A. Takada Sr, Y. Toyomasu, T. Kawamura, T. Mase, K. Omori, A. Taniguchi, S. Nakamura, H. Sakuma, and Y. Nomoto; Department of Radiology, Mie University Hospital, Mie, Japan
Purpose/Objective(s): The assessment of cardiac function before cancer therapy is crucial, as cancer treatment advancements have led to prolonged survival and a rise in cardiovascular complications. Specifically, esophageal cancer and heart disease share common risk factors, such as smoking and obesity. Moreover, radiotherapy (RT) for esophageal cancer is linked with elevated cardiac radiation exposure and a higher incidence of cardiac-related motalities compared to other cancers. This study aims to assess the incidence of cardiac complications among esophageal cancer patients eligible for RT. Materials/
Methods: This was a sub-study of a previously published prospective study that conducted comprehensive cardiac CT scans before and after RT in esophageal cancer patients and reported myocardial blood flow impairment three months after RT. Currently, we examined the prevalence of coronary artery stenosis, myocardial ischemia, and infarction using pre-RT cardiac CT data for 41 patients with thoracic esophageal cancer who were referred for RT from January 2017 to June 2023. Results: The median age of the 41 patients was 71 years; 40 (98%) were male, with the esophageal cancer stages distributed as follows: I (10 patients), II (5 patients), III (16 patients), IV (10 patients). Pre-treatment echocardiography in 31 patients revealed that 4 (13%) had abnormal ejection fraction values, and another 4 (13%) had impaired diastolic function. Cardiac CT identified significant coronary artery stenosis (=50% luminal narrowing) in 18 patients (44%), with the most critical three-vessel lesion present in 7 patients (39% [7/18]). Notably, stenosis in the left anterior descending artery (LAD) was prevalent, affecting 89% (16/18). Additionally, abnormal myocardial perfusion was detected in 16 patients (39%) and myocardial infarction in 8 patients (20%). Conclusion: There was a significant incidence of cardiac disease in patients with esophageal cancer. Cardiac CT has proven to be effective in detecting cardiac abnormalities not identifiable through echocardiography. Given that coronary artery stenosis predominantly affected the LAD, it is advisable to adopt advanced radiotherapy techniques, such as intensity-modulated radiotherapy, in treatment planning to minimize radiation exposure to the LAD. These insights indicate the need for an integrated approach to cancer treatment that balances oncologic efficacy with cardiovascular safety. Moreover, the data suggest that incorporating cardiac CT into routine pre-RT assessment may be a prudent step to better identify patients at higher risk of cardiac events, enabling the tailoring of therapy to individual risk profiles and improving overall patient care in this vulnerable population.
