The role of irradiated heart and left ventricular volumes in heart failure occurrence after childhood cancer
The role of irradiated heart and left ventricular volumes in heart failure occurrence after childhood cancer
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DOI：
10.1002/ejhf.1376
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发表时间：
2019-04-01
影响因子：
18.2
通讯作者：
Haddy, Nadia
中科院分区：
文献类型：
--
作者：
Mansouri, Imene;Allodji, Rodrigue S.;Haddy, Nadia
背景小儿癌症幸存者患心脏病的风险很高，最常见的心脏病是心力衰竭（HF）。尚未在儿童癌症幸存者 (CCS) 中探讨辐射剂量体积对心脏和心脏亚结构的影响。因此，受辐射心脏体积在该人群心力衰竭发生中的作用仍不清楚。本研究的目的是确定与 CCS 心衰风险相关的心脏和左心室 (LV) 的剂量和照射体积，并调查蒽环类药物暴露对此风险的影响。方法和结果法国儿童癌症幸存者研究队列中的病例对照研究。通过重建个体治疗来估计平均心脏和左心室剂量和容量指标。总共纳入了 239 例 HF 病例和 1042 例匹配对照。心力衰竭诊断的中位年龄为 25.1 岁。接受 30 Gy 照射的心脏体积中位数为 61.1%（病例组）和 16.9%（对照组）。在未接受蒽环类药物的患者中，与未接受任何心脏辐射和蒽环类药物的患者相比，当小于 10% 的左心室接受 30 Gy 照射时，心力衰竭的风险增加 3.6 倍。 结论 心脏或左心室的小辐射体积与心力衰竭风险显着相关。据作者所知，这是第一项报告基于CCS剂量-体积指标的剂量-反应关系的研究，可以有效地转化为当前的临床实践。
BackgroundPaediatric cancer survivors have a high risk of developing cardiac diseases, and the most frequent cardiac disease is heart failure (HF). The radiation dose-volume effects in the heart and cardiac substructures have not been explored in childhood cancer survivors (CCS). Therefore, the role of irradiated heart volume in the occurrence of HF among this population remains unclear. The aims of this study were to determine the doses and irradiated volumes of the heart and left ventricle (LV) related to the risk of HF in CCS and to investigate the impact of anthracycline exposure on this risk.Methods and resultsA case-control study nested in the French Childhood Cancer Survivors Study cohort. The mean heart and left ventricular doses and volumes indicators were estimated by reconstruction of individual treatments. A total of 239 HF cases and 1042 matched controls were included. The median age of HF diagnosis was 25.1 years. The median volume of the heart that received 30 Gy was 61.1% for cases and 16.9% for controls. In patients who did not receive anthracycline, the risk of HF was increased 3.6-fold when less than 10% of the LV received 30 Gy when compared to patients who were not exposed to any cardiac radiation and anthracycline.ConclusionsSmall irradiated volumes of the heart or LV were significantly associated with HF risk. To the author's knowledge, this is the first study to report a dose-response relationship based on dose-volume indicators in CCS, which can be translated efficiently into current clinical practice.