Effect Of Acute Radiation Injury Of Esophageal Carcinoma On Cardiac Structure And Function

Objects:The purpose of this study was to further clarify the relationship between cardiac radiation damage and radiation doses;analyze the effect of impaired cardiac function on patient survival.Methods:We Analyze data from 8,210 esophageal cancer survivors participating in the U.S.Surveillance Epidemiology and End-Result(SEER)Cancer Program.Descriptive statistics are used to report disease characteristics in the RT and non-RT groups.Determining independent risk factors for cardiac death using Cox hazard ratio regression and Kaplan-Meier method.We selected 86 patients with mid-thoracic esophageal cancer diagnosed by pathology and imaging in the Oncology Department of my hospital from January 2018 to October 2019.These patients all have radiation therapy.Validate the effects of esophageal cancer radiotherapy on cardiac function.There were 67 males and 19 females,aged 48-75 years,with an average age of 65.66 years.The patient's heart structure and function were detected by echocardiography before radiotherapy,at a dose of 40Gy,and after radiotherapy and myocardial enzymes was checked to analyze changes in blood biochemical indicators after myocardial injury.Observe 1.Changes in Left Ventricular Ejection Fraction(LVEF)and overall cardiac function measurement(Tei Index-Tei Index)before and after radiation.2.Changes in Left Atrial Diameter(LAD)before and after radiotherapy.3.Myocardial thickness before and after radiotherapy:change in Positive systolic peak longitudinal strain SL Peak G.4.Changes in myocardial enzymes.Results:1.Age(P<0.001);HR,14.297;95%CI:9.174-22.283)and radiotherapy(P<0.001;HR,1.952;95%CI:1.684-2.263)were found to be influencing factors for cardiac-related survival(CCS)Is the most important prognostic indicator.Older patients were at higher risk of dying from heart-related diseases after radiotherapy(P<0.001).2.In patients with middle esophageal and thoracic cancer(HR,1.872;95%CI:1.464-2.395;P<0.001)and lower thoracic cancer(P<0.001;95%CI:1.464-1.772;HR,1.539)without radiation With CCS advantages.There was no statistical difference between cervical esophageal cancer(P=0.273;95%CI:0.663-4.282;HR,1.685)and upper chest esophageal cancer(P=0.181;95%CI:0.853-2.318;HR,1.406).3.The ratio of preoperative and postoperative radiotherapy was approximately 4:1(1343 vs.309).Compared with the postoperative radiotherapy group,the survival rate of patients in the preoperative radiotherapy group was higher and the data were statistically significant(P<0.001;95%CI,0.37-0.62;HR,0.48).4.Cardiac ejection fraction of patients with esophageal cancer decreased after radiotherapy,and the LVEF value was statistically significant before and after radiotherapy(P<0.001);the left and right anterior and posterior diameters of radiotherapy decreased after radiotherapy,and the LAD value before and after radiotherapy was statistically significant(P<0.001).5.The value of myocardial SL Peak G increased during radiotherapy,and apAnt,basAnt,and midAnt were changed under the 2-cavity heart window,and apSept,apLat,and midLat were changed under the 4-cavity heart window(P<0.05).Conclusions:1.Cardiac-related survival is associated with radiation therapy,early diagnosis,distant metastases,black ethnicity,and older age.Histology and grade differences cannot independently predict survival.Among all the independent prognostic factors,age and radiotherapy had a greater impact.2.The incidence of cardiac-related diseases was higher after radiotherapy for the middle and lower thoracic esophageal cancer,and there was no statistically significant difference in heart-related survival rates between the upper and lower thoracic and cervical esophageal cancer.It is because the radiotherapy target area of the middle and lower chest esophageal cancer is near the heart,the heart receives a higher dose of radiation,and the radiation heart damage is more serious.3.The risk of radiation heart injury in the first year after radiotherapy is relatively high.Postoperative radiotherapy for esophageal cancer has a higher risk of heart injury than preoperative radiotherapy.This may be acceptable for younger patients,but higher risk for patients over 70 years of age.Need to prevent as much as possible to reduce the incidence of cardiac complications.4.The anteroposterior diameter of left atrium and left ventricular ejection fraction of patients with esophageal cancer after radiotherapy were decreased compared with before,and the results were statistically significant.It is suggested that the cardiac function of patients with esophageal cancer decreases after radiotherapy.5.After radiotherapy,the myocardial SL Peak G values of apAnt,basAnt,and midAnt were increased under the echocardiogram 2 cavity window,and the apSept,apLat,and midLat myocardial SL Peak G values increased under the 4-cavity cardiac window,suggesting a decrease in myocardial contractility and myocardial ischemia.6.There was no statistically significant change in myocardial enzyme spectrum after radiotherapy for esophageal cancer before radiotherapy.Myocardial enzyme spectrum is not sensitive as an index for evaluating cardiac radiation damage.