22 Chapter 2 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 Tripp et al (2005) 20 45–54 (1.8–2) Not relevant 1.5 55% any drop in ejection fraction but in 30% a rise in ejection fraction No correlation with heart dose Gayed et al. (2006) 51 50.4–60 (1.8–2) Not relevant 3 54% perfusion abnormalities and 42% inferior wall ischemia Irradiated patients; higher dose areas >45 Gy Gayedet al. (2009) 16 30–50.4 (1.8–2) 14.6 12 43% any cardiac complications: ischemia (n = 1), atrial fibrillation (n = 2), Pericardial effusion (n = 2), heart failure (n = 2) → complete heart block grade V (n = 1) Not available Konski et al. (2012) 102 45–57.6 (1.8) 10.7 4.2 12% > grade 2: pericardial effusion (n = 10), myocardial infarction (n = 1), sick sinus syndrome (n = 1) Correlation V20, V30 and V40 heart with symptomatic heart toxicity Jingu et al. (2006) 64 30–70 (2) Not relevant 9.3 20% increased uptake on FDG PET Higher SUV values within the radiation fields Hatakenaka et al. (2012) 31 41–60 (1.8–2) Not relevant 3 days Lower left ventricular end diastolic volume and stroke index, an increased heart rate and left ventricular wall motion disorders after treatment Significant difference in high vs. low left ventricular dose groups Only the paper published by Jingu et al. had a prospective design, the others were retrospective. All papers combined radiotherapy with chemotherapy, the most frequently used schedule was 5-FU and cisplatinum. Almost all patients were treated with a 3D CRT technique, IMRT was used in a few patients. Three papers reported specifically on retrospective follow-up data and late cardiopulmonary RTOG rated toxicity in esophageal cancer patients.[2–4] All patients in these studies were treated with concurrent chemoradiation to a total dose of 60 Gy in combination with cisplatin and 5-FU. Target definition and radiotherapy planning were performed with 2-dimensional techniques using simulation films. Therefore, individual cardiac dose distributions were not available and no attempts were made to correlate cardiac dose to toxicity. Patient numbers and details on
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