62 Chapter 5 In neo-adjuvant setting, in which the prescribed dose to the tumor is lower, the myocardium still receives substantial radiation doses. Therefore, we hypothesize that diffuse myocardial fibrosis occurs after nCRT in a dose dependent way. The aim of this cross-sectional pilot study was to test the hypothesis that nCRT can cause radiation-induced myocardial fibrosis in EC survivors by comparing the left ventricular myocardial ECV of nCRT patients to those undergoing surgery only and assessing the dose-effect relation per myocardial segment. Materials & Methods Patients This cross-sectional pilot study was approved by the local research ethics committee and registered at clinicaltrials.gov (NCT03396614, METC2017/335). All EC patients treated with a transthoracic esophagostomy between 2000 and 2012 in the University Medical Center Groningen who were alive without evidence of disease were eligible for this study. Survival and disease status were checked with their general practitioners. The exclusion criteria were thoracic radiation therapy or (adjuvant) chemotherapy other than nCRT according to the CROSS regimen[1] and any contraindication for cardiac magnetic resonance imaging (eg, pacemaker, metal not compliable with MRI). For this study, we included 20 patients with EC treated with nCRT followed by transthoracic esophagectomy and 20 patients with EC treated with surgery alone as a control group. In total, 36 nCRT patients and 40 control patients were contacted, and received written informed consent from 22 and 26 patients, respectively. Inclusion was in the order of response received. Radiation Therapy and Chemotherapy The nCRT was given according to the CROSS-regime[1] with a total dose of 41.4 Gy in 23 fractions of 1.8 Gy, five times a week, combined with weekly concurrent chemotherapy. All patients were treated with 3D conformal radiotherapy (3DCRT). The concurrent chemotherapy consisted of carboplatin (AUC 2 mg/mL per min) and paclitaxel (50 mg/m2 of body-surface area) and was administered intravenously for a maximum of five cycles.
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