Cardiac toxicity associated with dose and gender in patients undergoing chemoradiation for esophageal carcinoma.

Abstract

112 Background: The purpose of this study was to identify factors associated with symptomatic cardiac toxicity in patients treated with chemoradiotherapy (CRT) for esophageal carcinoma. Methods: One-hundred and forty-four patients with adenocarcinoma or squamous cell carcinoma were treated from 7/2002 - 6/2011 at 2 academic institutions with pre-operative, definitive or palliative CRT. Chemotherapy and radiation therapy was administered at the discretion of the treating oncologist. Altogether, 120 patients had sufficient dose volume histogram (DVH) data for analysis and ≥3 month follow up from treatment completion. Association of cardiac toxicity with a number of variables was investigated, including heart disease, cardiac bypass/angioplasty, diabetes, insulin use, smoking, and tumor location (upper/middle vs. lower/GE junction). T-test assessed risk of cardiac toxicity secondary to age. Percentage of heart volume receiving >20, 30, 40, and 50 Gy (V20-V50) and its association with cardiac toxicity was evaluated for each patient. Fisher’s exact test was used to test for an association between dose volume parameters and cardiac toxicity. Results: Patient population included 93 males and 27 females with a mean age of 63 years. Any cardiac toxicity occurred in 27 patients, 8 of which were symptomatic. T-test comparing age to toxicity was not significant; however, female patients were 3.57 times more likely to have cardiac toxicity ([95% Confidence Interval 1.42-9.01], p=0.005). A significant difference in V40 existed between patients with cardiac toxicity and those without (p=0.05). Patients above the median cut-off for V40 (54%) had 2.48 increased odds of developing cardiac toxicity ([95% Confidence Interval 1.02-6.02], p=0.04). None of the other investigated variables were associated with an increased risk of developing cardiac toxicity. Conclusions: Female patients were found to have an increased risk of cardiac toxicity subsequent to receiving CRT for esophageal carcinoma. V40 greater than 54% was associated with increased cardiac toxicity. These data suggest exercising increased care when designing radiation fields in women undergoing CRT for esophageal carcinoma.