1
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Sawada T, Kondo M, Goto M, Murakami M, Ishida T, Hiroshima Y, Hoshi SL, Okubo R, Okumura T, Sakurai H. Cost-utility analysis of proton beam therapy for locally advanced esophageal cancer in Japan. PLoS One 2024; 19:e0308961. [PMID: 39331653 PMCID: PMC11433116 DOI: 10.1371/journal.pone.0308961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 08/04/2024] [Indexed: 09/29/2024] Open
Abstract
PURPOSE Proton beam therapy (PBT) has recently been included in Japan's health insurance benefit package for certain cancer types. This study aimed to determine the cost-effectiveness of PBT as a replacement for conventional three-dimensional conformal radiotherapy (3D-CRT) for locally advanced esophageal cancer (LAEC) that is not covered by social insurance. METHODS We estimated the incremental cost-effectiveness ratio (ICER) of PBT as a replacement for 3D-CRT, using clinical evidence from the literature and expert opinions. We used an economic model, decision tree, and Markov model to illustrate the courses followed by patients with LAEC. Effectiveness was estimated as quality-adjusted life years (QALY) using utility weights for the health state. Social insurance fees were calculated as costs. We assumed two base cases depending on the two existing levels of fees for PBT in social insurance: 2,735,000 Japanese yen (US$20,652) or 1,600,000 yen (US$13,913). The stability of the ICER against these assumptions was appraised using sensitivity analysis. RESULTS The effectiveness of PBT and 3D-CRT was 2.62 and 2.51 QALY, respectively. The estimated ICER was 14,025,268 yen (US$121,958) per QALY for the higher fee level and 7,026,402 yen (US$61,099) for the lower fee level. According to the Japanese threshold for cost-effectiveness of anticancer therapy of 7,500,000 yen (US$65,217) per QALY gain, the inclusion of PBT for LAEC in the benefit package of social insurance is cost-effective if a lower fee is applied. CONCLUSION PBT is a cost-effective alternative to 3D-CRT for LAEC and making it available to patients under social insurance could be justifiable.
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Affiliation(s)
- Takuya Sawada
- Department of Radiation Oncology & Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masahide Kondo
- Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Masaaki Goto
- Department of Radiation Oncology & Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Radiation Oncology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Motohiro Murakami
- Department of Radiation Oncology & Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Toshiki Ishida
- Department of Radiation Oncology & Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuichi Hiroshima
- Department of Radiation Oncology & Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | - Shu-Ling Hoshi
- Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Reiko Okubo
- Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Clinical Laboratory Medicine, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology & Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology & Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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2
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Thakur P, Olson JD, Dugan GO, Daniel Bourland J, Kock ND, Mark Cline J. Quantitative Assessment and Comparative Analysis of Longitudinal Lung CT Scans of Chest-Irradiated Nonhuman Primates. Radiat Res 2023; 199:39-47. [PMID: 36394559 PMCID: PMC9987082 DOI: 10.1667/rade-21-00225.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022]
Abstract
Computed tomography (CT) imaging has been used to diagnose radiation-induced lung injury for decades. However, histogram-based quantitative tools have rarely been applied to assess lung abnormality due to radiation-induced lung injury (RILI). Here, we used first-order summary statistics to derive and assess threshold measures extracted from whole lung histograms of CT radiodensity in rhesus macaques. For the present study, CT scans of animals exposed to 10 Gy of whole thorax irradiation were utilized from a previous study spanning 2-9 months postirradiation. These animals were grouped into survivors and non-survivors based on their clinical and experimental endpoints. We quantified the change in lung attenuation after irradiation relative to baseline using three density parameters; average lung density (ALD), percent change in hyper-dense lung volume (PCHV), hyperdense volume as a percent of total volume (PCHV/TV) at 2-month intervals and compared each parameter between the two irradiated groups (non-survivors and survivors). We also correlated our results with histological findings. All the three indices (ALD, PCHV, PCHV/TV) obtained from density histograms showed a significant increase in lung injury in non-survivors relative to survivors, with PCHV relatively more sensitive to detect early RILI changes. We observed a significant positive correlation between histologic pneumonitis scores and each of the three CT measurements, indicating that CT density is useful as a surrogate for histologic disease severity in RILI. CT-based three density parameters, ALD, PCHV, PCHV/TV, may serve as surrogates for likely histopathology patterns in future studies of RILI disease progression.
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Affiliation(s)
- Priyanka Thakur
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1040
| | - John D. Olson
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1040
| | - Gregory O Dugan
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1040
| | - J. Daniel Bourland
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1040
| | - Nancy D. Kock
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1040
| | - J. Mark Cline
- Department of Pathology, Section on Comparative Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1040
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3
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Benveniste MF, Cuellar SLB, Szarf G, Benveniste APA, Ahuja J, Marom EM. Imaging of the Chest After Radiotherapy and Potential Pitfalls. Semin Ultrasound CT MR 2021; 42:574-587. [PMID: 34895613 DOI: 10.1053/j.sult.2021.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Radiotherapy is one of the cornerstones for the treatment of thoracic malignancies. The goal of radiotherapy is to deliver maximal dose to the tumor while minimizing damage to surrounding normal anatomical structures. Although advances in radiotherapy technology have considerably improved radiation delivery, potential adverse effects are still common. Post radiation changes to the chest may include different structures such as the lung, heart, great vessels, and esophagus. The purpose of this manuscript is to illustrate the post radiotherapy changes to these anatomical structures resulting from external beam radiotherapy, as well as discuss imaging pitfalls to prevent radiologist's interpretation errors.
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Affiliation(s)
- Marcelo F Benveniste
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | | | - Gilberto Szarf
- Department of Diagnostic Radiology, Federal University of Sao Paulo and Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Jitesh Ahuja
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Edith M Marom
- Department of Diagnostic Radiology, The Chaim Sheba Medical Center, Affiliated with the Tel Aviv University, Tel Aviv, Israel
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4
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Aqeel M, Medhora M, Gore E, Borkenhagen J, Klawikowski S, Eastwood D, Banerjee A, Jacobs ER. Evaluation of Radiation-induced Pleural Effusions after Radiotherapy to Support Development of Animal Models of Radiation Pneumonitis. HEALTH PHYSICS 2021; 121:434-443. [PMID: 34546223 PMCID: PMC8500166 DOI: 10.1097/hp.0000000000001462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
ABSTRACT Not all animal models develop radiation-induced pleural effusions (RIPEs) as a form of radiation-induced lung injury (RILI). Such effusions are also not well characterized in humans. The purpose of this study is to identify occurrences of RIPE in humans, provide justification for development of relevant animal models, and further characterize its risk factors in cancer patients. We also aim to identify dose thresholds for cardiopulmonary toxicity in humans to shed light on possible pathogenic mechanisms for RIPEs. We carried out a retrospective review of medical records of 96 cancer patients receiving thoracic irradiation (TRT) at our institution. Fifty-three (53%) patients developed a new pleural effusion post TRT; 18 (19%) had RIPE; and 67% developed RIPE ipsilateral to the site irradiated. None developed "contralateral only" effusions. Median time to development was 6 mo (IQR; 4-8 mo). Of 18, 8 patients (44%) had concomitant asymptomatic (radiographic only) or symptomatic radiation pneumonitis and pericardial effusion. Dosimetric factors, including combined and ipsilateral mean lung dose (MLD), were significantly associated with increased risk of RIPE. Angiotensin converting enzyme inhibition, steroids, or concurrent chemotherapy did not modify incidence of RIPE. Our results substantiate the occurrence and incidence of RIPEs in humans. In cancer patients, a median time to development of effusions around 6 mo also supports the onset of RIPEs concurrent with radiation pneumonitis. Future work needs to include large populations of cancer survivors in whom delayed RIPEs can be tracked and correlated with cardiovascular changes in the context of injury to multiple organs.
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Affiliation(s)
- Masooma Aqeel
- Current Affiliation: Section of Pulmonary & Critical
Care Medicine, Department of Medicine, Aga Khan University, Karachi, Pakistan.
Formerly at Division of Pulmonary Medicine, Department of Medicine, Froedtert
Hospital & Medical College of Wisconsin, Milwaukee, WI, United States
| | - Meetha Medhora
- Division of Pulmonary Medicine, Department of Medicine,
Froedtert Hospital & Medical College of Wisconsin, Milwaukee, WI, United
States
- Department of Radiation Oncology, Froedtert Hospital &
Medical College of Wisconsin, Milwaukee, WI, United States
- Research Service, Department of Veteran’s Affairs,
Clement J. Zablocki VA Medical Center, Milwaukee, WI, United States
| | - Elizabeth Gore
- Department of Radiation Oncology, Froedtert Hospital &
Medical College of Wisconsin, Milwaukee, WI, United States
- Research Service, Department of Veteran’s Affairs,
Clement J. Zablocki VA Medical Center, Milwaukee, WI, United States
| | - Jenna Borkenhagen
- Department of Radiation Oncology, Froedtert Hospital &
Medical College of Wisconsin, Milwaukee, WI, United States
| | - Slade Klawikowski
- Department of Radiation Oncology, Froedtert Hospital &
Medical College of Wisconsin, Milwaukee, WI, United States
| | - Daniel Eastwood
- Department of Biostatistics, Medical College of Wisconsin,
Milwaukee, WI, United States
| | - Anjishnu Banerjee
- Department of Biostatistics, Medical College of Wisconsin,
Milwaukee, WI, United States
| | - Elizabeth R. Jacobs
- Division of Pulmonary Medicine, Department of Medicine,
Froedtert Hospital & Medical College of Wisconsin, Milwaukee, WI, United
States
- Research Service, Department of Veteran’s Affairs,
Clement J. Zablocki VA Medical Center, Milwaukee, WI, United States
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5
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Fukada J, Fukata K, Koike N, Kota R, Shigematsu N. Mean heart dose-based normal tissue complication probability model for pericardial effusion: a study in oesophageal cancer patients. Sci Rep 2021; 11:18166. [PMID: 34518576 PMCID: PMC8437977 DOI: 10.1038/s41598-021-97605-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/24/2021] [Indexed: 12/13/2022] Open
Abstract
We investigated the normal tissue complication probability (NTCP) of the incidence of pericardial effusion (PCE) based on the mean heart dose (MHD) in patients with oesophageal cancer treated with definitive chemoradiotherapy. The incidences of PCE in any grade (A-PCE) and symptomatic PCE (S-PCE) were evaluated separately. To identify predictors for PCE, several clinical and dose-volume parameters were analysed using a receiver operating characteristic (ROC) curve and multivariate regression analysis. To validate its clinical applicability, the generated NTCP model was compared to the Lyman–Kutcher–Burman (LKB) model. Among 229 eligible patients, A-PCE and S-PCE were observed in 100 (43.7%) and 18 (7.9%) patients, respectively. MHD showed a preferable area under the curve (AUC) value for S-PCE (AUC = 0.821) and A-PCE (AUC = 0.734). MHD was the only significant predictor for A-PCE; MHD and hypertension were selected as significant factors for S-PCE. The estimated NTCP, using the MHD-based model, showed excellent correspondence to the LKB model in A-PCE and S-PCE. The NTCP curve of A-PCE was gentler than that of S-PCE and had no threshold. The MHD-based NTCP model was simple but comparable to the LKB model for both A-PCE and S-PCE. Therefore, the estimated NTCP may provide clinically useful parameters for predicting PCE.
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Affiliation(s)
- Junichi Fukada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Kyohei Fukata
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Cancer Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Naoyoshi Koike
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ryuichi Kota
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Naoyuki Shigematsu
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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6
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Benveniste MF, Gomez D, Carter BW, Betancourt Cuellar SL, Shroff GS, Benveniste APA, Odisio EG, Marom EM. Recognizing Radiation Therapy-related Complications in the Chest. Radiographics 2020; 39:344-366. [PMID: 30844346 DOI: 10.1148/rg.2019180061] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Radiation therapy is one of the cornerstones for the treatment of thoracic malignancies. Although advances in radiation therapy technology have improved the delivery of radiation considerably, adverse effects are still common. Postirradiation changes affect the organ or tissue treated and the neighboring structures. Advances in external-beam radiation delivery techniques and how these techniques affect the expected thoracic radiation-induced changes are described. In addition, how to distinguish these expected changes from complications such as infection and radiation-induced malignancy, and identify treatment failure, that is, local tumor recurrence, is reviewed. ©RSNA, 2019.
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Affiliation(s)
- Marcelo F Benveniste
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Daniel Gomez
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Brett W Carter
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Sonia L Betancourt Cuellar
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Girish S Shroff
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Ana Paula A Benveniste
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Erika G Odisio
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Edith M Marom
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
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7
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Nakatani Y, Kato K, Shoji H, Iwasa S, Honma Y, Takashima A, Ushijima T, Ito Y, Itami J, Boku N. Comparison of involved field radiotherapy and elective nodal irradiation in combination with concurrent chemotherapy for T1bN0M0 esophageal cancer. Int J Clin Oncol 2020; 25:1098-1104. [PMID: 32189155 DOI: 10.1007/s10147-020-01652-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The optimal radiation field of chemoradiation therapy (CRT) for stage I esophageal squamous cell carcinoma (ESCC) is unknown. This retrospective study compared efficacy and safety of two CRT modalities, involved field irradiation (IFI) and elective nodal irradiation (ENI), when treating patients with clinical stage I (T1bN0M0) ESCC. METHODS Patients had received 60 Gy CRT concurrently with 5-FU and cisplatin between January 2000 and December 2012. The clinical target volume of IFI was limited to the primary tumor plus a 2-cm craniocaudal margin; that of ENI covered the primary tumor plus the field of regional lymph nodes. RESULTS One hundred and ninety-five patients were selected (IFI group, 78; ENI group, 117). The 5-year overall, cause-specific and progression-free survival rates were 90.5%, 91.6% and 77.6% in the IFI group, and 72.5%, 88.3%, 57.9% in the ENI group, respectively. Of recurrent patients (n = 16 in the IF and n = 33 in the ENI groups) after achieving complete remission, 12 (75%) in the IFI group received definitive salvage therapy, 11 (33%) patients did in the ENI group. More patients died of diseases other than esophageal cancer in the ENI group (n = 29, 25%) than in the IFI group (n = 3, 3.8%). Multivariate analysis identified ENI (HR 3.63 [1.78-7.38], p < 0.001), age ≥ 70 (HR 2.65 [1.53-4.58], p < 0.001) and PS = 1 (HR 2.36 [1.33-4.18], p = 0.003) as poor prognostic factors for OS. CONCLUSIONS IF irradiation would be better than ENI for the patients with stage I ESCC who received definitive chemoradiotherapy.
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Affiliation(s)
- Yukihiro Nakatani
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan.,Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ken Kato
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan.
| | - Hirokazu Shoji
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Satoru Iwasa
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Yoshitaka Honma
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Atsuo Takashima
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
| | - Toshikazu Ushijima
- Division of Epigenomics, National Cancer Center Research Institute, Tokyo, Japan.,Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshinori Ito
- Department of Radiology, Showa University School of Medicine, Shinagawa , Tokyo, Japan
| | - Jun Itami
- Radiation Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Narikazu Boku
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, Japan
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8
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9
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Abstract
PURPOSE OF REVIEW This review highlights the literature related to pericardial injury following radiation for oncologic diseases. RECENT FINDINGS Radiation-associated pericardial disease can have devastating consequences. Unfortunately, there is considerably less evidence regarding pericardial syndromes following thoracic radiation as compared to other cardiovascular outcomes. Pericardial complications of radiation may arise acutely or have an insidious onset several decades after treatment. Transthoracic echocardiography is the screening imaging modality of choice, while cardiac magnetic resonance imaging further characterizes the pericardium and guides treatment decision-making. Cardiac CT can be useful for assessing pericardial calcification. Ongoing efforts to lessen inadvertent cardiac injury are directed towards the revision of radiation techniques and protocols. As survival of mediastinal and thoracic malignancies continues to improve, radiation-associated pericardial disease is increasingly relevant. Though advances in radiation oncology demonstrate promise in curtailing cardiotoxicity, the long-term effects pertaining to pericardial complications remain to be seen.
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Affiliation(s)
- Natalie Szpakowski
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Milind Y Desai
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA.
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10
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Alaee S, Foley PWX, Stanton AE. Life threatening polyserositis post oesophagectomy. Respir Med Case Rep 2018; 26:42-44. [PMID: 30519526 PMCID: PMC6260429 DOI: 10.1016/j.rmcr.2018.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/08/2018] [Accepted: 11/08/2018] [Indexed: 11/28/2022] Open
Abstract
A 46 year old lady presented three weeks after an oesophagectomy for oesophageal carcinoma with increasing breathlessness and a large left-sided pleural effusion. Computed tomography (CT) scan of her thorax, abdomen and pelvis revealed a large left-sided and small right-sided pleural effusions, a pericardial effusion, ascites and intra-abdominal lymphadenopathy. The patient underwent both pericardial and pleural fluid drainage, however, unfortunately, deteriorated despite these interventions with increasing oxygen requirements requiring nasal high flow oxygen on the Intensive Care Unit. Her pleural and pericardial collections resolved with colchicine and later introduction of prednisolone over a period of 5 weeks. Polyserositis is well recognised after cardiac surgery, but such a dramatic complication after thoracotomy for non-cardiac surgery has as not previously been reported. The polyserositis may relate to the induction chemotherapy combined with surgery.
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Affiliation(s)
- Seema Alaee
- Great Western Hospital, Swindon, Marlborough Road, SN3 6BB, UK
| | - Paul W X Foley
- Great Western Hospital, Swindon, Marlborough Road, SN3 6BB, UK
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11
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Takata N, Kataoka M, Hamamoto Y, Tsuruoka S, Kanzaki H, Uwatsu K, Nagasaki K, Mochizuki T. Risk factors for pericardial effusion after chemoradiotherapy for thoracic esophageal cancer-comparison of four-field technique and traditional two opposed fields technique. JOURNAL OF RADIATION RESEARCH 2018; 59:291-297. [PMID: 29659940 PMCID: PMC5967453 DOI: 10.1093/jrr/rry029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/24/2018] [Indexed: 06/08/2023]
Abstract
Pericardial effusion is an important late toxicity after concurrent chemoradiotherapy (CCRT) for locally advanced esophageal cancer. We investigated the clinical and dosimetric factors that were related to pericardial effusion among patients with thoracic esophageal cancer who were treated with definitive CCRT using the two opposed fields technique (TFT) or the four-field technique (FFT), as well as the effectiveness of FFT. During 2007-2015, 169 patients with middle and/or lower thoracic esophageal cancer received definitive CCRT, and 94 patients were evaluable (51 FFT cases and 43 TFT cases). Pericardial effusion was observed in 74 patients (79%) and appeared at 1-18.5 months (median: 5.25 months) after CCRT. The 1-year incidences of pericardial effusions were 73.2% and 76.7% in the FFT and TFT groups, respectively (P = 0.6395). The mean doses to the pericardium were 28.6 Gy and 31.8 Gy in the FFT and TFT groups, respectively (P = 0.0259), and the V40 Gy proportions were 33.5% and 48.2% in the FFT and TFT groups, respectively (P < 0.0001). Grade 3 pericardial effusion was not observed in patients with a pericardial V40 Gy of <40%, or in patients who were treated using the FFT. Although the mean pericardial dose and V40 Gy in the FFT group were smaller than those in the TFT group, the incidences of pericardial effusion after CCRT were similar in both groups. As symptomatic pericardial effusion was not observed in patients with a pericardial V40 Gy of <40% or in the FFT group, it appears that FFT with a V40 Gy of <40% could help minimize symptomatic pericardial effusion.
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Affiliation(s)
- Noriko Takata
- Department of Radiotherapy, Shikoku Cancer Center Hospital, Kou 160, Minami-Umemoto, Matsuyama, Ehime 791-0280, Japan
- Department of Radiology, Ehime University Hospital, Shitsukawa, Tohon, Ehime 791-0295, Japan
| | - Masaaki Kataoka
- Department of Radiotherapy, Shikoku Cancer Center Hospital, Kou 160, Minami-Umemoto, Matsuyama, Ehime 791-0280, Japan
| | - Yasushi Hamamoto
- Department of Radiology, Ehime University Hospital, Shitsukawa, Tohon, Ehime 791-0295, Japan
| | - Shintaro Tsuruoka
- Department of Radiology, Ehime University Hospital, Shitsukawa, Tohon, Ehime 791-0295, Japan
| | - Hiromitsu Kanzaki
- Department of Radiotherapy, Shikoku Cancer Center Hospital, Kou 160, Minami-Umemoto, Matsuyama, Ehime 791-0280, Japan
| | - Kotaro Uwatsu
- Department of Radiotherapy, Shikoku Cancer Center Hospital, Kou 160, Minami-Umemoto, Matsuyama, Ehime 791-0280, Japan
| | - Kei Nagasaki
- Department of Radiology, Ehime University Hospital, Shitsukawa, Tohon, Ehime 791-0295, Japan
| | - Teruhito Mochizuki
- Department of Radiology, Ehime University Hospital, Shitsukawa, Tohon, Ehime 791-0295, Japan
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12
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Yusuf SW, Venkatesulu BP, Mahadevan LS, Krishnan S. Radiation-Induced Cardiovascular Disease: A Clinical Perspective. Front Cardiovasc Med 2017; 4:66. [PMID: 29124057 PMCID: PMC5662579 DOI: 10.3389/fcvm.2017.00066] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/09/2017] [Indexed: 01/15/2023] Open
Abstract
Cancer survival has improved dramatically, and this has led to the manifestation of late side effects of multimodality therapy. Radiation (RT) to the thoracic malignancies results in unintentional irradiation of the cardiac chambers. RT-induced microvascular ischemia leads to disruption of capillary endothelial framework, and injury to differentiated myocytes results in deposition of collagen and fibrosis. Coexistence of risk factors of metabolic syndrome and preexisting atherosclerosis in addition to RT exposure results in accelerated occurrence of major coronary events. Hence, it becomes pertinent to understand the underlying pathophysiology and clinical manifestations of RT-induced cardiovascular disease to devise optimal preventive and surveillance strategies.
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Affiliation(s)
- Syed Wamique Yusuf
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Bhanu Prasad Venkatesulu
- Department of Experimental Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lakshmi Shree Mahadevan
- Department of Experimental Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sunil Krishnan
- Department of Experimental Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Radiation Oncology, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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13
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Zhao J, Day RM, Jin JY, Quint L, Williams H, Ferguson C, Yan L, King M, Albsheer A, Matuszak M, Kong FMS. Thoracic radiation-induced pleural effusion and risk factors in patients with lung cancer. Oncotarget 2017; 8:97623-97632. [PMID: 29228638 PMCID: PMC5722590 DOI: 10.18632/oncotarget.18824] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 06/08/2017] [Indexed: 12/25/2022] Open
Abstract
The risk factors and potential practice implications of radiation-induced pleural effusion (RIPE) are undefined. This study examined lung cancer patients treated with thoracic radiation therapy (TRT) having follow-up computed tomography (CT) or 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT. Increased volumes of pleural effusion after TRT without evidence of tumor progression was considered RIPE. Parameters of lung dose-volume histogram including percent volumes irradiated with 5-55 Gy (V5-V55) and mean lung dose (MLD) were analyzed by receiver operating characteristic analysis. Clinical and treatment-related risk factors were detected by univariate and multivariate analyses. 175 out of 806 patients receiving TRT with post-treatment imaging were included. 51 patients (24.9%) developed RIPE; 40 had symptomatic RIPE including chest pain (47.1%), cough (23.5%) and dyspnea (35.3%). Female (OR = 0.380, 95% CI: 0.156-0.926, p = 0.033) and Caucasian race (OR = 3.519, 95% CI: 1.327-9.336, p = 0.011) were significantly associated with lower risk of RIPE. Stage and concurrent chemotherapy had borderline significance (OR = 1.665, p = 0.069 and OR = 2.580, p = 0.080, respectively) for RIPE. Patients with RIPE had significantly higher whole lung V5-V40, V50 and MLD. V5 remained as a significant predictive factor for RIPE and symptomatic RIPE (p = 0.007 and 0.022) after adjusting for race, gender and histology. To include, the incidence of RIPE is notable. Whole lung V5 appeared to be the most significant independent risk factor for symptomatic RIPE.
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Affiliation(s)
- Jing Zhao
- Department of Oncology, Tongji Hospital, Tongji Medial College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Radiation Oncology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Regina M Day
- Department of Pharmacology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jian-Yue Jin
- Department of Radiation Oncology, Medical College of Georgia, Augusta University, Augusta, GA, USA.,Department of Radiation Oncology, Radiation Physics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie Quint
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Hadyn Williams
- Department of Radiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Catherine Ferguson
- Department of Radiation Oncology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Li Yan
- Department of Radiation Oncology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Maurice King
- Department of Radiation Oncology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Ahmad Albsheer
- Department of Radiation Oncology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Martha Matuszak
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Feng-Ming Spring Kong
- Department of Radiation Oncology, Medical College of Georgia, Augusta University, Augusta, GA, USA.,Department of Radiation Oncology, IU Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
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14
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Moreira LAR, Silva EN, Ribeiro ML, Martins WDA. Cardiovascular effects of radiotherapy on the patient with cancer. Rev Assoc Med Bras (1992) 2017; 62:192-6. [PMID: 27167552 DOI: 10.1590/1806-9282.62.02.192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 10/21/2014] [Indexed: 12/21/2022] Open
Abstract
The incidence of cancer (CA) has increased globally and radiotherapy (RT) is a vital component in its treatment. Cardiovascular injuries induced by RT in the treatment of thoracic and cervical CA have been causing problems in clinical practice for decades, and are among the most serious adverse effects of radiation experienced by the growing number of cancer survivors. This article presentes a review on the Lilacs, Scielo and Pubmed databases of the main cardiovascular injuries, their mechanisms, clinical presentations, treatments and prevention proposals. Injuries caused by RT include diseases of the pericardium, coronary artery disease, valvular disease, myocardial disease with systolic and diastolic dysfunction, conduction disorders, and carotid artery and great vessels disease. Thoracic and cervical irradiation increases cardiovascular morbidity and mortality. Despite the great progress in the improvement of RT techniques, totally excluding prime areas of the cardiovascular system from the irradiation field is not yet possible. Guidelines must be created for monitoring, diagnosis and treatment of patients with CA treated with RT.
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15
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16
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Hoeben A, Polak J, Van De Voorde L, Hoebers F, Grabsch HI, de Vos-Geelen J. Cervical esophageal cancer: a gap in cancer knowledge. Ann Oncol 2016; 27:1664-74. [PMID: 27117535 DOI: 10.1093/annonc/mdw183] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 04/20/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The aim of this systematic review is to provide an overview of the diagnosis, treatment options and treatment-related complications of cervical esophageal carcinoma (CEC) and to subsequently provide recommendations to improve quality of care. DESIGN Studies were identified in PubMed, EMBASE and Web of Science. A total of 107 publications fulfilled the inclusion criteria and were included. RESULTS CEC is uncommon, accounting for 2%-10% of all esophageal carcinomas. These tumors are often locally advanced at presentation and have a poor prognosis, with a 5-year overall survival of 30%. Tobacco and alcohol consumption seem to be the major risk factors for developing CEC. Surgery is usually not possible due to the very close relationship to other organs such as the larynx, trachea and thyroid gland. Therefore, the current standard of care is definitive chemoradiation (dCRT) with curative intent. Treatment regimens used to treat CEC are adapted by established regimens in lower esophageal squamous cell carcinoma and head and neck squamous cell carcinoma. However, dCRT may be accompanied by severe side-effects and complications. Several diagnostic and predictive markers have been studied, but currently, there is no other biomarker than clinical stage to determine patient management. Suggestions to improve patient outcomes are to determine the exact radiation dose needed for adequate locoregional control and to combine radiotherapy with optimal systemic therapy backbone. CONCLUSION CEC remains unchartered territory for many practising physicians and patients with CEC have a poor prognosis. To improve the outcome for CEC patients, future studies should focus on the identification of new diagnostic biomarkers or targets for radiosensitizers, amelioration of radiation schedules, optimal combination of chemotherapeutic agents and/or new therapeutic targets.
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Affiliation(s)
- A Hoeben
- Department of Internal Medicine, Division of Medical Oncology
| | - J Polak
- Department of Internal Medicine, Division of Medical Oncology
| | | | - F Hoebers
- Department of Radiation Oncology (MAASTRO Clinic)
| | - H I Grabsch
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands Department of Pathology & Tumour Biology, Leeds Institute of Cancer Studies and Pathology, University of Leeds, Leeds, UK
| | - J de Vos-Geelen
- Department of Internal Medicine, Division of Medical Oncology
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17
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Kumar R, Patel G, Kichenadasse G, Sukumaran S, Roy A, Koczwara B, Bowden JJ, Leung J, Woo T, Karapetis CS. Delayed onset of benign pleural effusion following concurrent chemoradiotherapy for inoperable non-small-cell lung cancer. Intern Med J 2015; 45:218-21. [PMID: 25650537 DOI: 10.1111/imj.12658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/25/2014] [Indexed: 11/26/2022]
Abstract
Chronic benign pleural effusion (BPE) is a rare complication of concurrent chemoradiotherapy (CRT) for inoperable stage IIIA non-small-cell lung cancer (NSCLC). This report presents three cases of BPE, the workup to differentiate this benign condition from recurrence of cancer and recommends a pleural biopsy as part of the diagnostic process. These inflammatory exudates often remain indolent, and may not require drainage or surgical intervention. In the absence of clinical, radiological and pathological evidence of recurrent disease, we recommend clinicians manage these patients expectantly, using regular clinical assessment and imaging.
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Affiliation(s)
- R Kumar
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, South Australia, Australia
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18
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Cui RT, Yu SY, Huang XS, Zhang JT, Tian CL, Dou LP, Pu CQ. Incidence and risk factors of pleural effusions in patients with POEMS syndrome. Hematol Oncol 2015; 33:80-4. [PMID: 24519469 DOI: 10.1002/hon.2135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 12/19/2013] [Accepted: 01/03/2014] [Indexed: 12/27/2022]
Abstract
Information regarding the characteristics of pleural effusions in patients with POEMS syndrome is limited. The aim of this study was to describe the incidence and risk factors of pleural effusions in patients with POEMS syndrome and characterize the pleural fluid biochemistry in those patients. A retrospective review of 96 patients with POEMS syndrome was conducted. The patients were divided into groups with and without pleural effusions. The clinical data were obtained from medical charts. Risk factors were studied with univariate and multivariate analysis. The median age at the time of diagnosis of POEMS syndrome was 45.1 years, and the median disease duration was 30.4 months. Pleural effusions were detected in 41 (42.7%) of the 96 patients. Increased serum vascular endothelial growth factor (VEGF), complement component 3 (C3), Lambda light chain, tumour necrosis factor (TNF)-α, interleukin (IL)-6 levels and low albumin as well as cardiac disease were found to be significantly correlated with pleural effusions. By multivariate logistic regression, independent risk factors for pleural effusions in POEMS syndrome were VEGF [odds ratio (OR): 2.46, 95% confidence interval (CI): 1.720-3.414, p = 0.01], TNF-α (OR: 3.64, 95% CI: 1.073-4.338, p = 0.04) and C3 (OR: 3.77, 95% CI: 1.225-3.591, p = 0.02) levels. Pleural effusions are the most common thoracic involvement findings in patients with POEMS syndrome, and all the pleural fluids are exudates. Serum VEGF, TNF-α and C3 levels are identified as important risk factors for presence of pleural effusions in POEMS syndrome.
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Affiliation(s)
- Rong-Tai Cui
- Department of Neurology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Sheng-Yuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xu-Sheng Huang
- Department of Neurology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jia-Tang Zhang
- Department of Neurology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Cheng-Lin Tian
- Department of Neurology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Li-Ping Dou
- Department of Hematology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Chuan-Qiang Pu
- Department of Neurology, Chinese PLA General Hospital, Beijing, 100853, China
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Hayashi K, Fujiwara Y, Nomura M, Kamata M, Kojima H, Kohzai M, Sumita K, Tanigawa N. Predictive factors for pericardial effusion identified by heart dose-volume histogram analysis in oesophageal cancer patients treated with chemoradiotherapy. Br J Radiol 2014; 88:20140168. [PMID: 25429644 DOI: 10.1259/bjr.20140168] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To identify predictive factors for the development of pericardial effusion (PCE) in patients with oesophageal cancer treated with chemotherapy and radiotherapy (RT). METHODS From March 2006 to November 2012, patients with oesophageal cancer treated with chemoradiotherapy (CRT) using the following criteria were evaluated: radiation dose >50 Gy; heart included in the radiation field; dose-volume histogram (DVH) data available for analysis; no previous thoracic surgery; and no PCE before treatment. The diagnosis of PCE was independently determined by two radiologists. Clinical factors, the percentage of heart volume receiving >5-60 Gy in increments of 5 Gy (V5-60, respectively), maximum heart dose and mean heart dose were analysed. RESULTS A total of 143 patients with oesophageal cancer were reviewed retrospectively. The median follow-up by CT was 15 months (range, 2.1-72.6 months) after RT. PCE developed in 55 patients (38.5%) after RT, and the median time to develop PCE was 3.5 months (range, 0.2-9.9 months). On univariate analysis, DVH parameters except for V60 were significantly associated with the development of PCE (p < 0.001). No clinical factor was significantly related to the development of PCE. Recursive partitioning analysis including all DVH parameters as variables showed a V10 cut-off value of 72.8% to be the most influential factor. CONCLUSION The present results showed that DVH parameters are strong independent predictive factors for the development of PCE in patients with oesophageal cancer treated with CRT. ADVANCES IN KNOWLEDGE A heart dosage was associated with the development of PCE with radiation and without prophylactic nodal irradiation.
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Affiliation(s)
- K Hayashi
- 1 Department of Radiology, Kansai Medical University, Hirakata, Japan
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