Regarding the 2 latter associations, the authors noted that cardiac dose parameters and MHD were significantly lower in patients treated with PBT compared with IMRT. Furthermore, in the subgroup of patients with preexisting cardiac disease, the overall cumulative incidence rates of 2-year (30% vs 11%) and 5-year grade 3 or higher cardiac AEs (32% vs 14%) were significantly lower for those patients treated with PBT compared with IMRT (P =.018).

In addition, multivariable analysis also showed that patients with locoregional esophageal cancer with preexisting heart disease treated with RT had significantly worse OS (HR, 1.363; 95% CI, 1.013-1.834; P =.041) compared with those without preexisting heart conditions.

In commenting on these results, the study authors noted that “severe cardiac events were relatively common with early onset in patients [with esophageal cancer] after radiotherapy.”

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They further recommended that “all thoracic cancer patients should undergo appropriate screening for cardiac disease prior to starting treatment. Patients with a history of heart disease may need alternative treatment approaches, which could include non-radiation approaches or radiation technologies like PBT to reduce the risk of cardiac toxicity.”


Wang X, Palaskas NI, Yusuf SW, et al. Incidence and onset of severe cardiac events after radiotherapy for esophageal cancer. J Thorac Oncol [published June 26, 2020]. doi: 10.1016/j.jtho.2020.06.014