Risk factors for pericardial effusion in inoperable esophageal cancer patients treated with definitive chemoradiation therapy.

Abstract

PURPOSE:

To identify clinical and dosimetric factors influencing the risk of pericardial effusion (PCE) in patients with inoperable esophageal cancer treated with definitive concurrent chemotherapy and radiation therapy (RT).

METHODS AND MATERIALS:

Data for 101 patients with inoperable esophageal cancer treated with concurrent chemotherapy and RT from 2000 to 2003 at our institution were analyzed. The PCE was confirmed from follow-up chest computed tomography scans and radiologic reports, with freedom from PCE computed from the end of RT. Log-rank tests were used to identify clinical and dosimetric factors influencing freedom from PCE. Dosimetric factors were calculated from the dose-volume histogram for the whole heart and pericardium.

RESULTS:

The crude rate of PCE was 27.7% (28 of 101). Median time to onset of PCE was 5.3 months (range, 1.0-16.7 months) after RT. None of the clinical factors investigated was found to significantly influence the risk of PCE. In univariate analysis, a wide range of dose-volume histogram parameters of the pericardium and heart were associated with risk of PCE, including mean dose to the pericardium, volume of pericardium receiving a dose greater than 3 Gy (V3) to greater than 50 Gy (V50), and heart volume treated to greater than 32-38 Gy. Multivariate analysis selected V30 as the only parameter significantly associated with risk of PCE.

CONCLUSIONS:

High-dose radiation to the pericardium may strongly increase the risk of PCE. Such a risk may be reduced by minimizing the dose-volume of the irradiated pericardium and heart.

• Authors: Xiong Wei, H Helen Liu, Susan L Tucker, Shulian Wang, Radhe Mohan, James D Cox, Ritsuko Komaki, Zhongxing Liao
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 70 Issue 3 Pg. 707-14 (Mar 01 2008) ISSN: 0360-3016 [Print] United States
• PMID: 18191334 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Analysis of Variance
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Combined Modality Therapy (methods)
• Esophageal Neoplasms (drug therapy, radiotherapy)
• Female
• Follow-Up Studies
• Humans
• Male
• Pericardial Effusion (etiology, prevention & control)
• Pericardium (radiation effects)
• Radiotherapy Dosage
• Radiotherapy, Conformal (methods)
• Risk Factors