title: Symptomatic radiation-induced cardiac disease in long-term survivors of esophageal cancer.
abstract: OBJECTIVE
  To evaluate clinical and dosimetric factors retrospectively affecting the risk of symptomatic cardiac disease (SCD) in esophageal cancer patients treated with radiotherapy.
  
  
  METHODS
  A total of 343 patients with newly diagnosed esophageal cancer were managed with concurrent chemoradiotherapy or radiotherapy alone. Of these, 58 patients were followed at our hospital for at least 4 years. Median clinical follow-up was 79 months. Cardiac toxicity was determined by Common Terminology Criteria for Adverse Events (CTCAE) v. 4.0. The maximum and mean doses to the heart and percentage of the volume were calculated from the dose-volume histograms.
  
  
  RESULTS
  SCD manifested in 11 patients. The heart diseases included three pericardial effusions, one pericardial effusion with valvular disease and paroxysmal atrial tachycardia, three atrial fibrillations, one sinus tachycardia, one coronary artery disease, one chest pain with strongly suspected coronary artery disease, and one congestive heart failure. The actual incidence of SCD was 13.8 % at 5 years. Univariate and multivariate analyses of continuous variables revealed that the risk of developing an SCD depended on the volume of the heart receiving a dose greater than 45 Gy (V45), 50 Gy (V50), and 55 Gy (V55). No other clinical factors were found to influence the risk of SCD. For V45, V50, and V55, the lowest significant cutoff values were 15, 10, and 5 %, respectively.
  
  
  CONCLUSIONS
  High-dose and large-volume irradiation of the heart increased the risk of SCD in long-term survivors. Using modern radiotherapy techniques, it is important to minimize the heart dose-volume parameters without reducing the tumor dose.
authors.affiliation: , 4-57 Urahune-cho, Minami-ku, Yokohama, Kanagawa-prefecture, Japan. ogino1ro@urahp.yokohama-cu.ac.jp.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Ogino
authors.affiliation: , 4-57 Urahune-cho, Minami-ku, Yokohama, Kanagawa-prefecture, Japan.
authors.forename: Shigenobu
authors.initials: S
authors.lastname: Watanabe
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Iwahashi
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Kosuge
authors.affiliation: Department of Biostatistics, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sakamaki
authors.affiliation: Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Chikara
authors.initials: C
authors.lastname: Kunisaki
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000532:radiotherapy*; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk / Q000528:radiation effects; D015995:Prevalence; D000069079:Radiation Exposure / Q000706:statistics & numerical data; D011832:Radiation Injuries / Q000175:diagnosis* / Q000453:epidemiology*; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data; D063189:Symptom Assessment / Q000706:statistics & numerical data
keywords: Chemoradiotherapy; Hodgkin’s disease; Radiotherapy; Risk factors; Toxicity