title: Radiation dose and long term risk of cardiac pathology following radiotherapy and anthracyclin for a childhood cancer.
abstract: 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.
authors.affiliation: National Institute of Health and Medical Research (INSERM), Institut Gustave Roussy, Villejuif, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Guldner
authors.forename: Nadia
authors.initials: N
authors.lastname: Haddy
authors.forename: François
authors.initials: F
authors.lastname: Pein
authors.forename: Ibrahima
authors.initials: I
authors.lastname: Diallo
authors.forename: Akthar
authors.initials: A
authors.lastname: Shamsaldin
authors.forename: Michel
authors.initials: M
authors.lastname: Dahan
authors.forename: Jérome
authors.initials: J
authors.lastname: Lebidois
authors.forename: Pascal
authors.initials: P
authors.lastname: Merlet
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Villain
authors.forename: Daniel
authors.initials: D
authors.lastname: Sidi
authors.forename: Olivia
authors.initials: O
authors.lastname: Sakiroglu
authors.forename: Olivier
authors.initials: O
authors.lastname: Hartmann
authors.forename: Dimitri
authors.initials: D
authors.lastname: Leftakopoulos
authors.forename: Florent
authors.initials: F
authors.lastname: de Vathaire
mesh_terms: 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
chemical_list: D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin