The role of irradiated heart and left ventricular volumes in heart failure occurrence after childhood cancer.
Adult
Anthracyclines
/ adverse effects
Cardiac Volume
/ drug effects
Cardiotoxicity
/ etiology
Case-Control Studies
Child
Child, Preschool
Dose-Response Relationship, Radiation
Female
Heart
/ drug effects
Heart Failure
/ chemically induced
Heart Ventricles
/ drug effects
Humans
Male
Neoplasms
/ radiotherapy
Radiation Dosage
Radiotherapy
/ adverse effects
Dose response
Heart failure
Heart radiation dose
Left ventricle
Volume histograms
Journal
European journal of heart failure
ISSN: 1879-0844
Titre abrégé: Eur J Heart Fail
Pays: England
ID NLM: 100887595
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
received:
21
02
2018
revised:
01
10
2018
accepted:
06
11
2018
pubmed:
29
12
2018
medline:
25
8
2020
entrez:
29
12
2018
Statut:
ppublish
Résumé
Paediatric cancer survivors have a high risk of developing cardiac diseases, and the most frequent cardiac disease is heart failure (HF). The radiation dose-volume effects in the heart and cardiac substructures have not been explored in childhood cancer survivors (CCS). Therefore, the role of irradiated heart volume in the occurrence of HF among this population remains unclear. The aims of this study were to determine the doses and irradiated volumes of the heart and left ventricle (LV) related to the risk of HF in CCS and to investigate the impact of anthracycline exposure on this risk. A case-control study nested in the French Childhood Cancer Survivors Study cohort. The mean heart and left ventricular doses and volumes indicators were estimated by reconstruction of individual treatments. A total of 239 HF cases and 1042 matched controls were included. The median age of HF diagnosis was 25.1 years. The median volume of the heart that received ≥ 30 Gy was 61.1% for cases and 16.9% for controls. In patients who did not receive anthracycline, the risk of HF was increased 3.6-fold when less than 10% of the LV received ≥ 30 Gy when compared to patients who were not exposed to any cardiac radiation and anthracycline. Small irradiated volumes of the heart or LV were significantly associated with HF risk. To the author's knowledge, this is the first study to report a dose-response relationship based on dose-volume indicators in CCS, which can be translated efficiently into current clinical practice.
Sections du résumé
BACKGROUND
Paediatric cancer survivors have a high risk of developing cardiac diseases, and the most frequent cardiac disease is heart failure (HF). The radiation dose-volume effects in the heart and cardiac substructures have not been explored in childhood cancer survivors (CCS). Therefore, the role of irradiated heart volume in the occurrence of HF among this population remains unclear. The aims of this study were to determine the doses and irradiated volumes of the heart and left ventricle (LV) related to the risk of HF in CCS and to investigate the impact of anthracycline exposure on this risk.
METHODS AND RESULTS
A case-control study nested in the French Childhood Cancer Survivors Study cohort. The mean heart and left ventricular doses and volumes indicators were estimated by reconstruction of individual treatments. A total of 239 HF cases and 1042 matched controls were included. The median age of HF diagnosis was 25.1 years. The median volume of the heart that received ≥ 30 Gy was 61.1% for cases and 16.9% for controls. In patients who did not receive anthracycline, the risk of HF was increased 3.6-fold when less than 10% of the LV received ≥ 30 Gy when compared to patients who were not exposed to any cardiac radiation and anthracycline.
CONCLUSIONS
Small irradiated volumes of the heart or LV were significantly associated with HF risk. To the author's knowledge, this is the first study to report a dose-response relationship based on dose-volume indicators in CCS, which can be translated efficiently into current clinical practice.
Substances chimiques
Anthracyclines
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
509-518Subventions
Organisme : Electricité de France (EDF)
Pays : International
Organisme : Pfizer Foundation for childhood and adolescent health
Pays : International
Organisme : Ligue Nationale Contre le Cancer (LNCC)
Pays : International
Organisme : Institut de Recherche en Santé Publique (IRESP)
Pays : International
Organisme : Programme Hospitalier de Recherche Clinique (PHRC)
Pays : International
Organisme : Agence Française de Sécurité Sanitaire et Produit de Santé (AFSSAPS)
Pays : International
Organisme : French Agence Nationale Pour la Recherche Scientifique (Hope-Epi Project)
Pays : International
Informations de copyright
© 2018 The Authors. European Journal of Heart Failure © 2018 European Society of Cardiology.