Changes in cardiac volume determined with repeated enhanced 4DCT during chemoradiotherapy for esophageal cancer

• Published in: Radiation oncology (London, England) Vol. 13; no. 1; p. 181
• Main Authors: Wang, Xue, Wang, Jin-Zhi, Li, Jian-Bin, Zhang, Ying-Jie, Li, Feng-Xiang, Wang, Wei, Guo, Yan-Luan, Shao, Qian, Xu, Min, Liu, Xi-Jun, Wang, Yue
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 18.09.2018; BioMed Central; BMC
• Subjects: Aged; Blood pressure; Breast cancer; Cancer; Cancer therapies; Carcinoma, Squamous Cell - therapy; Cardiac Volume - radiation effects; Cardiovascular disease; Care and treatment; CAT scans; Change detection; Chemoradiotherapy; Chemotherapy; Comparative analysis; Computed tomography; Concurrent chemoradiotherapy; Contrast enhanced four-dimensional computed tomography; Diagnosis; Dosage; Esophageal cancer; Esophageal Neoplasms - therapy; Esophagus; Female; Four-Dimensional Computed Tomography; Heart - diagnostic imaging; Heart - radiation effects; Heart failure; Heart rate; Heart volume change; Humans; Male; Medical imaging; Methods; Patients; Prospective Studies; Radiation; Radiation damage; Radiation effects; Radiation therapy; Radiotherapy; Radiotherapy Planning, Computer-Assisted; Reduction; China; Blood pressure; Heart volume change; Concurrent chemoradiotherapy; Contrast enhanced four-dimensional computed tomography; Esophageal cancer
• ISSN: 1748-717X; 1748-717X
• DOI: 10.1186/s13014-018-1121-z

Concurrent chemoradiotherapy is considered curative intent treatment for patients with non-operative esophageal cancer. Radiation-induced heart damage receives much attention. We performed repeated four-dimensional computed tomography (4DCT) to detect changes in cardiac volume during radiotherapy for esophageal cancer patients, and explored potential factors responsible for those changes. Forty-six patients with esophageal cancer underwent enhanced 4DCT and three-dimensional (3D) CT scans before radiotherapy and every 10 fractions during treatment. The heart was contoured on 3DCT images, 4DCT end expiratory (EE) images and 4DCT maximum intensity projection (MIP) images by the same radiation oncologist. Heart volumes and other relative parameters were compared by the SPSS software package, version 19.0. Compared with its initial value, heart volume was smaller at the 10th fraction (reduction = 3.27%, 4.45% and 4.52% on 3DCT, EE and MIP images, respectively, p < 0.05) and the 20th fraction (reduction = 6.05%, 5.64% and 4.51% on 3DCT, EE and MIP images, respectively, p < 0.05), but not at the 30th fraction. Systolic and diastolic blood pressures were reduced (by 16.95 ± 16.69 mmHg and 7.14 ± 11.64 mmHg, respectively, both p < 0.05) and the heart rate was elevated by 5.27 ± 6.25 beats/min (p < 0.05) after radiotherapy. None of the potential explanatory variables correlated with heart volume changes. Cardiac volume reduced significantly from an early treatment stage and maintained the reduction until the middle stage. The heart volume changes observed on 3DCT and 4DCT were consistent during radiotherapy. The changes in heart volume, blood pressure and heart rate may be valuable indicators of cardiac impairment and target dose changes.