title: The clinical implications of myocardial perfusion abnormalities in patients with esophageal or lung cancer after chemoradiation therapy.
abstract: OBJECTIVE
  This study aims to identify the clinical implications of myocardial perfusion defects after chemoradiation therapy (CRT) in patients with esophageal and lung cancer.
  
  
  METHODS
  We retrospectively compared myocardial perfusion imaging (MPI) results before and after CRT in 16 patients with esophageal cancer and 24 patients with lung cancer. New MPI defects in the radiation therapy (RT) fields were considered related to RT. Follow-up to evaluate for cardiac complications and their relation with the results of MPI was performed. Statistical analysis identified predictors of cardiac morbidities.
  
  
  RESULTS
  Eleven females and twenty nine males at a mean age of 66.7 years were included. Five patients (31%) with esophageal cancer and seven patients (29%) with lung cancer developed myocardial ischemia in the RT field at mean intervals of 7.0 and 8.4 months after RT. The patients were followed-up for mean intervals of 15 and 23 months in the esophageal and lung cancer groups, respectively. Seven patients in each of the esophageal (44%) and lung (29%) cancer patients (P = 0.5) developed cardiac complications of which one patient with esophageal cancer died of complete heart block. Six out of the fourteen patients (43%) with cardiac complication had new ischemia on MPI after CRT of which only one developed angina. The remaining eight patients with cardiac complications had normal MPI results. MPI result was not a statistically significant predictor of future cardiac complications after CRT. A history of congestive heart failure (CHF) (P = 0.003) or arrhythmia (P = 0.003) is a significant predictor of cardiac morbidity after CRT in univariate analysis but marginal predictors when multivariate analysis was performed (P = 0.06 and 0.06 for CHF and arrhythmia, respectively).
  
  
  CONCLUSIONS
  Cardiac complications after CRT are more common in esophageal than lung cancer patients but the difference is not statistically significant. MPI abnormalities are frequently seen after CRT but are not predictive of future cardiac complications. A history of arrhythmia or CHF is significantly associated with cardiac complications after CRT.
authors.affiliation: Department of Nuclear Medicine, University of Texas M.D. Anderson Cancer Center, 6431 Fannin Street, Houston, TX 77030, USA. isis.w.gayed@uth.tmc.edu
authors.forename: Isis
authors.initials: I
authors.lastname: Gayed
authors.forename: Salman
authors.initials: S
authors.lastname: Gohar
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.forename: Mary
authors.initials: M
authors.lastname: McAleer
authors.forename: Roland
authors.initials: R
authors.lastname: Bassett
authors.forename: Syed Wamique
authors.initials: SW
authors.lastname: Yusuf
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000150:complications; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D006333:Heart Failure / Q000150:complications; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D016017:Odds Ratio; D011832:Radiation Injuries / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000970:Antineoplastic Agents