title: Reduction of heart volume during neoadjuvant chemoradiation in patients with resectable esophageal cancer.
abstract: OBJECTIVE
  Neoadjuvant chemoradiation (nCRT) followed by surgery is considered curative intent treatment for patients with resectable esophageal cancer. The aim was to establish hemodynamic aspects of changes in heart volume and to explore whether changes in heart volume resulted in clinically relevant changes in the dose distribution of radiotherapy.
  
  
  METHODS
  A prospective study was conducted in patients who were treated with nCRT consisting of carboplatin and paclitaxel concomitant with radiotherapy (41.4 Gy/1.8 Gy per fraction). Physical parameters, cardiac volume on CT and Cone beam CT, cardiac blood markers and cardiac ultrasound were obtained.
  
  
  RESULTS
  In 23 patients a significant decrease of 55.3 ml in heart volume was detected (95% CI 36.7-73.8 ml, p<0.001). There was a decrease in both systolic (mean decrease 18 mmHg, 95% CI 11-26 mmHg, p<0.001) and diastolic blood pressure (mean decrease 8 mmHg, 95% CI 2-14 mmHg, p=0.008) and an increase in heart rate with 6 beats/min (95% CI 1-11 beats/min, p=0.021). Except for Troponin T, no change in other cardiac markers and echocardiography parameters were observed. The change in heart volume did not result in a clinically relevant change in radiation dose distribution.
  
  
  CONCLUSIONS
  Heart volume was significantly reduced, but was not accompanied by overt cardiac dysfunction. All observed changes in hemodynamic parameters are consistent with volume depletion. Adaptation of the treatment plan during the course of radiotherapy is not advocated.
authors: Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: n.hajmohammad@amc.nl.
authors: Nadia
authors: N
authors: Haj Mohammad
authors: Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Martijn
authors: M
authors: Kamphuis
authors: Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Maarten C C M
authors: MC
authors: Hulshof
authors: Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Lotte J
authors: LJ
authors: Lutkenhaus
authors: Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Suzanne S
authors: SS
authors: Gisbertz
authors: Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Jacques J G H M
authors: JJ
authors: Bergman
authors: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: H A C M Rianne
authors: HA
authors: de Bruin-Bon
authors: Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Elisabeth D
authors: ED
authors: Geijsen
authors: Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Arjan
authors: A
authors: Bel
authors: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: S Mathijs
authors: SM
authors: Boekholdt
authors: Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Hanneke W M
authors: HW
authors: van Laarhoven
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000528:radiation effects; D016190:Carboplatin / Q000008:administration & dosage; D002306:Cardiac Volume / Q000187:drug effects / Q000528:radiation effects*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods*; D004938:Esophageal Neoplasms / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D017239:Paclitaxel / Q000008:administration & dosage; D011446:Prospective Studies; D011829:Radiation Dosage; D011879:Radiotherapy Dosage
chemical_list: D016190:Carboplatin; D017239:Paclitaxel
keywords: Cardiac volume; Esophageal cancer; Neoadjuvant chemoradiation