Dynamic Changes Of Cardiac Biomarkers During Radiotherapy For Esophageal Cancer And Its Correlation With Cardiac Dosimetry

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Hypothesis: myocardial biomarkers were elevated in esophageal cancer during radiotherapy, which was associated with cardiac dose. To investigate the dynamic changes of myocardial enzyme, high-sensitive troponin T (hs-TnT), and N-terminal pro-brain natriuretic peptide precursors (PRO-BNP) during radiotherapy and one month after radiotherapy for middle and lower thoracic squamous cell carcinoma, and to analyze the correlation between these indicators and dose-volume histogram (DVH) parameters of the heart. Twenty-one patients with thoracic esophageal squamous cell carcinoma (twelve cases with middle location, and nine cases with lower location) who underwent radical concurrent chemoradiotherapy were enrolled in the study. Radiation therapy was performed for up to 6 weeks. All patients received Intensity modulated radiation therapy (IMRT). Total radiation dose was 60 Gy in each patient with a dose of 2.0 Gy per fraction. Blood samples to determine creatine kinase (CK), creatine kinase isoenzyme MB (CK-MB), lactic dehydrogenase (LDH), alpha-hydroxybutyric dehydrogenase (α-HBDH), hs-TnT and PRO-BNP were taken before radiotherapy, during (30Gy), at the end of radiotherapy (60Gy) and one month after radiotherapy. The dynamic changes of the above indexes were analyzed. The correlation between the above indexes and the mean heart dose (Dmean), V5-V60 (dose-volume histograms data were recorded in discrete 5Gy dose levels) of the heart in the course of radiotherapy was also analyzed. The hs-TnT and PRO-BNP showed an increasing tendency during radiotherapy. The hs-TnT of patients before, during, at the end of radiotherapy and 1 month after radiotherapy were 5.27pg/ml, 6.54 pg/ml, 9.68 pg/ml and 8.46 pg/ml, respectively (p = 0.036). The PRO-BNP were 76.3pg/ml, 121.75pg/ml, 142pg/ml, 92.84pg/ml, respectively (p = 0.024). One patient had a 30-fold increase in PRO-BNP at the end of radiotherapy (40.91pg/ml VS 1258 pg/ml). The changes of myocardial enzyme were not significant during the treatment. The CK of patients before, during, at the end of radiotherapy and 1 month after radiotherapy were 63U/L, 41U/L, 40.5U/L and 46U/L, respectively (p = 0.092). The CK-MB were 14U/L, 10 U/L, 11.5 U/L, 8.5 U/L respectively (p = 0.074). The LDH were 201.5U/L, 171.5 U/L, 167 U/L, 172 1 U/L respectively (p = 0.199). The α-HBDH were 152.5 U/L, 135 U/L, 127 U/L, 135.4 U/L, respectively (p = 0.583). There was no correlation between the changes of myocardial enzyme, hs-TnT, PRO-BNP and the heart mean dose, V5-V60 during radiotherapy (p>0.05). PRO-BNP increased significantly in the high-dose group (Dmean ≥20Gy) compared with the low-dose group (Dmean <20Gy) (p = 0.041). hs-TnT and PRO-BNP are sensitive parameters to reflect the heart damage in esophageal cancer radiotherapy, which may provide reference for the heart protection during radiotherapy.