87 Late cardiac toxicity in survivors of esophageal cancer As the prevalence of atrial fibrillation (AF) was higher among nCRT patients compared to the surgery alone group (6 vs. 2, p=0.07), we performed additional analyses in order to unravel the possible mechanisms behind this complication and its consequences for physical functioning (Table 4). Table 4 differentiating factors in patients with or without (a history) of atrial fibrillation** AF (n=8) no AF (n=32) p value Age corrected p value Mean RT dose right atrium(Gy) 18.4 (4.5) 9.7 (2.3) 0.09 0.05 Mean RT dose left atrium(Gy) 26.3 (5.8) 13.0 (2.9) 0.05 0.02 Mean RT dose right ventricle(Gy) 21.1 (4.7) 10.9 (2.3) 0.07 0.03 Mean RT dose left ventricle(Gy) 11.9 (3.0) 7.8 (1.7) ns ns Left ventricular ejection fraction(%) 51.5 (5.8) 59.4 (1.4) ns 0.04 Right ventricular ejection fraction(%) 46.0 (4.5) 50.7 (1.1) 0.13 0.13 6-minute walking test (%predicted) 64.8 (6.2) 74.7 (2.6) 0.10 Global health(EORTC QLQC30) 62.5 (5.2) 73.4 (2.0) 0.03 0.03 Physical functioning(EORTC QLQ-C30) 84.4 (3.1) 89.7 (1.8) 0.18 ns Dyspnoea total(QLQ LC-13) 1.8 (0.3) 1.4 (0.1) 0.07 0.08 NT pro BNP(ng/L) 852.9 (260.8) 169 (32.8) 0.01 0.01 HS TNT(ng/L) 15.8 (4.1) 11.4 (1.0) 0.16 0.17 Mean ECV(%) 27.9 (0.8) 26.1 (0.5) 0.13 0.11 Log. regression analyses predicting AF regression coefficient p value AUC Left atrium volume index(LAVI ml/m2) 0.08 0.1 0.65 Mean left atrium dose(Gy) 0.05 0.06 0.69 LAVI/left atrium dose* 0.11/0.11 0.02/0.02 0.93 *Multivariate analysis with corresponding regression coefficients and p values per predicting item ** standard error of the mean between brackets Patients with AF received markedly higher radiation doses to the heart, especially to the atria. This was not only seen in the entire group investigated but also when the analysis was restricted to the irradiated patient group. However, in this analysis, it did not become statistically significant in most substructures of the heart (supplement 2). 6
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