Skip to main content

Advertisement

Log in

The clinical implications of myocardial perfusion abnormalities in patients with esophageal or lung cancer after chemoradiation therapy

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Purpose This study aims to identify the clinical implications of myocardial perfusion defects after chemoradiation therapy (CRT) in patients with esophageal and lung cancer. Methods We retrospectively compared myocardial perfusion imaging (MPI) results before and after CRT in 16 patients with esophageal cancer and 24 patients with lung cancer. New MPI defects in the radiation therapy (RT) fields were considered related to RT. Follow-up to evaluate for cardiac complications and their relation with the results of MPI was performed. Statistical analysis identified predictors of cardiac morbidities. Results Eleven females and twenty nine males at a mean age of 66.7 years were included. Five patients (31%) with esophageal cancer and seven patients (29%) with lung cancer developed myocardial ischemia in the RT field at mean intervals of 7.0 and 8.4 months after RT. The patients were followed-up for mean intervals of 15 and 23 months in the esophageal and lung cancer groups, respectively. Seven patients in each of the esophageal (44%) and lung (29%) cancer patients (P = 0.5) developed cardiac complications of which one patient with esophageal cancer died of complete heart block. Six out of the fourteen patients (43%) with cardiac complication had new ischemia on MPI after CRT of which only one developed angina. The remaining eight patients with cardiac complications had normal MPI results. MPI result was not a statistically significant predictor of future cardiac complications after CRT. A history of congestive heart failure (CHF) (= 0.003) or arrhythmia (= 0.003) is a significant predictor of cardiac morbidity after CRT in univariate analysis but marginal predictors when multivariate analysis was performed (= 0.06 and 0.06 for CHF and arrhythmia, respectively). Conclusions Cardiac complications after CRT are more common in esophageal than lung cancer patients but the difference is not statistically significant. MPI abnormalities are frequently seen after CRT but are not predictive of future cardiac complications. A history of arrhythmia or CHF is significantly associated with cardiac complications after CRT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hull MC, Morris CG, Pepine CJ et al (2003) Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of Hodgkin lymphoma treated with radiation therapy. JAMA 290:2831–2837. doi:10.1001/jama.290.21.2831

    Article  PubMed  CAS  Google Scholar 

  2. Rutqvist LE, Lax I, Fornander T et al (1992) Cardiovascular mortality in a randomized trial of adjuvant radiation therapy versus surgery alone in primary breast cancer. Int J Radiat Oncol Biol Phys 22(5):887–896. doi:10.2172/5375237

    PubMed  CAS  Google Scholar 

  3. Haybittle JL, Brinkley D, Houghton J et al (1989) Postoperative radiotherapy and late mortality: evidence from the cancer research campaign trial for early breast cancer. BMJ 298(6688):1611–1614

    Article  PubMed  CAS  Google Scholar 

  4. Biovin JF, Hutchinson GB, Lubin JH et al (1992) Coronary artery disease mortality in patients treated for Hodgkin’s disease. Cancer 69(5):1241–1247

    Google Scholar 

  5. Hancock SL, Tucker MA, Hoppe RT (1993) Factors affecting late mortality from heart disease after treatment of Hodgkin’s disease. JAMA 270(16):1949–1955. doi:10.1001/jama.270.16.1949

    Article  PubMed  CAS  Google Scholar 

  6. Patt DA, Goodwin JS, Kuo YF et al (2005) Cardiac morbidity of adjuvant radiotherapy for breast cancer. J Clin Oncol 23(30):7475–7482. doi:10.1200/JCO.2005.13.755

    Article  PubMed  Google Scholar 

  7. Giordano SH, Kuo YF, Freeman JL et al (2005) Risk of cardiac death after adjuvant radiotherapy for breast cancer. J Natl Cancer Inst 97(6):419–424

    Article  PubMed  Google Scholar 

  8. Darby SC, McGale P, Taylor CW et al (2005) Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: prospective cohort study of about 300, 000 women in US SEER cancer registries. Lancet Oncol 6(8):557–565. doi:10.1016/S1470-2045(05)70251-5

    Article  PubMed  Google Scholar 

  9. Harris EER, Correa C, Hwang W-T et al (2006) Late cardiac mortality and morbidity in early-stage beast cancer patients after breast-conservation treatment. J Clin Oncol 24(25):4100–4106. doi:10.1200/JCO.2005.05.1037

    Article  PubMed  Google Scholar 

  10. Gyenes G, Fornander T, Carlens P et al (1996) Myocardial damage in breast cancer patients treated with adjuvant radiotherapy: a prospective study. Int J Radiat Oncol Biol Phys 36:899–905. doi:10.1016/S0360-3016(96)00125-3

    PubMed  CAS  Google Scholar 

  11. Hojris I, Sand N, Andersen J et al (2000) Myocardial perfusion imaging in breast cancer patients with or without post-mastectomy radiotherapy. Radiother Oncol 55:163–172. doi:10.1016/S0167-8140(00)00170-5

    Article  Google Scholar 

  12. Hardenbergh PH, Munley MT, Bentel GC et al (2001) Cardiac perfusion changes in patients treated for breast cancer with radiation therapy and doxorubicin: preliminary results. Int J Radiat Oncol Biol Phys 49:1023–1028. doi:10.1016/S0360-3016(00)01531-5

    Article  PubMed  CAS  Google Scholar 

  13. Yu X, Prosnitz R, Zhou S et al (2003) Symptomatic cardiac events following radiation therapy for left-sided breast cancer: possible association with radiation therapy-induced changes in regional perfusion. Clin Breast Cancer 4(3):193–197. doi:10.3816/CBC.2003.n.024

    Article  PubMed  Google Scholar 

  14. Heidenreich PA, Schnittger I, Strauss HW et al (2007) Screening for coronary artery disease after mediastinal irradiation for Hodgkin’s disease. J Clin Oncol 25:43–49. doi:10.1200/JCO.2006.07.0805

    Article  PubMed  Google Scholar 

  15. Carver JR, Shapiro CL, Ng A et al (2007) American Society of clinical oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects. J Clin Oncol 25:3991–4008. doi:10.1200/JCO.2007.10.9777

    Article  PubMed  CAS  Google Scholar 

  16. Espey DK, Wu X, Swan J, Wiggins C et al (2007) Annual report to the nation on the status of cancer, 1975–2004, featuring cancer in American Indians and Alaska natives. NCI-SEER report

  17. Palm A, Johansson KA (2007) A review of the impact of photon and proton external beam radiotherapy treatment modalities on the dose distribution in field and out-of-field; implications for the long-term morbidity of cancer survivors. Acta Oncol 46(4):462–473. doi:10.1080/02841860701218626

    Article  PubMed  Google Scholar 

  18. Bush DA, Slater JD, Shin BB et al (2004) Hypofractionated proton beam radiotherapy for stage I lung cancer. Chest 126(4):1198–1203. doi:10.1378/chest.126.4.1198

    Article  PubMed  Google Scholar 

  19. Wagdi P, Fluri M, Aeschbacher B et al (1996) Cardioprotection in patients undergoing chemo- and/or radiotherapy for neoplastic disease. A pilot study. Jpn Heart J 37(3):353–359

    PubMed  CAS  Google Scholar 

  20. Gayed IW, Liu HH, Yusuf SW et al (2006) The prevalence of myocardial ischemia after concurrent chemoradiation therapy as detected by gated myocardial perfusion imaging in patients with esophageal cancer. J Nucl Med 47:1756–1762. doi:10.1007/3-540-30005-8

    PubMed  Google Scholar 

  21. Gayed IW, Liu HH, Wei X et al (2009) Patterns of cardiac perfusion abnormalities after chemoradiotherapy in patients with lung cancer. J Thorac Oncol 4(2):179–184

    Article  PubMed  Google Scholar 

  22. Rice DC, Correa AM, Vaporciyan AA et al (2005) Preoperative chemoradiotherapy prior to esophagectomy in elderly patients is not associated with increased morbidity. Ann Thorac Surg 79(2):391–397. doi:10.1016/j.athoracsur.2004.08.045

    Article  PubMed  Google Scholar 

  23. Orzan F, Brusca A, Gaita F et al (1993) Associated cardiac lesions in patients with radiation-induced complete heart block. Int J Cardiol 39(2):151–156. doi:10.1016/0167-5273(93)90027-E

    Article  PubMed  CAS  Google Scholar 

  24. Arsenian MA (1991) Cardiovascular sequelae of therapeutic thoracic radiation. Prog Cardiovasc Dis 33(5):299–311. doi:10.1016/0033-0620(91)90022-E

    Article  PubMed  CAS  Google Scholar 

  25. Cohen SI, Bharati S, Glass J et al (1981) Radiotherapy as a cause of complete atrioventricular block in Hodgkin’s disease. An electrophysiological-pathological correlation. Arch Intern Med 141(5):676–679. doi:10.1001/archinte.141.5.676

    Article  PubMed  CAS  Google Scholar 

  26. Franken NA, van der Laarse A, Bosker FJ et al (1992) Time dependent changes in myocardial norepinephrine concentration and adrenergic receptor density following X-irradiation of the rat heart. Int J Radiat Oncol Biol Phys 24(4):721–727. doi:10.2172/5375237

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Robyn Harrell for her contribution to the statistical analysis of this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Isis Gayed.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gayed, I., Gohar, S., Liao, Z. et al. The clinical implications of myocardial perfusion abnormalities in patients with esophageal or lung cancer after chemoradiation therapy. Int J Cardiovasc Imaging 25, 487–495 (2009). https://doi.org/10.1007/s10554-009-9440-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-009-9440-7

Keywords

Navigation