The relatively higher cardiac dose exposure for esophageal cancer (EC) may result in the earlier onset of cardiac diseases. This MD Anderson study analyzed 479 patients treated with either IMRT or PBT either preoperatively or definitively. This study found that G3+ cardiac events occurred in 18% of patients at a median of 7 months with a median follow-up time of 76 months.

Preexisting cardiac disease (p = 0.001) and radiation modality (IMRT vs PBT) (p = 0.027) were significantly associated with G3+ cardiac events. The mean heart dose, particularly of less than 15 Gy, was associated with reduced G3+ events. Furthermore, G3+ cardiac events were associated with worse overall survival (p = 0.041). This study suggested that optimal treatment approaches should be taken to reduce cumulative doses to the heart, especially for patients with preexisting cardiac disease.