The Impact of Radiation Dose to Heart Substructures on Major Coronary Events and Patient Survival after Chemoradiation Therapy for Esophageal Cancer.
The Impact of Radiation Dose to Heart Substructures on Major Coronary Events and Patient Survival after Chemoradiation Therapy for Esophageal Cancer.
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DOI：
10.3390/cancers14051304
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发表时间：
2022-03-03
期刊：
影响因子：
5.2
通讯作者：
Lin SH
中科院分区：
文献类型：
--
作者：
Wang X;Palaskas NL;Hobbs BP;Abe JI;Nead KT;Yusuf SW;Hermann J;Deswal A;Lin SH
在制定放射治疗计划时是否有必要对心脏各亚结构的照射量进行评估是目前的研究热点之一。在355例食管癌患者的队列研究中，关键冠状动脉亚结构（如左前降支V30 Gy和平均左主干冠状动脉）的辐射剂量与主要冠状动脉事件和患者总体生存率密切相关，并且显示出比现行指南推荐的平均心脏剂量或心脏V30 Gy更好的预测价值。我们的研究结果表明，除了整个心脏，关键的冠状动脉子结构应轮廓的器官在放射治疗计划优化的风险。背景资料：在接受放化疗的食管癌（ESOC）患者中，关于心脏亚结构的辐射暴露与主要冠状动脉事件（MCE）发生率之间的相关性的数据很少。我们研究了MCE风险的辐射剂量决定因素，并使用在单一机构接受治疗的ESOC患者队列测量了其对患者预后的影响。研究方法：2005年3月至2015年10月期间，从前瞻性维护和机构监管委员会批准的临床数据库中确定了355例接受同步放化疗治疗的ESOC患者。提取了全心脏、心房、心室、左冠状动脉主干和三支主要冠状动脉的剂量分布参数进行分析。结果：在67个月的中位随访时间内，14例患者在中位16个月时发生MCE。MCE的发生率与接受≥30戈伊（V30戈伊）的冠状动脉左前降支（LAD）显著相关（p = 0.048）。接受LAD V30 Gy ≥ 10%体积的患者的MCE发生率高于LAD V30 Gy < 10%组（p = 0.044）。相对死亡率随左冠状动脉主干（LMA）平均剂量（戈伊）增加而增加（p = 0.002）。此外，高脂血症和RT对MCE有相互促进作用。结论：冠状动脉亚结构的辐射剂量与ESOC患者的MCE和总生存率相关。在这项研究中，这些亚结构的剂量似乎是比平均心脏剂量（MHD）或全心脏V30 Gy更好的毒性结局预测因子。这些发现对通过放射治疗计划减少冠状动脉事件有意义。
Whether it is necessary to evaluate the radiation exposure of cardiac substructures when making radiotherapy plans is one of the current research hotspots. In this cohort study of 355 patients with esophageal cancer, the radiation dose to key coronary substructures such as the left anterior descending artery V30Gy and mean left main coronary artery was closely associated with major coronary events and overall patient survival, and showed better predictive value than the mean heart dose or heart V30Gy recommended by current guidelines. Our findings suggest that, in addition to the whole heart, key coronary substructures should be contoured as organs at risk during radiotherapy plan optimization. Background: There is a paucity of data regarding the association between radiation exposure of heart substructures and the incidence of major coronary events (MCEs) in patients with esophageal cancer (ESOC) undergoing chemoradiation therapy. We studied radiation dosimetric determinants of MCE risk and measured their impact on patient prognosis using a cohort of ESOC patients treated at a single institution. Methods: Between March 2005 and October 2015, 355 ESOC patients treated with concurrent chemoradiotherapy were identified from a prospectively maintained and institutional-regulatory-board-approved clinical database. Dose-distribution parameters of the whole heart, the atria, the ventricles, the left main coronary artery, and three main coronary arteries were extracted for analysis. Results: Within a median follow-up time of 67 months, 14 patients experienced MCEs at a median of 16 months. The incidence of MCEs was significantly associated with the left anterior descending coronary artery (LAD) receiving ≥30 Gy (V30Gy) (p = 0.048). Patients receiving LAD V30Gy ≥ 10% of volume experienced a higher incidence of MCEs versus the LAD V30Gy < 10% group (p = 0.044). The relative rate of death increased with the left main coronary artery (LMA) mean dose (Gy) (p = 0.002). Furthermore, a mutual promotion effect of hyperlipidemia and RT on MCEs was observed. Conclusion: Radiation dose to coronary substructures is associated with MCEs and overall survival in patients with ESOC. In this study, the doses to these substructures appeared to be better predictors of toxicity outcomes than mean heart dose (MHD) or whole-heart V30Gy. These findings have implications for reducing coronary events through radiation therapy planning.
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影响因子：
158.5
作者：
Darby, Sarah C.;Ewertz, Marianne;Hall, Per
通讯作者：
Hall, Per
DOI：
10.1016/j.radonc.2016.11.016
发表时间：
2017-01
期刊：
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
影响因子：
--
作者：
Zhou R;Liao Z;Pan T;Milgrom SA;Pinnix CC;Shi A;Tang L;Yang J;Liu Y;Gomez D;Nguyen QN;Dabaja BS;Court L;Yang J
通讯作者：
Yang J
影响因子：
51.1
作者：
Bradley, Jeffrey D.;Paulus, Rebecca;Komaki, Ritsuko;Masters, Gregory;Blumenschein, George;Schild, Steven;Bogart, Jeffrey;Hu, Chen;Forster, Kenneth;Magliocco, Anthony;Kavadi, Vivek;Garces, Yolanda I.;Narayan, Samir;Iyengar, Puneeth;Robinson, Cliff;Wynn, Raymond B.;Koprowski, Christopher;Meng, Joanne;Beitler, Jonathan;Gaur, Rakesh;Curran, Walter, Jr.;Choy, Hak
通讯作者：
Choy, Hak
影响因子：
51.1
作者：
Darby, SC;McGale, P;Peto, R
通讯作者：
Peto, R
影响因子：
5.7
作者：
McGale, Paul;Darby, Sarah C.;Ewertz, Marianne
通讯作者：
Ewertz, Marianne