title: Acute cardiac impairment associated with concurrent chemoradiotherapy for esophageal cancer: magnetic resonance evaluation.
abstract: OBJECTIVE
  To evaluate acute cardiac effects of concurrent chemoradiotherapy (CCRT) for esophageal cancer.
  
  
  METHODS
  This prospective study was approved by the institutional review board, and written informed consent was obtained from all participants. The left ventricular function (LVF) of 31 patients with esophageal cancer who received cisplatin and 5-fluorouracil-based CCRT was evaluated using cardiac cine magnetic resonance imaging. The patients were classified into two groups according to mean LV dose. The parameters related to LVF were compared between before and during (40 Gy) or between before and after CCRT using a Wilcoxon matched-pairs single rank test, and parameter ratios (during/before CCRT, after/before CCRT) were also compared between the groups with a t test. Data were expressed as mean ± SE.
  
  
  RESULTS
  In the low LV-dose group (n = 10; mean LV dose <0.6 Gy), LV ejection fraction decreased significantly (before vs. during vs. after CCRT; 62.7% ± 2.98% vs. 59.8% ± 2.56% vs. 60.6% ± 3.89%; p < 0.05). In the high LV-dose group (n = 21; mean LV dose of 3.6-41.2 Gy), LV end-diastolic volume index (before vs. after CCRT; 69.1 ± 2.93 vs. 57.0 ± 3.23 mL/m(2)), LV stroke volume index (38.6 ± 1.56 vs. 29.9 ± 1.60 mL/m(2)), and LV ejection fraction (56.9% ± 1.79% vs. 52.8% ± 1.15%) decreased significantly (p < 0.05) after CCRT. Heart rate increased significantly (before vs. during vs. after CCRT; 66.8 ± 3.05 vs. 72.4 ± 4.04 vs. 85.4 ± 3.75 beats per minute, p < 0.01). Left ventricle wall motion decreased significantly (p < 0.05) in segments 8 (before vs. during vs. after CCRT; 6.64 ± 0.54 vs. 4.78 ± 0.43 vs. 4.79 ± 0.50 mm), 9 (6.88 ± 0.45 vs. 5.04 ± 0.38 vs. 5.27 ± 0.47 mm), and 10 (9.22 ± 0.48 vs. 8.08 ± 0.34 vs. 8.19 ± 0.56 mm). The parameter ratios of LV end-diastolic volume index, stroke volume index, wall motion in segment 9, and heart rate showed significant difference (p < 0.05) after CCRT between the groups.
  
  
  CONCLUSIONS
  Concurrent chemoradiotherapy for esophageal cancer impairs LVF from an early treatment stage. This impairment is prominent in patients with high LV dose.
authors.affiliation: Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. mhatakenaka@sapmed.ac.jp
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Hatakenaka
authors.forename: Masato
authors.initials: M
authors.lastname: Yonezawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nonoshita
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Nakamura
authors.forename: Hidetake
authors.initials: H
authors.lastname: Yabuuchi
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Shioyama
authors.forename: Michinobu
authors.initials: M
authors.lastname: Nagao
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Matsuo
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kamitani
authors.forename: Taiki
authors.initials: T
authors.lastname: Higo
authors.forename: Kei
authors.initials: K
authors.lastname: Nishikawa
authors.forename: Taro
authors.initials: T
authors.lastname: Setoguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Honda
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000009:adverse effects*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006339:Heart Rate / Q000187:drug effects / Q000528:radiation effects; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects / Q000528:radiation effects; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D013318:Stroke Volume / Q000187:drug effects / Q000528:radiation effects; D016277:Ventricular Function, Left / Q000187:drug effects* / Q000528:radiation effects*
chemical_list: D002945:Cisplatin; D005472:Fluorouracil