OBJECTIVES: Preoperative radiotherapy improves outcomes for operable esophageal cancer patients, though the proximity of the heart to the esophagus puts patients at risk of radiation-induced cardiovascular disease. This study characterizes the impact of radiotherapy and different radiation techniques on cardiovascular morbidity among a cohort of esophageal cancer patients. MATERIALS AND METHODS: We identified 1125 patients aged 65 and older diagnosed between 2000 and 2011 with esophageal cancer who received surgery alone, or surgery preceded by either preoperative chemotherapy or preoperative chemoradiation from the Surveillance Epidemiology and End Results (SEER)-Medicare database. We used Medicare claims to identify severe perioperative and late cardiovascular events. Multivariable logistic regression and Fine-Gray models were used to determine the effect of presurgery treatment on the risk of perioperative and late cardiovascular disease. RESULTS: Preoperative chemotherapy or chemoradiation did not significantly increase the risk of perioperative cardiovascular complications compared with surgery alone. Patients treated with preoperative chemoradiation had a 36% increased risk of having a late cardiovascular event compared with patients treated with surgery alone (subdistribution hazard ratio [SDHR]: 1.36; P=0.035). There was no significant increase in late cardiovascular events among patients treated with preoperative chemotherapy (SDHR: 1.18; P=0.40). Among patients treated with preoperative chemoradiation, those receiving intensity modulated radiotherapy had a 68% decreased risk of having a late cardiovascular event compared with patients receiving conventional radiation (SDHR: 0.32; P=0.007). CONCLUSIONS: This study demonstrates an increased risk of cardiovascular complications among operative esophageal cancer patients treated with preoperative chemoradiation, though these risks might be reduced with more cardioprotective radiation techniques such as intensity modulated radiotherapy.
OBJECTIVES: Preoperative radiotherapy improves outcomes for operable esophageal cancer patients, though the proximity of the heart to the esophagus puts patients at risk of radiation-induced cardiovascular disease. This study characterizes the impact of radiotherapy and different radiation techniques on cardiovascular morbidity among a cohort of esophageal cancer patients. MATERIALS AND METHODS: We identified 1125 patients aged 65 and older diagnosed between 2000 and 2011 with esophageal cancer who received surgery alone, or surgery preceded by either preoperative chemotherapy or preoperative chemoradiation from the Surveillance Epidemiology and End Results (SEER)-Medicare database. We used Medicare claims to identify severe perioperative and late cardiovascular events. Multivariable logistic regression and Fine-Gray models were used to determine the effect of presurgery treatment on the risk of perioperative and late cardiovascular disease. RESULTS: Preoperative chemotherapy or chemoradiation did not significantly increase the risk of perioperative cardiovascular complications compared with surgery alone. Patients treated with preoperative chemoradiation had a 36% increased risk of having a late cardiovascular event compared with patients treated with surgery alone (subdistribution hazard ratio [SDHR]: 1.36; P=0.035). There was no significant increase in late cardiovascular events among patients treated with preoperative chemotherapy (SDHR: 1.18; P=0.40). Among patients treated with preoperative chemoradiation, those receiving intensity modulated radiotherapy had a 68% decreased risk of having a late cardiovascular event compared with patients receiving conventional radiation (SDHR: 0.32; P=0.007). CONCLUSIONS: This study demonstrates an increased risk of cardiovascular complications among operative esophageal cancer patients treated with preoperative chemoradiation, though these risks might be reduced with more cardioprotective radiation techniques such as intensity modulated radiotherapy.
Authors: Scott C Lester; Steven H Lin; Michael Chuong; Neha Bhooshan; Zhongxing Liao; Andrea L Arnett; Sarah E James; Jaden D Evans; Grant M Spears; Ritsuko Komaki; Michael G Haddock; Minesh P Mehta; Christopher L Hallemeier; Kenneth W Merrell Journal: Int J Radiat Oncol Biol Phys Date: 2017-02-20 Impact factor: 7.038
Authors: Jaffer A Ajani; Thomas A D'Amico; David J Bentrem; Joseph Chao; Carlos Corvera; Prajnan Das; Crystal S Denlinger; Peter C Enzinger; Paul Fanta; Farhood Farjah; Hans Gerdes; Michael Gibson; Robert E Glasgow; James A Hayman; Steven Hochwald; Wayne L Hofstetter; David H Ilson; Dawn Jaroszewski; Kimberly L Johung; Rajesh N Keswani; Lawrence R Kleinberg; Stephen Leong; Quan P Ly; Kristina A Matkowskyj; Michael McNamara; Mary F Mulcahy; Ravi K Paluri; Haeseong Park; Kyle A Perry; Jose Pimiento; George A Poultsides; Robert Roses; Vivian E Strong; Georgia Wiesner; Christopher G Willett; Cameron D Wright; Nicole R McMillian; Lenora A Pluchino Journal: J Natl Compr Canc Netw Date: 2019-07-01 Impact factor: 11.908
Authors: Anthony V D'Amico; James W Denham; Juanita Crook; Ming-Hui Chen; Samuel Z Goldhaber; David S Lamb; David Joseph; Keen-Hun Tai; Shawn Malone; Charles Ludgate; Allison Steigler; Philip W Kantoff Journal: J Clin Oncol Date: 2007-06-10 Impact factor: 44.544
Authors: Steven H Lin; Lu Wang; Bevan Myles; Peter F Thall; Wayne L Hofstetter; Stephen G Swisher; Jaffer A Ajani; James D Cox; Ritsuko Komaki; Zhongxing Liao Journal: Int J Radiat Oncol Biol Phys Date: 2012-08-03 Impact factor: 7.038
Authors: Ted C Ling; Jerry M Slater; Prashanth Nookala; Rachel Mifflin; Roger Grove; Anh M Ly; Baldev Patyal; Jerry D Slater; Gary Y Yang Journal: Cancers (Basel) Date: 2014-12-05 Impact factor: 6.639