Radiation Oncology/Toxicity/Heart

Consequences of Radiotherapy to the Heart

See also: RT toxicity from Breast

Pericardial Effusion

• MD Anderson; 2008 (2001-2003) PMID 18191334 -- "Risk factors for pericardial effusion in inoperable esophageal cancer patients treated with definitive chemoradiation therapy." (Wei X, Int J Radiat Oncol Biol Phys. 2008 Mar 1;70(3):707-14. Epub 2008 Jan 11.)
  • Retrospective. 101 patients, inoperable esophageal CA, treated with concurrent chemo-RT. RT dose 45-50.4 Gy. Pericardium defined as 0.5 cm radial expansion to cardiac contour
  • Outcome: crude rate 28%, median time-to-onset 5.3 months (1-17 months)
  • Predictors: no clinical factors; dosimetric V30 >46%, mean dose >26 Gy
  • Conclusion: High-dose RT to pericardium may increase risk of pericardial effusion

Breast cancer

• U Penn; 2007 (1977-1995) PMID 17634481 -- "Coronary artery findings after left-sided compared with right-sided radiation treatment for early-stage breast cancer." (Correa CR, J Clin Oncol. 2007 Jul 20;25(21):3031-7.)
  • Retrospective. 961 patients with Stage I-II BCA, conventional tangents. Screened with stress tests and cardiac cath
  • 10-year risk of CAD: right and left 7% (NS)
  • 12-year risk of cath abnormalities: right 8% vs. left 59% (SS); 70% in LAD territory
  • Conclusion: Left-sided RT as component of BCS causes increased risk of later coronary damage

• Duke; 2005 (1998-2001) PMID 16111592 — "The incidence and functional consequences of RT-associated cardiac perfusion defects." Marks LB et al. Int J Radiat Oncol Biol Phys. 2005 Sep 1;63(1):214-23.
  • 114 pts. Breast cancer. Pts imaged with technetium 99m sestamibi or tetrofosmin pre- and post-RT.
  • 42% incidence of perfusion defects at 24 months.

• Danish trials 82b/82c
  • 1999: PMID 10543669 — "Morbidity and mortality of ischaemic heart disease in high-risk breast-cancer patients after adjuvant postmastectomy systemic treatment with or without radiotherapy: analysis of DBCG 82b and 82c randomised trials." Hojris I et al. Lancet. 1999 Oct 23;354(9188):1425-30.
    • No increased risk of ischemic heart disease at 12 yrs.

Hodgkin Disease

• Zurich, 2007 PMID 17512861 -- "Radiotherapy and the heart." (Bramkamp M, Lancet. 2007 May 19;369(9574):1762.)
  • Case report. 47M with CAD, s/p mantle field to 40 Gy for HD in his teens

Non-Hodgkin's Lymphoma

• SEER/Colorado; 2010 (1988-2004) PMID 19515509 -- "Cardiac mortality in patients with stage I and II diffuse large B-cell lymphoma treated with and without radiation: a surveillance, epidemiology, and end-results analysis." (Pugh TJ, Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3):845-9. Epub 2009 Jun 8.)
  • SEER analysis. 15,454 patients, Stage I-II DLBCL, treated with anthracycline-based chemo, anti-CD20 antibody. RT given in 39%. Primary outcome cardiac-specific mortality (CSM). Median F/U 3 years
  • Cardiac-specific mortality: 5-year RT+ 4.3% vs RT- 5.9%; 10-years 9.0% vs 10.8%; 15-years 13.8% vs 16.1% (HR 1.3, SS)
  • Conclusion: Increased anthracycline exposure in patients treated only with chemo may result in increase in cardiac deaths

Childhood disease

• INSERM; 2010 (1942-1986) PMID 20142603 -- "Role of cancer treatment in long-term overall and cardiovascular mortality after childhood cancer." (Tukenova M, J Clin Oncol. 2010 Mar 10;28(8):1308-15. Epub 2010 Feb 8.)
  • Retrospective. 4,122 5-year survivors of childhood cancer in France and UK. Chemotherapy and RT info collected; RT heart dose estimate. Average F/U 27 years
  • Outcome: Overall standardized mortality ratio 8.3 compared to general population. Cardiac death SMR 5.0, if anthracycline >360 mg/m2 RR 4.4 (SS), if RT dose 5-15 Gy RR 12.5, if RT dose >15 Gy RR 25. Linear relationship between heart dose and risk of cardiac mortality, estimated RR 60% at 1 Gy
  • Conclusion: Relationship between RT dose to heart and long-term cardiac mortality