Risk stratification of postoperative cardiopulmonary toxicity after trimodality therapy for esophageal cancer
Purpose/objectivePostoperative toxicity for esophageal cancer impacts patient quality of life and potentially overall survival (OS). We studied whether patient and toxicity parameters post-chemoradiation therapy predict for post-surgical cardiopulmonary total toxicity burden (CPTTB) and whether CPTT...
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-02-01
|
| Series: | Frontiers in Oncology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1081024/full |
| _version_ | 1811168138404823040 |
|---|---|
| author | Roman O. Kowalchuk Grant M. Spears Lindsay K. Morris Dawn Owen Harry H. Yoon Krishan Jethwa Michael D. Chuong Matthew J. Ferris Michael G. Haddock Christopher L. Hallemeier Dennis Wigle Steven H. Lin Kenneth W. Merrell |
| author_facet | Roman O. Kowalchuk Grant M. Spears Lindsay K. Morris Dawn Owen Harry H. Yoon Krishan Jethwa Michael D. Chuong Matthew J. Ferris Michael G. Haddock Christopher L. Hallemeier Dennis Wigle Steven H. Lin Kenneth W. Merrell |
| author_sort | Roman O. Kowalchuk |
| collection | DOAJ |
| description | Purpose/objectivePostoperative toxicity for esophageal cancer impacts patient quality of life and potentially overall survival (OS). We studied whether patient and toxicity parameters post-chemoradiation therapy predict for post-surgical cardiopulmonary total toxicity burden (CPTTB) and whether CPTTB was associated with short and long-term outcomes.Materials/methodsPatients had biopsy-proven esophageal cancer treated with neoadjuvant chemoradiation and esophagectomy. CPTTB was derived from total perioperative toxicity burden (Lin et al. JCO 2020). To develop a CPTTB risk score predictive for major CPTTB, recursive partitioning analysis was used.ResultsFrom 3 institutions, 571 patients were included. Patients were treated with 3D (37%), IMRT (44%), and proton therapy (19%). 61 patients had major CPTTB (score ≥ 70). Increasing CPTTB was predictive of decreased OS (p<0.001), lengthier post-esophagectomy length of stay (LOS, p<0.001), and death or readmission within 60 days of surgery (DR60, p<0.001). Major CPTTB was also predictive of decreased OS (hazard ratio = 1.70, 95% confidence interval: 1.17-2.47, p=0.005). The RPA-based risk score included: age ≥ 65, grade ≥ 2 nausea or esophagitis attributed to chemoradiation, and grade ≥ 3 hematologic toxicity attributed to chemoradiation. Patients treated with 3D radiotherapy had inferior OS (p=0.010) and increased major CPTTB (18.5% vs. 6.1%, p<0.001).ConclusionCPTTB predicts for OS, LOS, and DR60. Patients with 3D radiotherapy or age ≥ 65 years and chemoradiation toxicity are at highest risk for major CPTTB, predicting for higher short and long-term morbidity and mortality. Strategies to optimize medical management and reduce toxicity from chemoradiation should be strongly considered. |
| first_indexed | 2024-04-10T16:22:08Z |
| format | Article |
| id | doaj.art-23f2d6302263427d9034c7e70803efb9 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-10T16:22:08Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-23f2d6302263427d9034c7e70803efb92023-02-09T11:59:28ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-02-011310.3389/fonc.2023.10810241081024Risk stratification of postoperative cardiopulmonary toxicity after trimodality therapy for esophageal cancerRoman O. Kowalchuk0Grant M. Spears1Lindsay K. Morris2Dawn Owen3Harry H. Yoon4Krishan Jethwa5Michael D. Chuong6Matthew J. Ferris7Michael G. Haddock8Christopher L. Hallemeier9Dennis Wigle10Steven H. Lin11Kenneth W. Merrell12Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United StatesDepartment of Statistics, Mayo Clinic, Rochester, MN, United StatesDepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, United StatesDepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, United StatesDepartment of Medical Oncology, Mayo Clinic, Rochester, MN, United StatesDepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, United StatesDepartment of Radiation Oncology, Miami Cancer Institute, Miami, FL, United StatesDepartment of Radiation Oncology, University of Maryland Medical System, Baltimore, MD, United StatesDepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, United StatesDepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, United StatesDepartment of Thoracic Surgery, Mayo Clinic, Rochester, MN, United StatesDepartment of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, United StatesDepartment of Radiation Oncology, Mayo Clinic, Rochester, MN, United StatesPurpose/objectivePostoperative toxicity for esophageal cancer impacts patient quality of life and potentially overall survival (OS). We studied whether patient and toxicity parameters post-chemoradiation therapy predict for post-surgical cardiopulmonary total toxicity burden (CPTTB) and whether CPTTB was associated with short and long-term outcomes.Materials/methodsPatients had biopsy-proven esophageal cancer treated with neoadjuvant chemoradiation and esophagectomy. CPTTB was derived from total perioperative toxicity burden (Lin et al. JCO 2020). To develop a CPTTB risk score predictive for major CPTTB, recursive partitioning analysis was used.ResultsFrom 3 institutions, 571 patients were included. Patients were treated with 3D (37%), IMRT (44%), and proton therapy (19%). 61 patients had major CPTTB (score ≥ 70). Increasing CPTTB was predictive of decreased OS (p<0.001), lengthier post-esophagectomy length of stay (LOS, p<0.001), and death or readmission within 60 days of surgery (DR60, p<0.001). Major CPTTB was also predictive of decreased OS (hazard ratio = 1.70, 95% confidence interval: 1.17-2.47, p=0.005). The RPA-based risk score included: age ≥ 65, grade ≥ 2 nausea or esophagitis attributed to chemoradiation, and grade ≥ 3 hematologic toxicity attributed to chemoradiation. Patients treated with 3D radiotherapy had inferior OS (p=0.010) and increased major CPTTB (18.5% vs. 6.1%, p<0.001).ConclusionCPTTB predicts for OS, LOS, and DR60. Patients with 3D radiotherapy or age ≥ 65 years and chemoradiation toxicity are at highest risk for major CPTTB, predicting for higher short and long-term morbidity and mortality. Strategies to optimize medical management and reduce toxicity from chemoradiation should be strongly considered.https://www.frontiersin.org/articles/10.3389/fonc.2023.1081024/fulltrimodality therapycardiac toxicityradiotherapy toxicitymodelingoutcomesesophagus |
| spellingShingle | Roman O. Kowalchuk Grant M. Spears Lindsay K. Morris Dawn Owen Harry H. Yoon Krishan Jethwa Michael D. Chuong Matthew J. Ferris Michael G. Haddock Christopher L. Hallemeier Dennis Wigle Steven H. Lin Kenneth W. Merrell Risk stratification of postoperative cardiopulmonary toxicity after trimodality therapy for esophageal cancer Frontiers in Oncology trimodality therapy cardiac toxicity radiotherapy toxicity modeling outcomes esophagus |
| title | Risk stratification of postoperative cardiopulmonary toxicity after trimodality therapy for esophageal cancer |
| title_full | Risk stratification of postoperative cardiopulmonary toxicity after trimodality therapy for esophageal cancer |
| title_fullStr | Risk stratification of postoperative cardiopulmonary toxicity after trimodality therapy for esophageal cancer |
| title_full_unstemmed | Risk stratification of postoperative cardiopulmonary toxicity after trimodality therapy for esophageal cancer |
| title_short | Risk stratification of postoperative cardiopulmonary toxicity after trimodality therapy for esophageal cancer |
| title_sort | risk stratification of postoperative cardiopulmonary toxicity after trimodality therapy for esophageal cancer |
| topic | trimodality therapy cardiac toxicity radiotherapy toxicity modeling outcomes esophagus |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1081024/full |
| work_keys_str_mv | AT romanokowalchuk riskstratificationofpostoperativecardiopulmonarytoxicityaftertrimodalitytherapyforesophagealcancer AT grantmspears riskstratificationofpostoperativecardiopulmonarytoxicityaftertrimodalitytherapyforesophagealcancer AT lindsaykmorris riskstratificationofpostoperativecardiopulmonarytoxicityaftertrimodalitytherapyforesophagealcancer AT dawnowen riskstratificationofpostoperativecardiopulmonarytoxicityaftertrimodalitytherapyforesophagealcancer AT harryhyoon riskstratificationofpostoperativecardiopulmonarytoxicityaftertrimodalitytherapyforesophagealcancer AT krishanjethwa riskstratificationofpostoperativecardiopulmonarytoxicityaftertrimodalitytherapyforesophagealcancer AT michaeldchuong riskstratificationofpostoperativecardiopulmonarytoxicityaftertrimodalitytherapyforesophagealcancer AT matthewjferris riskstratificationofpostoperativecardiopulmonarytoxicityaftertrimodalitytherapyforesophagealcancer AT michaelghaddock riskstratificationofpostoperativecardiopulmonarytoxicityaftertrimodalitytherapyforesophagealcancer AT christopherlhallemeier riskstratificationofpostoperativecardiopulmonarytoxicityaftertrimodalitytherapyforesophagealcancer AT denniswigle riskstratificationofpostoperativecardiopulmonarytoxicityaftertrimodalitytherapyforesophagealcancer AT stevenhlin riskstratificationofpostoperativecardiopulmonarytoxicityaftertrimodalitytherapyforesophagealcancer AT kennethwmerrell riskstratificationofpostoperativecardiopulmonarytoxicityaftertrimodalitytherapyforesophagealcancer |