Preoperative chemoradiation ups CV complications risk in oesophageal cancer patients

Operative oesophageal cancer patients treated with preoperative chemoradiation are at increased risk of cardiovascular (CV) complications, reports a study. However, these risks may be lessened with more cardioprotective radiation techniques such as intensity modulated radiotherapy.

The investigators identified 1,125 patients aged ≥65 years diagnosed between 2000 and 2011 with oesophageal cancer who received surgery alone, or surgery preceded by either chemotherapy or chemoradiation from the Surveillance Epidemiology and End Results (SEER)-Medicare database.

Medicare claims were used to identify severe perioperative and late CV events. Finally, the effect of presurgery treatment on the risk of perioperative and late CV disease was determined using multivariable logistic regression and Fine-Gray models.

Preoperative chemotherapy or chemoradiation did not significantly elevate the risk of perioperative CV complications relative to surgery alone. However, a 36-percent higher risk of having a late CV event was noted in patients treated with preoperative chemoradiation compared with those treated with surgery alone (subdistribution hazard ratio [SDHR], 1.36; p=0.035).

No significant increase in late CV events was seen in patients treated with preoperative chemotherapy (SDHR, 1.18; p=0.40). Among patients treated with preoperative chemoradiation, those who received intensity modulated radiotherapy had a reduced risk of developing a late CV event than those receiving conventional radiation (SDHR, 0.32; p=0.007).

“Preoperative radiotherapy improves outcomes for operable oesophageal cancer patients, though the proximity of the heart to the oesophagus puts patients at risk of radiation-induced CV disease,” the investigators said.