Changes in cardiac volume determined with repeated enhanced 4DCT during chemoradiotherapy for esophageal cancer

Wei Wang,Feng-Xiang Li,Xi-Jun Liu,Jian-Bin Li,Jin-Zhi Wang,Qian Shao,Yan-Luan Guo,Yue Wang,Xue Wang,Min Xu,Ying-Jie Zhang

doi:10.1186/s13014-018-1121-z

Abstract

BackgroundConcurrent chemoradiotherapy is considered curative intent treatment for patients with non-operative esophageal cancer. Radiation-induced heart damage receives much attention. We performed repeated four-dimensional computed tomography (4DCT) to detect changes in cardiac volume during radiotherapy for esophageal cancer patients, and explored potential factors responsible for those changes.MethodsForty-six patients with esophageal cancer underwent enhanced 4DCT and three-dimensional (3D) CT scans before radiotherapy and every 10 fractions during treatment. The heart was contoured on 3DCT images, 4DCT end expiratory (EE) images and 4DCT maximum intensity projection (MIP) images by the same radiation oncologist. Heart volumes and other relative parameters were compared by the SPSS software package, version 19.0.ResultsCompared with its initial value, heart volume was smaller at the 10th fraction (reduction = 3.27%, 4.45% and 4.52% on 3DCT, EE and MIP images, respectively, p < 0.05) and the 20th fraction (reduction = 6.05%, 5.64% and 4.51% on 3DCT, EE and MIP images, respectively, p < 0.05), but not at the 30th fraction. Systolic and diastolic blood pressures were reduced (by 16.95 ± 16.69 mmHg and 7.14 ± 11.64 mmHg, respectively, both p < 0.05) and the heart rate was elevated by 5.27 ± 6.25 beats/min (p < 0.05) after radiotherapy. None of the potential explanatory variables correlated with heart volume changes.ConclusionsCardiac volume reduced significantly from an early treatment stage and maintained the reduction until the middle stage. The heart volume changes observed on 3DCT and 4DCT were consistent during radiotherapy. The changes in heart volume, blood pressure and heart rate may be valuable indicators of cardiac impairment and target dose changes.

Highlights

Concurrent chemoradiotherapy is considered curative intent treatment for patients with non-operative esophageal cancer
We explored the influence of radiotherapy on the heart volume by performing repeated Four-dimensional computed tomography (4DCT) scans with intravenous contrast during the course of Concurrent chemoradiotherapy (CCRT) in patients with esophageal cancer
Changes in heart volume and maximum heart distance during radiotherapy Between the initial measurement and the tenth fraction, the heart volume and MHD were markedly reduced at the middle location

Summary

Introduction

Concurrent chemoradiotherapy is considered curative intent treatment for patients with non-operative esophageal cancer. We performed repeated four-dimensional computed tomography (4DCT) to detect changes in cardiac volume during radiotherapy for esophageal cancer patients, and explored potential factors responsible for those changes. Concurrent chemoradiotherapy (CCRT) is considered to be a curative-intent treatment for patients with medically inoperable esophageal cancer [2]. Concerns about radiation-related cardiac toxicity have been thoroughly discussed for patients with breast cancer and Hodgkin’s disease [5,6,7,8,9,10,11]. The maximum dose delivered to the heart is usually higher for patients with esophageal cancer than for patients with Hodgkin’s disease. The irradiated volume of the heart is larger for esophageal cancer patients than for breast cancer patients [12].

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