ArticleInternational journal of radiation oncology, biology, physics2024
Incident Atrial Fibrillation and Survival Outcomes in Esophageal Cancer following Radiotherapy.
Article in International journal of radiation oncology, biology, physics, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it, 30 citations in OpenAlex.
- Associations between reported atrial fibrillation burden and cardiac substructure dosimetric variables in patients receiving thoracic radiotherapy for malignancies involving the thorax: a systematic review and meta-analysis.Frontiers in oncology · 2026Pooled it
- Heart Substructure Radiation Dose and Cardiac Outcomes: Contemporary Evidence and Actionable Opportunities: JACC CardioOncology State-of-the-Art Review.JACC. CardioOncology · 2026Review
- Cardioprotective medications and the incidence of cardiovascular events in patients treated with radiotherapy: a systematic review and meta-analysis.Cardio-oncology (London, England) · 2026Review
- Clinical outcomes of atrial tachyarrhythmia hospitalizations with and without prior thoracic irradiation.Frontiers in oncology · 2026Article
- Characteristics of cardiac toxicity after definitive radiation therapy for thoracic esophageal cancer in Japanese patients.Journal of radiation research · 2025Article
- Radiation-induced cardiac substructure damage and dose constraints: a review.Radiation oncology (London, England) · 2025Review
- Screening and Risk Analysis of Atrial Fibrillation After Radiotherapy for Breast Cancer: Protocol for the Cross-Sectional Cohort Study "Watch Your Heart (WATCH)".JMIR research protocols · 2025Article
- Causal associations between atrial fibrillation and esophageal cancer: a two-sample Mendelian randomization study.Translational cancer research · 2025Article
- Neoadjuvant Concurrent Chemoradiation and Esophagectomy for Esophageal Cancer: Outcomes With New-Onset Atrial Fibrillation.Thoracic cancer · 2025Article
- Atrial Fibrillation and Cancer-Epidemiology, Mechanisms, and Management.Journal of clinical medicine · 2024Review
- Cardiac Conduction System as an OAR in Radiation Therapy: Doses to SA/AV Nodes and Their Reduction.International journal of particle therapy · 2024Article
- Moving beyond mean heart dose: The importance of cardiac substructures in radiation therapy toxicity.Journal of medical imaging and radiation oncology · 2024Review
- Elucidating the Signal from the Noise: Mapping Cardiac Conduction Events to Cardiac Substructure Radiation Exposure.JACC. CardioOncology · 2024Article
- Predictors of Atrial Fibrillation After Thoracic Radiotherapy.JACC. CardioOncology · 2024Article
- Consequences of ionizing radiation exposure to the cardiovascular system.Nature reviews. Cardiology · 2024Review
- Radiation-associated cardiovascular disease in patients with cancer: current insights from a cardio-oncologist.Journal of radiation research · 2024Review
- Cardiac Substructure Radiation Dose and Associations With Tachyarrhythmia and Bradyarrhythmia After Lung Cancer Radiotherapy.JACC. CardioOncology · 2024Article
- Nuclear factor erythroid 2-related factor 2 promotes radioresistance by regulating glutamate-cysteine ligase modifier subunit and its unique immunoinvasive pattern.Biomolecules & biomedicine · 2024Article
- Cancer, Inflammation, and Thrombosis: Drivers of Atrial Fibrillation in Oncology Patients.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisReview
Corrections and comments
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Authors and funding
23 authors at 6 institutions in 1 country.
Funding
Abstract
purposeRadiation therapy (RT) associates with long-term cardiotoxicity. In preclinical models, RT exposure induces early cardiotoxic arrhythmias including atrial fibrillation (AF). Yet, whether this occurs in patients is unknown. METHODS AND MATERIALS: Leveraging a large cohort of consecutive patients with esophageal cancer treated with thoracic RT from 2007 to 2019, we assessed incidence and outcomes of incident AF. Secondary outcomes included major adverse cardiovascular events (MACE), defined as AF, heart failure, ventricular arrhythmias, and sudden death, by cardiac RT dose. We also assessed the relationship between AF development and progression-free and overall survival. Observed incident AF rates were compared with Framingham predicted rates, and absolute excess risks were estimated. Multivariate regression was used to define the relationship between clinical and RT measures, and outcomes. Differences in outcomes, by AF status, were also evaluated via 30-day landmark analysis. Furthermore, we assessed the effect of cardiac substructure RT dose (eg, left atrium, LA) on the risk of post RT-related outcomes.
resultsOverall, from 238 RT treated patients with esophageal cancer, 21.4% developed incident AF, and 33% developed MACE with the majority (84%) of events occurring ≤2 years of RT initiation (median time to AF, 4.1 months). Cumulative incidence of AF and MACE at 1 year was 19.5%, and 25.7%, respectively; translating into an observed incident AF rate of 824 per 10,000 person-years, compared with the Framingham predicted rate of 92 (relative risk, 8.96; P < .001, absolute excess risk 732). Increasing LA dose strongly associated with incident AF (P = .001); and those with AF saw worse disease progression (hazard ratio, 1.54; P = .03). In multivariate models, outside of traditional cancer-related factors, increasing RT dose to the LA remained associated with worse overall survival.
conclusionsAmong patients with esophageal cancer, radiation therapy increases AF risk, and associates with worse long-term outcomes.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.