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Dosimetric predictors of radiation-induced pericardial effusion in esophageal cancer

Dosimetrische Prädiktoren für einen strahleninduzierten Perikarderguss bei Speiseröhrenkrebs

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Abstract

Purpose

To evaluate the dose–volume parameters of the pericardium and heart in order to reduce the risk of radiation-induced pericardial effusion (PE) and symptomatic PE (SPE) in esophageal cancer patients treated with concurrent chemoradiotherapy.

Methods

In 86 of 303 esophageal cancer patients, follow-up CT was obtained at least 24 months after concurrent chemoradiotherapy. Correlations between clinical factors, including risk factors for cardiac disease, dosimetric factors, and the incidence of PE and SPE after radiotherapy were analyzed using Cox proportional hazard regression analysis. Significant dosimetric factors with the highest hazard ratios were investigated using zones separated according to their distance from esophagus.

Results

PE developed in 49 patients. Univariate analysis showed the mean heart dose, heart V5–V55, mean pericardium dose, and pericardium V5–V50 to all significantly affect the incidence of PE. Additionally, body surface area was correlated with the incidence of PE in multivariate analysis. Grade 3 and 4 SPE developed in 5 patients. The pericardium V50 and pericardium D10 significantly affected the incidence of SPE. The pericardium V50 in patients with SPE ranged from 17.1 to 21.7%. Factors affecting the incidence of SPE were the V50 of the pericardium zones within 3 cm and 4 cm of the esophagus.

Conclusion

A wide range of radiation doses to the heart and pericardium were related to the incidence of PE. A pericardium V50 ≤ 17% is important to avoid symptomatic PE in esophageal cancer patients treated with concurrent chemoradiotherapy.

Zusammenfassung

Ziel

Beurteilung der Dosis-Volumen-Parameter für Perikard und Herz zur Risikoreduzierung eines strahleninduzierten Perikardergusses (PE) und eines symptomatischen PE (SPE) bei mit kombinierter Strahlenchemotherapie behandelten Speiseröhrenkrebspatienten.

Methoden

Bei 86 von 303 Speiseröhrenkrebspatienten wurde mindestens 24 Monate nach der Strahlenchemotherapie ein Kontroll-CT angefertigt. Die Korrelationen zwischen klinischen Faktoren, einschließlich Risikofaktoren für Herzerkrankungen, dosimetrischen Faktoren und der Inzidenz eines PE und SPE nach Strahlentherapie wurden mittels proportionaler Cox-Regressionsanalyse analysiert. Signifikante dosimetrische Faktoren mit den höchsten Hazard Ratios wurden unter Verwendung des Bereichs, der entsprechend dem Abstand vom Ösophagus abgegrenzt wurde, untersucht.

Ergebnisse

Einen PE hatten 49 Patienten. Die univariate Analyse ergab einen signifikanten Einfluss von mittlerer Herzdosis, Herz V5–V55, mittlerer Perikarddosis und Perikard V5–V50 auf die PE-Inzidenz. Die multivariate Analyse zeigte eine Korrelation zwischen Körperoberfläche und PE-Inzidenz. Bei 5 Patienten trat ein SPE Grad 3 und 4 auf. Perikard V50 und D10 beeinflussten die Inzidenz eines SPE signifikant. Die Spanne von Perikard V50 bei SPE betrug 17,1–21,7 %. Beeinflussende Faktoren für die SPE-Inzidenz war V50 in den 3 und 4 cm von der Speiseröhre entfernten Perikardbereichen.

Schlussfolgerung

Eine breite Spanne von an Herz und Perikard abgegebenen Strahlendosen korrelierten mit der PE-Inzidenz. Ein Perikard V50 ≤ 17 % ist wichtig, um einen SPE bei Speiseröhrenkrebspatienten unter Strahlenchemotherapie zu vermeiden.

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Authors and Affiliations

  1. Department of Radiation Oncology, Yokohama City University Medical Center, 4–57 Urahune-cho, Minami-ku, Yokohama, Kanagawa-prefecture, Japan

    Ichiro Ogino M.D. & Shigenobu Watanabe

  2. Department of Biostatistics, Yokohama City University, Yokohama City University, Yokohama, Japan

    Kentaro Sakamaki

  3. Department of Systems and Control Engineering, Tokyo Institute of Technology, Tokyo, Japan

    Yuka Ogino

  4. Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan

    Chikara Kunisaki

  5. Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan

    Kazuo Kimura

Authors
  1. Ichiro Ogino M.D.
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  2. Shigenobu Watanabe
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  3. Kentaro Sakamaki
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  4. Yuka Ogino
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  5. Chikara Kunisaki
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  6. Kazuo Kimura
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Correspondence to Ichiro Ogino M.D..

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Conflict of interest

I. Ogino, S. Watanabe, K. Sakamaki, Y. Ogino, C. Kunisaki, and K. Kimura declare that they have no competing interests.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Ogino, I., Watanabe, S., Sakamaki, K. et al. Dosimetric predictors of radiation-induced pericardial effusion in esophageal cancer. Strahlenther Onkol 193, 552–560 (2017). https://doi.org/10.1007/s00066-017-1127-8

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  • DOI: https://doi.org/10.1007/s00066-017-1127-8

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