title: Women at increased risk for cardiac toxicity following chemoradiation therapy for esophageal carcinoma.
abstract: OBJECTIVE
  The purpose of this study was to identify factors associated with cardiac toxicity in patients treated with chemoradiation therapy (CRT) for esophageal carcinoma.
  
  
  METHODS
  One hundred twenty-seven patients with adenocarcinoma or squamous cell carcinoma of the esophagus treated from July 2002 to June 2011 at 2 academic institutions with preoperative or definitive CRT were retrospectively reviewed. Association of cardiac toxicity with a number of variables was investigated, including heart disease, cardiac bypass and angioplasty, diabetes, insulin use, smoking, chemotherapy regimen, and tumor location. T test assessed risk of cardiac toxicity secondary to age. Dose volume histograms (DVH) were evaluated for percentage of heart volume receiving >20, 30, 40, and 50 Gy (V20-V50). The Fisher exact test analyzed for an association between dose volume parameters and cardiac toxicity.
  
  
  RESULTS
  Patient population included 100 men and 27 women with a mean age of 64 years. Median follow-up was 12.7 months (range, 0.3-99.6 months). Any cardiac toxicity occurred in 28 patients, the majority of which were pericardial effusion (23/28). Odds ratio for toxicity in women was 4.15 (95% confidence interval [CI], 1.63-10.50; P = .0017) and time to cardiac toxicity by sex was significant (P = .0003). Patients above the median cutoff for V20, V30, and V40 had increased odds of developing cardiac toxicity (P = .03, .008, .002). There was 4.0 increased odds of developing cardiac toxicity with V40 >57% (95% CI, 1.5-10.3, P = .002). On multivariable logistic regression analysis, sex was the only variable associated with any cardiac toxicity and pericardial effusion (P = .0016, P = .0038). None of the other investigated variables were associated with increased risk of cardiac toxicity.
  
  
  CONCLUSIONS
  Female patients and dose greater than the median for V20-V40 were associated with the development of cardiac toxicity, specifically pericardial effusion. These data suggest exercising increased care when designing radiation fields in women undergoing CRT for esophageal carcinoma, as pericardial effusion may be a long-term complication.
authors.affiliation: Department of Radiation Oncology, Wayne State University/Barbara A. Karmanos Cancer Center, Detroit, Michigan. Electronic address: lauren.tait@ucdmc.ucdavis.edu.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Tait
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Meyer
authors.affiliation: Department of Radiation Oncology, Wayne State University/Barbara A. Karmanos Cancer Center, Detroit, Michigan.
authors.forename: Erin
authors.initials: E
authors.lastname: McSpadden
authors.affiliation: Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Cheng
authors.affiliation: Thoracic Surgical Oncology, Wayne State University/Barbara A. Karmanos Cancer Center, Detroit, Michigan.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Baciewicz
authors.affiliation: Division of Hematology and Oncology, University Hospitals/Case Comprehensive Cancer Center, Cleveland, Ohio.
authors.forename: Neal J
authors.initials: NJ
authors.lastname: Meropol
authors.affiliation: Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Cohen
authors.affiliation: Division of Hematology and Oncology, Wayne State University/Barbara A. Karmanos Cancer Center, Detroit, Michigan.
authors.forename: Antoinette J
authors.initials: AJ
authors.lastname: Wozniak
authors.affiliation: Division of Hematology and Oncology, Wayne State University/Barbara A. Karmanos Cancer Center, Detroit, Michigan.
authors.forename: Minsig
authors.initials: M
authors.lastname: Choi
authors.affiliation: Department of Radiation Oncology, Wayne State University/Barbara A. Karmanos Cancer Center, Detroit, Michigan.
authors.forename: Andre A
authors.initials: AA
authors.lastname: Konski