Purpose

To look into the relationship between cardiac substructures (CS) dosimetric parameters and cardiac events (CE) or overall survival (OS) in patients undergoing radiation therapy (RT) for esophageal squamous cell carcinoma (ESCC).

Methods and materials

A retrospective study included 350 patients with ESCC receiving definitive chemoradiotherapy or radiotherapy (d-CRT/d-RT) or neoadjuvant chemoradiotherapy (NCRT) from March 2013 to May 2022. Our study examined the adverse cardiac events of any grade or G3+, as defined by the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Competing risk analysis and Cox regression analysis were used to assess the relationship between CS doses and CEs or OS.

Results

201 (57.4 %) patients received any grade CEs over a median follow-up time of 22.50 months (IQR, 12.40–45.60), and 24 (6.86 %) patients suffered G3+ CEs. On landmark analysis, patients with any grade CEs had significantly lower OS (P = 0.003). Multivariable analysis revealed that any grade CEs were predicted by the dose of CSs in all populations. In addition, for G3+ cardiac events, arrhythmic and small probability of cardiac events, LAD V20 ((HR: 1.02, 95 % CI: 1.00–1.03, P = 0.012; HR: 1.01, 95 % CI: 1.00–1.02, P = 0.005; HR; 1.01, 95 % CI: 1.00–1.02, P = 0.012) was also an independent predictive factor. LAD V50 (HR: 1.07, 95 % CI: 1.03–1.10, P <0.001) predicted pericardium effusion events. Moreover, the multivariable analysis revealed that OS was predicted by LAD V30 (HR: 1.03; 95 % CI, 1.01–1.05, P = 0.015).

Conclusions

In the population of ESCC patients receiving RT, we showed that the CS factors had a substantial predictive value for the various types and grades of CEs. The elevated radiation dose of LAD was a significant contributor to a higher rate of cardiac events and a worse prognosis.

中文翻译：

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心脏亚结构剂量学预测食管鳞状细胞癌放疗的心脏毒性和预后

目的

旨在研究接受食管鳞状细胞癌 (ESCC) 放射治疗 (RT) 的患者心脏亚结构 (CS) 剂量学参数与心脏事件 (CE) 或总生存期 (OS) 之间的关系。

方法和材料

一项回顾性研究纳入了 2013 年 3 月至 2022 年 5 月期间接受根治性放化疗或放疗 (d-CRT/d-RT) 或新辅助放化疗 (NCRT) 的 350 名 ESCC 患者。我们的研究检查了定义为任何级别或 G3+ 的不良心脏事件不良事件通用术语标准 (CTCAE) 5.0 版。使用竞争风险分析和 Cox 回归分析来评估 CS 剂量与 CE 或 OS 之间的关系。

结果

201 名 (57.4%) 患者在中位随访时间 22.50 个月 (IQR，12.40–45.60) 中接受了任何级别的 CE，24 名 (6.86%) 患者接受了 G3+ CE。根据里程碑分析，具有任何级别 CE 的患者的 OS 均显着较低 ( P  = 0.003)。多变量分析显示，任何级别的 CE 都是通过所有人群中 CS 的剂量来预测的。此外，对于 G3+ 心脏事件、心律失常和小概率心脏事件，LAD V20（（HR：1.02，95 % CI：1.00–1.03，P  = 0.012；HR：1.01，95 % CI：1.00–1.02，P  = 0.005; HR; 1.01, 95 % CI: 1.00–1.02, P  = 0.012) 也是一个独立的预测因素。LAD V50 (HR: 1.07, 95 % CI: 1.03–1.10, P <0.001) 预测心包积液事件。 ，多变量分析显示，OS 由 LAD V30 预测（HR：1.03；95% CI，1.01–1.05，P  = 0.015）。

结论

在接受 RT 的 ESCC 患者群体中，我们发现 CS 因素对各种类型和级别的 CE 具有显着的预测价值。LAD 辐射剂量升高是导致心脏事件发生率较高和预后较差的重要原因。