pleural effusion, hypertension (n = 11), arrhythmia (n = 5), ischemia (n = 2), cardiomyopathy (2), mitral regurgitation (1) Older age and V50 heart Mukherjee et al. (2003) 15 45–50 (1.8–2) Not relevant 1 80% any drop in ejection fraction 1 month after CRT No correlation with heart dose Table 1. Selected papers on cardiotoxicity in chemoradiotherapy for esophageal cancer.a 2
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