Therapy-Related Cardiac Disease Risk in Childhood Cancer Survivors


Key Points

  • Low to moderate radiation doses to large cardiac volumes and high doses to small volumes were associated with increased risk of cardiac disease.
  • Anthracycline therapy was associated with a dose-related increase in risk. 

As reported by Bates et al in the Journal of Clinical Oncology, an analysis from the Childhood Cancer Survivor Study indicated that radiation doses in conjunction with heart volume exposed to radiation and anthracycline treatment were associated with increased risk of late-onset cardiac disease in childhood cancer survivors.

Study Details

In the study, rates of severe to fatal cardiac disease were determined among 24,214 5-year cancer survivors diagnosed between 1970 and 1999 at a median age of 7.0 years (range = 0–20.9 years). Patients had a median attained age of 27.5 years (range = 5.6–58.9 years).

Cardiac Disease Risk

The cumulative incidence of cardiac disease at 30 years from diagnosis was 4.8%. Compared with survivors without cardiac radiotherapy exposure, those with low to moderate radiotherapy doses (5.0–19.9 Gy) to large cardiac volumes (≥ 50% of heart; relative rate [RR] = 1.6, 95% confidence interval [CI] = 1.1–2.3) and those with high doses of radiotherapy (≥ 20 Gy) to small cardiac volumes (0.1%–29.9%; RR = 2.4, 95% CI = 1.4–4.2) were at increased risk of cardiac disease.

A dose-response relationship between anthracycline exposure and cardiac disease was observed, with RRs of 1.7 (95% CI = 1.1–2.5) for cumulative doses of 0.1 to < 250 mg/m2 and 2.4 (95% CI = 1.7–3.5) for cumulative doses of ≥ 250 mg/m2 compared with no anthracycline treatment.  Younger children (aged ≤ 13 years) were at increased risk of cardiac disease vs older children at both low to intermediate and high cumulative anthracycline doses.

The investigators concluded, “These observations support advances in radiation field design and delivery technology to reduce cardiac dose/volume and should guide future treatment protocols. They also inform clinical practice guidelines for post-therapy surveillance and risk-reducing strategies.”

Louis S. Constine, MD, of the University of Rochester Medical Center, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The Childhood Cancer Survivor Study is supported by National Cancer Institute grants and by the American Lebanese Syrian Associated Charities. The study authors' full disclosures can be found at

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.