Radiation dose and long term risk of cardiac pathology following radiotherapy and anthracyclin for a childhood cancer

Radiother Oncol. 2006 Oct;81(1):47-56. doi: 10.1016/j.radonc.2006.08.020. Epub 2006 Sep 20.


Purpose: To determine the cardiac status in children 15 years (yrs) or more after a solid tumour treatment.

Patients and 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.

Conclusion: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Antibiotics, Antineoplastic / adverse effects*
  • Child
  • Child, Preschool
  • Dose Fractionation, Radiation
  • Doxorubicin / adverse effects*
  • Epidemiologic Methods
  • Female
  • Heart / drug effects
  • Heart / radiation effects
  • Heart Diseases / chemically induced
  • Heart Diseases / etiology*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Neoplasms / drug therapy*
  • Neoplasms / radiotherapy*
  • Radiation Dosage
  • Radiation Injuries / complications
  • Radiotherapy, Adjuvant / adverse effects


  • Antibiotics, Antineoplastic
  • Doxorubicin