There may be no threshold dose below which radiation to cardiac substructures does not increase the risk for later cardiac diseases in children with cancer.
Review of 25,481 patients in the Childhood Cancer Survivor Study who had no cardiac complications in the first 5 years following cancer treatment from 1970-1999; nearly half had been exposed to radiotherapy.
Radiation doses to the coronary arteries, heart chambers, heart valves, and whole heart were calculated based on radiotherapy records.Mean radiation doses of 5.0–9.9 Gy to the whole heart did not increase the risk for later cardiac disease. Mean doses of 5.0–9.9 Gy to the right coronary artery and left ventricle did increase the risk for subsequentMean doses of 5.0–9.9 Gy to the tricuspid valve and right ventricle increased the risk for later valvular disease.
Linear modeling adequately described the dose-response relationship for many cardiac substructures, suggesting there is no threshold dose necessary for cardiac damage."These findings solidify the need to consider cardiac substructure doses in [pediatric] radiation treatment planning and in survivorship care.
The work was funded by the National Cancer Institute. Investigators reported ties to Doximity, Abbott, Merck, Grail, and other companies.Send comments and news tips to
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