Symptomatic and Asymptomatic Pericardial Effusion after Definitive Radiotherapy or Concurrent Chemoradiotherapy for Esophageal Cancer - Dose Volume Analyses

Abstract Background The prognostic significance of cardiac radiation dose in esophageal cancer after definitive concurrent chemoradiotherapy (CCRT) without surgery remains largely unknown. This study aimed to investigate the association between cardiac dose-volume parameters and overall survival (OS) in esophageal cancer after definitive CCRT. Methods A total of 121 consecutive esophageal cancer patients undergoing definitive CCRT between 2008 and 2018 were reviewed. Dose-volume parameters of the heart were calculated. Survival of patients and cumulative incidence of adverse events were estimated by the Kaplan–Meier method and compared between groups by the log-rank test. The prognostic significance of cardiac dose-volume parameters was determined with multivariate Cox proportional hazards regression analysis. Results Median follow-up was 16.2 months (range, 4.3-109.3). Median OS was 18.4 months. Heart V5, V10, and V20 were independent prognostic factors of OS. The median heart V5, V10, and V20 were 94.3%, 86.4%, and 76.9%, respectively. Median OS was longer for patients with heart V5 ≤ 94.3% (24.7 vs. 16.3 months, p = 0.0025), heart V10 ≤ 86.4% (24.8 vs. 16.9 months, p = 0.0041), and heart V20 ≤ 76.9% (20.0 vs. 17.2 months, p = 0.047). Moreover, lower cumulative incidence of symptomatic cardiac adverse events was observed among patients with heart V5 ≤ 94.3% (p = 0.017), heart V10 ≤ 86.4% (p = 0.02), and heart V20 ≤ 76.9% (p = 0.0057). The patients without symptomatic cardiac adverse events had a higher 3-year OS rate (33.8% vs. 0%, p = 0.03). Conclusions Cardiac radiation dose was inversely correlated with survival in esophageal cancer treated by definitive CCRT. Radiation dose to the heart should be minimized.

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Analysis of dose–volume histogram parameters for radiation pneumonitis after definitive concurrent chemoradiotherapy for esophageal cancer

Radiotherapy and Oncology ◽

10.1016/j.radonc.2010.02.006 ◽

2010 ◽

Vol 95 (2) ◽

pp. 240-244 ◽

Cited By ~ 45

Author(s):

Hirofumi Asakura ◽

Takayuki Hashimoto ◽

Sadamoto Zenda ◽

Hideyuki Harada ◽

Koichi Hirakawa ◽

...

Keyword(s):

Esophageal Cancer ◽

Concurrent Chemoradiotherapy ◽

Radiation Pneumonitis ◽

Dose Volume Histogram ◽

Dose Volume

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Interobserver variability in target volume delineation in definitive radiotherapy for thoracic esophageal cancer: a multi-center study from China

Radiation Oncology ◽

10.1186/s13014-020-01691-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xiao Chang ◽

Wei Deng ◽

Xin Wang ◽

Zongmei Zhou ◽

Jun Yang ◽

...

Keyword(s):

Esophageal Cancer ◽

Gross Tumor Volume ◽

Tumor Volume ◽

Interobserver Variability ◽

Target Volume ◽

Thoracic Esophageal Cancer ◽

Target Volume Delineation ◽

Cancer Centers ◽

Definitive Radiotherapy ◽

Volume Delineation

Abstract Purpose To investigate the interobserver variability (IOV) in target volume delineation of definitive radiotherapy for thoracic esophageal cancer (TEC) among cancer centers in China, and ultimately improve contouring consistency as much as possible to lay the foundation for multi-center prospective studies. Methods Sixteen cancer centers throughout China participated in this study. In Phase 1, three suitable cases with upper, middle, and lower TEC were chosen, and participants were asked to contour a group of gross tumor volume (GTV-T), nodal gross tumor volume (GTV-N) and clinical target volume (CTV) for each case based on their routine experience. In Phase 2, the same clinicians were instructed to follow a contouring protocol to re-contour another group of target volume. The variation of the target volume was analyzed and quantified using dice similarity coefficient (DSC). Results Sixteen clinicians provided routine volumes, whereas ten provided both routine and protocol volumes for each case. The IOV of routine GTV-N was the most striking in all cases, with the smallest DSC of 0.37 (95% CI 0.32–0.42), followed by CTV, whereas GTV-T showed high consistency. After following the protocol, the smallest DSC of GTV-N was improved to 0.64 (95% CI 0.45–0.83, P = 0.005) but the DSC of GTV-T and CTV remained constant in most cases. Conclusion Variability in target volume delineation was observed, but it could be significantly reduced and controlled using mandatory interventions.

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18F-FDG PET/CT Parameters for Predicting Prognosis in Esophageal Cancer Patients Treated With Concurrent Chemoradiotherapy

Technology in Cancer Research & Treatment ◽

10.1177/15330338211024655 ◽

2021 ◽

Vol 20 ◽

pp. 153303382110246

Author(s):

Seokmo Lee ◽

Yunseon Choi ◽

Geumju Park ◽

Sunmi Jo ◽

Sun Seong Lee ◽

...

Keyword(s):

Esophageal Cancer ◽

Cancer Patients ◽

Fdg Pet ◽

Concurrent Chemoradiotherapy ◽

Curative Intent ◽

Squamous Cell Esophageal Cancer ◽

Pet Ct ◽

Significant Difference ◽

Fdg Pet Ct

Background and Aims: This study evaluated the prognostic value of 18F-fluorodeoxyglucose positron emission tomography with integrated computed tomography (18F-FDG PET/CT) performed before and after concurrent chemoradiotherapy (CCRT) in esophageal cancer. Methods: We analyzed the prognosis of 50 non-metastatic squamous cell esophageal cancer (T1-4N0-2) patients who underwent CCRT with curative intent at Inje University Busan Paik Hospital and Haeundae Paik Hospital from 2009 to 2019. Median total radiation dose was 54 Gy (range 34-66 Gy). Our aim was to investigate the relationship between PET/CT values and prognosis. The primary end point was progression-free survival (PFS). Results: The median follow-up period was 9.9 months (range 1.7-85.7). Median baseline maximum standard uptake value (SUVmax) was 14.2 (range 3.2-27.7). After treatment, 29 patients (58%) showed disease progression. The 3-year PFS and overall survival (OS) were 24.2% and 54.5%, respectively. PFS was significantly lower ( P = 0.015) when SUVmax of initial PET/CT exceeded 10 (n = 22). However, OS did not reach a significant difference based on maximum SUV ( P = 0.282). Small metabolic tumor volume (≤14.1) was related with good PFS ( P = 0.002) and OS ( P = 0.001). Small total lesion of glycolysis (≤107.3) also had a significant good prognostic effect on PFS ( P = 0.009) and OS ( P = 0.025). In a subgroup analysis of 18 patients with follow-up PET/CT, the patients with SUV max ≤3.5 in follow-up PET/CT showed longer PFS ( P = 0.028) than those with a maximum SUV >3.5. Conclusion: Maximum SUV of PET/CT is useful in predicting prognosis of esophageal cancer patients treated with CCRT. Efforts to find more effective treatments for patients at high risk of progression are still warranted.

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