Risk factors for pericardial effusion in inoperable esophageal cancer patients treated with definitive chemoradiation therapy.
OBJECTIVE
To identify clinical and dosimetric factors influencing the risk of pericardial effusion (PCE) in patients with inoperable esophageal cancer treated with definitive concurrent chemotherapy and radiation therapy (RT).


METHODS
Data for 101 patients with inoperable esophageal cancer treated with concurrent chemotherapy and RT from 2000 to 2003 at our institution were analyzed. The PCE was confirmed from follow-up chest computed tomography scans and radiologic reports, with freedom from PCE computed from the end of RT. Log-rank tests were used to identify clinical and dosimetric factors influencing freedom from PCE. Dosimetric factors were calculated from the dose-volume histogram for the whole heart and pericardium.


RESULTS
The crude rate of PCE was 27.7% (28 of 101). Median time to onset of PCE was 5.3 months (range, 1.0-16.7 months) after RT. None of the clinical factors investigated was found to significantly influence the risk of PCE. In univariate analysis, a wide range of dose-volume histogram parameters of the pericardium and heart were associated with risk of PCE, including mean dose to the pericardium, volume of pericardium receiving a dose greater than 3 Gy (V3) to greater than 50 Gy (V50), and heart volume treated to greater than 32-38 Gy. Multivariate analysis selected V30 as the only parameter significantly associated with risk of PCE.


CONCLUSIONS
High-dose radiation to the pericardium may strongly increase the risk of PCE. Such a risk may be reduced by minimizing the dose-volume of the irradiated pericardium and heart.
Wei
Xiong
X
Department of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
Liu
H Helen
HH
Tucker
Susan L
SL
Wang
Shulian
S
Mohan
Radhe
R
Cox
James D
JD
Komaki
Ritsuko
R
Liao
Zhongxing
Z
D000368:Aged; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000379:methods; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010490:Pericardial Effusion / Q000209:etiology* / Q000517:prevention & control; D010496:Pericardium / Q000528:radiation effects; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000379:methods; D012307:Risk Factors