Acute Cardiac Impairment Associated With Concurrent Chemoradiotherapy for Esophageal Cancer: Magnetic Resonance Evaluation

作者：Hatakenaka Masamitsu^*; Yonezawa Masato; Nonoshita Takeshi; Nakamura Katsumasa; Yabuuchi Hidetake; Shioyama Yoshiyuki; Nagao Michinobu; Matsuo Yoshio; Kamitani Takeshi; Higo Taiki; Nishikawa Kei; Setoguchi Taro; Honda Hiroshi

来源：International Journal of Radiation Oncology, Biology, Physics, 2012, 83(1): E67-E73.

DOI：10.1016/j.ijrobp.2011.12.018

• Esophageal cancer
• Chemoradiotherapy
• Cardiac function
• Magnetic resonance imaging

Purpose: To evaluate acute cardiac effects of concurrent chemoradiotherapy (CCRT) for esophageal cancer. %26lt;br%26gt;Methods and Materials: This prospective study was approved by the institutional review board, and written informed consent was obtained from all participants. The left ventricular 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. %26lt;br%26gt;Results: In the low LV-dose group (n = 10; mean LV dose %26lt;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 %26lt; 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 %26lt; 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 %26lt; 0.01). Left ventricle wall motion decreased significantly (p %26lt; 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 %26lt; 0.05) after CCRT between the groups. %26lt;br%26gt;Conclusions: Concurrent chemoradiotherapy for esophageal cancer impairs LVF from an early treatment stage. This impairment is prominent in patients with high LV dose.

• 出版日期2012-5-1