Radiation dose and long term risk of cardiac pathology following radiotherapy and anthracyclin for a childhood cancer.
OBJECTIVE
To determine the cardiac status in children 15 years (yrs) or more after a solid tumour treatment.


METHODS
Of the 447 patients, 229 were fully studied and 218 were not. The following cardiac evaluation was proposed to all the 447 consecutive patients: (1) cardiac Doppler US by one of two expert cardiologists; (2) cardiac rhythm and conduction abnormalities including 24-h holter ECG; (3) (131)I-mIBG myocardial scintigraphy; (4) serum brain natriuretic peptide levels at rest; (5) an exercise test with VO(2)max measurement. The radiation dose delivered to 7 points in the heart was estimated for all patients who had received radiotherapy.


RESULTS
Cardiac disorder was diagnosed in 89 evaluated patients (39%) including 24 heart failures and 65 other asymptomatic cardiac diseases. When adjusting on potential confounders, cardiac disorder and cardiac failure risks were respectively linear (ERR at 1 Gy: 26%) and linear-quadratic (ERR at 1 Gy: 19%) functions of the average radiation dose received to the heart. No interaction between cumulative dose of adriamycin and average radiation dose was evidenced for cardiac disorders, but the ERR/Gy of cardiac failure was higher for patients receiving less than 350 mg/m(2) of Adriamycin.


CONCLUSIONS
Long term heart pathologies are probably one of the major iatrogenic risks encored by patients who survived a childhood cancer. This study strongly emphasizes the need to limit the heart irradiation during radiotherapy, particularly, for patients who also received or were susceptible to later received adriamycin.
Guldner
Laurence
L
National Institute of Health and Medical Research (INSERM), Institut Gustave Roussy, Villejuif, France.
Haddy
Nadia
N
Pein
François
F
Diallo
Ibrahima
I
Shamsaldin
Akthar
A
Dahan
Michel
M
Lebidois
Jérome
J
Merlet
Pascal
P
Villain
Elisabeth
E
Sidi
Daniel
D
Sakiroglu
Olivia
O
Hartmann
Olivier
O
Leftakopoulos
Dimitri
D
de Vathaire
Florent
F
D000293:Adolescent; D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D019583:Dose Fractionation, Radiation; D004317:Doxorubicin / Q000009:adverse effects*; D004812:Epidemiologic Methods; D005260:Female; D006321:Heart / Q000187:drug effects / Q000528:radiation effects; D006331:Heart Diseases / Q000139:chemically induced / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D011829:Radiation Dosage; D011832:Radiation Injuries / Q000150:complications; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects
D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin