Radiation-Induced Myocardial Fibrosis in Long-Term Esophageal Cancer Survivors.

Autor:	de Groot C; Department of Radiation Oncology, Isala Hospital, Zwolle, Netherlands; Department of Radiation Oncology, University Medical Center, Groningen, Netherlands. Electronic address: c.de.groot@isala.nl., Beukema JC; Department of Radiation Oncology, University Medical Center, Groningen, Netherlands., Langendijk JA; Department of Radiation Oncology, University Medical Center, Groningen, Netherlands., van der Laan HP; Department of Radiation Oncology, University Medical Center, Groningen, Netherlands., van Luijk P; Department of Radiation Oncology, University Medical Center, Groningen, Netherlands., van Melle JP; Department of Cardialogy, University Medical Center, Groningen, Netherlands., Muijs CT; Department of Radiation Oncology, University Medical Center, Groningen, Netherlands., Prakken NHJ; Department of Radiology, University Medical Center, Groningen, Netherlands.
Jazyk:	angličtina
Zdroj:	International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2021 Jul 15; Vol. 110 (4), pp. 1013-1021. Date of Electronic Publication: 2021 Feb 10.
DOI:	10.1016/j.ijrobp.2021.02.007
Abstrakt:	Purpose: Radiation-induced cardiac toxicity is a potential lethal complication. The aim of this study was to assess whether there is a dose-dependent relationship between radiation dose and myocardial fibrosis in patients who received neoadjuvant chemoradiation (nCRT) for esophageal cancer (EC). Methods and Materials: Forty patients with EC treated with a transthoracic esophagectomy with (n = 20) or without (n = 20) nCRT (CROSS study regimen) were included. Cardiovascular magnetic resonance imaging (1.5 Tesla) for left ventricular (LV) function, late gadolinium enhancement, and T1 mapping were performed. Extracellular volume (ECV), as a surrogate for collagen burden, was measured for all LV segments separately. The dose-response relationship between ECV and mean radiation dose per LV myocardial segment was evaluated using a mixed-model analysis. Results: Seventeen nCRT and 16 control patients were suitable for analysis. The mean time after treatment was 67.6 ± 8.1 (nCRT) and 122 ± 35 (controls) months (P = .02). In nCRT patients, we found a significantly higher mean global ECV of 28.2% compared with 24.0% in the controls (P < .001). After nCRT, LV myocardial segments with elevated ECV had received significantly higher radiation doses. In addition, a linear dose-effect relation was found with a 0.136% point increase of ECV for each Gy (P < .001). There were no differences in LV function measures and late gadolinium enhancement between both groups. Conclusions: Myocardial ECV was significantly higher in long-term EC survivors after nCRT compared with surgery only. Moreover, this ECV increase was linear with the radiation dose per LV segment, indicating radiation-induced myocardial fibrosis. (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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