PV QA 1 - Poster Viewing Q&A 1
Purpose/Objective(s):The purpose of this study was to evaluate the relation between the cardiovascular complications after definitive chemoradiotherapy (CRT) for esophageal cancer and dose volume histogram (DVH) of organs at risk (OAR) using biological equivalent dose (BED).
Materials/Methods:We analyzed the data of patients with esophageal cancer treated by definitive CRT between January 2001 and December 2015. Selection criteria were clinical T1-2N0M0, and observation period of at least one year. Exclusion criteria were patients with history of thoracic irradiation, and patients receiving postoperative irradiation, palliative irradiation, irradiation alone, and salvage operation after CRT. In this study, we analyzed pericardial effusion and pleural effusion as the cardiovascular complications. We contoured heart, pericardium, lung, pleura as OARs based on RTOG atlas. We created dose distribution of each plan converted of DVH to DVH using BED (bDVH). We prescribed that alpha / beta ratio of heart, pericardium, lung, pleura was 3 Gy. Toxicity was evaluated by CTCAE v4.0. We analyzed bDVH of each OAR from V10 to V100 and investigated a significant difference in the incidence of cardiovascular complications.
Results:We analyzed data of 69 patients. Median total irradiation dose was 60 Gy (50.4–70 Gy). Pericardial effusion (≧ G2) was observed in 45 patients (65%). Symptomatic pericardial effusion (≧ G3) was observed in 5 patients (7%). Symptomatic pleural effusion (≧ G2) was observed in 8 patients (11%). In the pericardial effusion (≧ G2), there was no significant difference in bDVH of heart. In the symptomatic pericardial effusion, there were significant differences in V10 - V90 of heart. The most significant difference was observed in V50 (p=0.022). In the pericardial effusion (≧ G2), there was significant difference in only V10 of pericardia. In the symptomatic pericardial effusion, there were significant differences in V10 - V90 except for V50 - 60 of pericardia. The most significant difference was observed in V10 (p=0.024). In the symptomatic pleural effusion (≧ G2), there were significant differences in V70 - 100 of lung and pleura respectively. The most significant difference was observed in V80 (p=0.006) of lung and V70 (p=0.005) of pleura.
Conclusion:We showed the relation of the irradiated dose of the OARs to the cardiovascular complication using bDVH. It was suggested that the medium dose irradiated volumes of the heart and the low dose irradiated volumes of pericardium was related to the symptomatic pericardial effusion and that high dose irradiated volumes of the lung and pleura were related to the symptomatic pleural effusion.
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