title: Cardiovascular morbidity after radiotherapy or chemoradiation in patients with cervical cancer.
abstract: OBJECTIVE
  To evaluate the risk of cardiovascular events (CVE) in patients with cervical cancer treated with radiotherapy or chemoradiation.
  
  
  METHODS
  The incidence of CVE in patients treated between 1989 and 2002 by radiotherapy or chemoradiation was compared with a Dutch reference population. Standardized incidence ratios (SIRs) were calculated for myocardial infarction (MI), angina pectoris (AP), congestive heart failure (CHF), cerebrovascular accident (CVA) separately and for any cardiac event combined (MI, AP, and CHF).
  
  
  RESULTS
  In 277 patients with a median follow-up of 4.5 years (range, 0.1-17 years) and a median survival of 9.2 years, 27 cardiac events occurred. The 5-, 10-, and 15-year actuarial incidence of any cardiac event were 9, 14, and 16%, respectively. For the whole population, the SIR for MI was elevated (2.05, 95% CI: 1.12-3.43). The radiotherapy group (n = 132) was older and had more cardiovascular risk factors than the chemoradiation group (n = 145). The SIR for MI in the radiotherapy group was 2.88 (95% CI: 1.44-5.15) and in the chemoradiation group 1.00 (95% CI: 0.21-7.47). In multivariate analyses, there was no relation between treatment modality and the risk for MI.
  
  
  CONCLUSIONS
  In this cohort of cervical cancer patients, an increased risk for developing a MI was observed. This increased risk of MI, in combination with the high prevalence of cardiovascular risk factors in cervical cancer patients, urges the need to explore strategies to reduce their risk for cardiovascular morbidity.
authors.affiliation: Department of Radiation Oncology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: John H
authors.initials: JH
authors.lastname: Maduro
authors.forename: Helena A
authors.initials: HA
authors.lastname: den Dekker
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Pras
authors.forename: Elisabeth G
authors.initials: EG
authors.lastname: de Vries
authors.forename: Ate G
authors.initials: AG
authors.lastname: van der Zee
authors.forename: Willem J
authors.initials: WJ
authors.lastname: Klokman
authors.forename: Anna K
authors.initials: AK
authors.lastname: Reyners
authors.forename: Flora E
authors.initials: FE
authors.lastname: van Leeuwen
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Langendijk
authors.forename: Geertruida H
authors.initials: GH
authors.lastname: de Bock
authors.forename: Jourik A
authors.initials: JA
authors.lastname: Gietema
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D055815:Young Adult