8 Chapter 1 Introduction In the Netherlands, approximately 3000 new esophageal cancer patients are diagnosed each year and its incidence is still rising, which is especially true for adenocarcinomas located in the distal part of the esophagus. About 60% of patients present with potentially curable disease and the majority undergoes neoadjuvant chemoradiotherapy followed by surgery or definitive (chemo)radiotherapy[1]. Although cure rates improved over the last decade, treatment-induced toxicity is still a matter of concern[2]. For most esophageal cancer patients, radiotherapy target volumes are relatively large and located near critical organs like the heart and the lungs. Therefore, high toxicity rates related to these organs at risk can be expected. However, trade-offs between cardiac and pulmonary toxicities, and thus decisions on how to optimize dose distributions in radiotherapy treatment planning, require more detailed information on toxicities in relation to radiation dose distributions. At the time of the start of this thesis, literature from clinical trials mainly focused on pulmonary toxicity and its relationship with lung dose volume parameters. Whereas literature on radiation induced cardiac toxicity, specifically in esophageal cancer patients, was scarce (Figure 1). For this reason, we decided to focus this thesis on radiation-induced cardiac toxicity in the treatment of esophageal cancer patients. Table 1 timeline of PubMed results when comparing the number of clinical trials on radiation AND “cardiac toxicity” vs “pulmonary toxicity”.
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