Identification of Chemo and Radiation Induced Systolic and Diastolic Myocardial Dysfunction in Patients With Cancer in Oesophagus and Gastroesophagael Junction - a Prospective Study

Background:

Patients with cancer in the esophagus and gastroesophageal junction (EGEJ) treated with chemoradiotherapy (chemoRT) have increased risk of cardiovascular disease. Both chemotherapy and radiotherapy have been reported to be associated with increased cardiovascular morbidity. Still, there is a survival benefit due to multimodal treatment and a careful patient selection. Radiation induced heart disease (RIHD) may include pericarditis, systolic and diastolic myocardial dysfunction, coronary heart disease, valvular heart disease and conduction abnormalities. Standard treatment of locally advanced EGEJ cancer today consists of neoadjuvant chemoRT followed by surgery or chemoRT alone. Elderly patients with frailty and pre-existing cardiovascular disease are in general not offered surgery but might be candidates for treatment with chemoRT alone, still with curative intent. However, the current understanding of RIHD in EGEJ patients is limited as data are sparse. In Sweden a single study has shown that chemoRT might potentially induce acute impairment of both systolic and especially diastolic left ventricular function. The lack of more substantial evidence leaves room for variation in clinical practice. Hence, there is a need for additional studies to provide more insights into the risk of RIHD, in particular on myocardial function during and after chemoRT as congestive heart failure is a serious complication associated with increased morbidity and mortality. Proton-based radiation therapy (RT) is a new alternative to standard photon-based radiation therapy, which reduces the radiation dose to the heart and subsequent risks of cardiovascular complications. However, the availability of proton therapy is still relatively limited for the general EGEJ population, and the indication for proton based RT is not yet evidence based. It is crucial to evaluate risk of heart failure during and after standard chemoRT and to identify potential high-risk patients who might benefit from proton therapy instead of the current standard therapy.

Hypothesis:

Treatment with chemoRT might induce myocardial dysfunction, symptoms of heart failure and decreased physical performance in patients with EGEJ Cancer.

The aim is: