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Cardiac Toxicity in Operable Esophageal Cancer Patients Treated With or Without Chemoradiation

Witt, Jacob S. MD*; Jagodinsky, Justin C. BA; Liu, Yifei MS; Yadav, Poonam PhD*; Kuczmarska-Haas, Aleksandra MD*; Yu, Menggang PhD§; Maloney, James D. MD; Ritter, Mark A. MD, PhD*; Bassetti, Michael F. MD, PhD*; Baschnagel, Andrew M. MD*

American Journal of Clinical Oncology: August 2019 - Volume 42 - Issue 8 - p 662–667
doi: 10.1097/COC.0000000000000573
Original Articles: Thoracic

Purpose: The purpose of this study was to evaluate predictors of cardiac events in esophageal cancer patients treated with neoadjuvant chemoradiotherapy (NA CRT) followed by surgery compared with surgery alone.

Materials and Methods: We retrospectively identified patients treated for esophageal cancer between 2006 and 2016. A total of 123 patients were identified; 70 were treated with surgery alone, and 53 were treated with NA CRT. Cardiac events were scored based on Common Terminology Criteria for Adverse Events (version 4.03), and dosimetric data was compiled for all patients who received radiation. Univariate analysis and multivariable analysis (MVA) were performed to identify predictors of cardiac events. Competing risk of death regression was performed to a model the cumulative incidence of cardiac events.

Results: The overall rates of grade ≥3 cardiac events were 24.5% in the NA CRT group versus 10% in the surgery group (P=0.04). On MVA, use of NA CRT (P<0.01, hazard ratio [HR]: 3.45, 95% confidence interval [CI]: 1.35-9.09) predicted for grade ≥3 cardiac events, though no dosimetric variable predicted for grade ≥3 cardiac events or overall survival. On MVA, NA CRT predicted for pericardial effusions of any grade (P<0.01, HR: 3.70, 95% CI: 1.67-8.33). The V45 Gy was the most significant predictor of pericardial effusions (P=0.012, HR: 1.03, 95% CI: 1.01-1.06)

Conclusions: NA CRT significantly increased the rate of grade ≥3 cardiac events compared with patients treated with surgery alone. Although no dosimetric parameter predicted for grade ≥3 cardiac events or survival, the V45 Gy predicted for pericardial effusions.

Departments of *Human Oncology

Cardiothoracic Surgery, University of Wisconsin Hospital and Clinics

University of Wisconsin School of Medicine and Public Health

§Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health

Department of Statistics, University of Wisconsin, Madison, WI

The authors declare no conflicts of interest.

Reprints: Andrew M. Baschnagel, MD, Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, K4/B100-0600, Madison, WI 53792. E-mail:

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