title: Symptomatic pericardial effusion after chemoradiation therapy in esophageal cancer patients.
abstract: OBJECTIVE
  We investigated clinical and treatment-related factors as predictors of symptomatic pericardial effusion in esophageal cancer patients after concurrent chemoradiation therapy.
  
  
  METHODS
  We reviewed 214 consecutive primary esophageal cancer patients treated with concurrent chemoradiation therapy between 2001 and 2010 in our institute. Pericardial effusion was detected on follow-up computed tomography. Symptomatic effusion was defined as effusion ≥grade 3 according to Common Terminology Criteria for Adverse Events v4.0 criteria. Percent volume irradiated with 5 to 65 Gy (V5-V65) and mean dose to the pericardium were evaluated employing dose-volume histograms. To evaluate dosimetry for patients treated with two-dimensional planning in the earlier period (2001-2005), computed tomography data at diagnosis were transferred to a treatment planning system to reconstruct three-dimensional plans without modification. Optimal dosimetric thresholds for symptomatic pericardial effusion were calculated by receiver operating characteristic curves. Associating clinical and treatment-related risk factors for symptomatic pericardial effusion were detected by univariate and multivariate analyses.
  
  
  RESULTS
  The median follow-up was 29 (range, 6-121) months for eligible 167 patients. Symptomatic pericardial effusion was observed in 14 (8.4%) patients. Dosimetric analyses revealed average values of V30 to V45 for the pericardium and mean pericardial doses were significantly higher in patients with symptomatic pericardial effusion than in those with asymptomatic pericardial effusion (P<.05). Pericardial V5 to V55 and mean pericardial doses were significantly higher in patients with symptomatic pericardial effusion than in those without pericardial effusion (P<.001). Mean pericardial doses of 36.5 Gy and V45 of 58% were selected as optimal cutoff values for predicting symptomatic pericardial effusion. Multivariate analysis identified mean pericardial dose as the strongest risk factor for symptomatic pericardial effusion.
  
  
  CONCLUSIONS
  Dose-volume thresholds for the pericardium facilitate predicting symptomatic pericardial effusion. Mean pericardial dose was selected based not only on the optimal dose-volume threshold but also on the most significant risk factor for symptomatic pericardial effusion.
authors: Department of Radiology, School of Medicine, Keio University, Tokyo, Japan. Electronic address: fukada@rad.med.keio.ac.jp.
authors: Junichi
authors: J
authors: Fukada
authors: Naoyuki
authors: N
authors: Shigematsu
authors: Hiroya
authors: H
authors: Takeuchi
authors: Toshio
authors: T
authors: Ohashi
authors: Yoshiro
authors: Y
authors: Saikawa
authors: Hiromasa
authors: H
authors: Takaishi
authors: Takashi
authors: T
authors: Hanada
authors: Yutaka
authors: Y
authors: Shiraishi
authors: Yuko
authors: Y
authors: Kitagawa
authors: Keiichi
authors: K
authors: Fukuda
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects* / Q000379:methods; D004938:Esophageal Neoplasms / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058958:Organs at Risk / Q000528:radiation effects*; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000209:etiology*; D010496:Pericardium / Q000528:radiation effects*; D012372:ROC Curve; D011879:Radiotherapy Dosage; D014057:Tomography, X-Ray Computed