Imaging and Blood-Based Biomarkers for the Evaluation of Early Signs of Myocardial Injury After Thoracic Radiation Therapy

Inclusion Criteria:

• Patients who have been evaluated by a radiation oncologist and have been felt to besuitable to undergo thoracic RT for histologically confirmed NSCLC with a dose rangeof 60-70 Gy at 1.8-2 Gy per fraction OR histologically confirmed clinical stageI-IVA (AJCC 8th ed) middle or thoracic esophageal or gastroesophageal cancer (squamous cell carcinoma or adenocarcinoma) with a planned dose range of 41.4-60 Gyat 1.8-2 Gy per fraction as part of treatment of their malignancy

• Concurrent chemotherapy is permitted

• For NSCLC patients, both concurrent and/or adjuvant immunotherapy is permitted

• Patients participating in other research studies are eligible as long asparticipation in this study does not interfere with activities required in the otherstudies

• Patients with no contra-indications to magnetic resonance (MR) or PET imaging asstated in the section exclusion criteria

• For the delayed enhancement and the T1 contrast mapping portions of the study, thepatient must have an adequate baseline renal function defined as an estimatedglomerular filtration rate (eGFR) > 30 ml/min per the Ohio State InstitutionalGuidelines. Of note, if the patient's eGFR is =< 30 ml/min, the patient would stillbe eligible for enrollment, but only the strain-encoded (SENC) imaging and T2mapping non-contrast sequences would be obtained. The dynamic contrast-enhanced (DCE) and T1 mapping sequences, which require intravenous (IV) contrast, would notbe included

• Patients with moderate to end-stage renal disease, or who are at high-risk ofnephrogenic systemic fibrosis (e.g. hepatorenal syndrome, liver transplant, acuterenal failure, chronic kidney disease, and iron overload conditions) would still beeligible for enrollment, but only the non-contrast SENC and T2 mapping imagingsequences would be obtained. The DCE and T1 mapping sequences, which require IVcontrast, would not be included

• Age >= 18 years old

• Within 4 weeks of study entry: patients must have vital signs, history/physicalexamination, and kidney function test (eGFR)

• Ability to provide written informed consent obtained prior to participation in thestudy and any study specific procedures being performed

• Women of child-bearing potential (WOCBP) must have a negative pregnancy test within 14 days of the study entry. Urine human chorionic gonadotropin (HCG) is anacceptable pregnancy assessment

Exclusion Criteria:

• Subjects who are breast-feeding, or have a positive pregnancy test will be excludedfrom the study. Should a woman become pregnant or suspect she is pregnant whileparticipating in this study, she should inform her treating physician immediately

• Medical contraindications to MR imaging (e.g. pacemakers, metallic implants,aneurysm clips, known contrast allergy to Gadolinium contrast, pregnancy, nursingmothers, weight greater than 350 pounds)

• Subjects with advanced renal disease (eGFR < 45 mL/min/1.72m^2) - exclusion fromreceipt of contrast, but may still be enrolled for basic CMR imaging (leftventricular ejection [LVEF], strain, T2, etc)

• Medical contraindications to PET imaging (e.g. pregnancy, nursing mothers, weightgreater than 420 pounds - scanner limit)

• Any serious and/or unstable pre-existing medical disorder (aside from malignancyexception above), psychiatric disorder, or other condition that could preventcompliance with study procedures or providing informed consent

• Subjects who are prisoners