Coronary heart disease after radiotherapy for peptic ulcer disease.
OBJECTIVE
To evaluate the risk of coronary heart disease (CHD) and cerebrovascular disease after radiotherapy (RT) for peptic ulcer disease.


METHODS
Peptic ulcer disease patients treated with RT (n = 1859) or by other means (n = 1860) at the University of Chicago Medical Center between 1936 and 1965, were followed through 1997. The observed numbers of cause-specific deaths were compared with the expected numbers from the general population rates. During RT, 5% of the heart was in the treatment field and the remainder of the heart mostly received scattered radiation. A volume-weighted cardiac dose was computed to describe the average tissue dose to the entire organ. We used Cox proportional hazards regression analysis to analyze the CHD and cerebrovascular disease risk associated with RT, adjusting for confounding factors.


RESULTS
Greater than expected CHD mortality was observed among the irradiated patients. The irradiated patients received volume-weighted cardiac doses ranging from 1.6 to 3.9 Gy and the portion of the heart directly in the field received doses of 7.6-18.4 Gy. The CHD risk increased with the cardiac dose (p trend = 0.01). The cerebrovascular disease risk was not associated with the surrogate carotid dose.


CONCLUSIONS
The excess CHD risk in patients undergoing RT for peptic ulcer disease decades previously indicates the need for long-term follow-up for cardiovascular disease after chest RT.
Carr
Zhanat A
ZA
Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH/DHHS, 6120 Executive Boulevard, EPS 7038, Rockville, MD 20852, USA.
Land
Charles E
CE
Kleinerman
Ruth A
RA
Weinstock
Robert W
RW
Stovall
Marilyn
M
Griem
Melvin L
ML
Mabuchi
Kiyohiko
K
D000328:Adult; D002423:Cause of Death; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D003327:Coronary Disease / Q000209:etiology* / Q000401:mortality; D005260:Female; D006321:Heart / Q000528:radiation effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000150:complications*; D011879:Radiotherapy Dosage; D012044:Regression Analysis; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D020521:Stroke / Q000209:etiology* / Q000401:mortality