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Title: Valvular Abnormalities Detected by Echocardiography in 5-Year Survivors of Childhood Cancer: A Long-Term Follow-Up Study

Purpose: To determine the prevalence of valvular abnormalities after radiation therapy involving the heart region and/or treatment with anthracyclines and to identify associated risk factors in a large cohort of 5-year childhood cancer survivors (CCS). Methods and Materials: The study cohort consisted of all 626 eligible 5-year CCS diagnosed with childhood cancer in the Emma Children's Hospital/Academic Medical Center between 1966 and 1996 and treated with radiation therapy involving the heart region and/or anthracyclines. We determined the presence of valvular abnormalities according to echocardiograms. Physical radiation dose was converted into the equivalent dose in 2-Gy fractions (EQD{sub 2}). Using multivariable logistic regression analyses, we examined the associations between cancer treatment and valvular abnormalities. Results: We identified 225 mainly mild echocardiographic valvular abnormalities in 169 of 545 CCS (31%) with a cardiac assessment (median follow-up time, 14.9 years [range, 5.1-36.8 years]; median attained age 22.0 years [range, 7.0-49.7 years]). Twenty-four CCS (4.4%) had 31 moderate or higher-graded abnormalities. Most common abnormalities were tricuspid valve disorders (n=119; 21.8%) and mitral valve disorders (n=73; 13.4%). The risk of valvular abnormalities was associated with increasing radiation dose (using EQD{sub 2}) involving the heart region (odds ratio 1.33 per 10 Gy) and the presence of congenital heart disease (odds ratiomore » 3.43). We found no statistically significant evidence that anthracyclines increase the risk. Conclusions: Almost one-third of CCS treated with potentially cardiotoxic therapy had 1 or more asymptomatic, mostly mild valvular abnormalities after a median follow-up of nearly 15 years. The most important risk factors are higher EQD{sub 2} to the heart region and congenital heart disease. Studies with longer follow-up are necessary to investigate the clinical course of asymptomatic valvular abnormalities in CCS.« less
Authors:
 [1] ;  [2] ;  [3] ;  [4] ;  [5] ; ;  [6] ; ;  [3] ;  [7] ; ; ;  [6]
  1. Department of Medical Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam (Netherlands)
  2. (Netherlands)
  3. Department of Radiation Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam (Netherlands)
  4. Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Emma Children's Hospital/Academic Medical Center, Amsterdam (Netherlands)
  5. Department of Cardiology, Emma Children's Hospital/Academic Medical Center, Amsterdam (Netherlands)
  6. Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam (Netherlands)
  7. Department of Epidemiology, Netherlands Cancer Institute, Amsterdam (Netherlands)
Publication Date:
OSTI Identifier:
22423857
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 91; Journal Issue: 1; Other Information: Copyright (c) 2015 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARDIOVASCULAR DISEASES; CHILDREN; CONGENITAL DISEASES; DIAGNOSIS; DOSE EQUIVALENTS; HAZARDS; HEART; HOSPITALS; NEOPLASMS; RADIATION DOSES; RADIOTHERAPY; REGRESSION ANALYSIS; VALVES