Cardiac remodeling after anthracycline and radiotherapy exposure in adult survivors of childhood cancer: A report from the St Jude Lifetime Cohort Study.

Authors

• John L Jefferies
• Wojciech M Mazur
• Carrie R Howell
• Juan C Plana
• Kirsten K Ness
• Zhenghong Li
• Vijaya M Joshi
• Daniel M Green
• Daniel A Mulrooney
• Jeffrey A Towbin
• Hugo R Martinez
• Jason F Goldberg
• Rebecca M Howell
• Deo Kumar Srivastava
• Leslie L Robison
• Melissa M Hudson
• Gregory T Armstrong

Publication/Presentation Date

12-15-2021

Abstract

BACKGROUND: Limited data exist regarding left ventricular remodeling patterns observed in adult survivors of childhood cancer after therapy.

METHODS: Among 1190 adult survivors diagnosed with childhood cancer (median age at diagnosis, 9 years [interquartile range (IQR), 3.8-14.4 years]; age at evaluation, 35.6 years [IQR, 29.5-42.8 years]), treatment exposures included anthracyclines (n = 346), chest radiotherapy (n = 174), both (n = 245), or neither (n = 425). Prospective echocardiographic assessment compared survivors with 449 noncancer controls classified according to left ventricle geometric patterns. Associations between left ventricle geometric patterns and decreased exercise tolerance were assessed.

RESULTS: Overall, 28.2% of survivors (95% confidence interval [CI], 25.6%-30.8%) exhibited concentric remodeling, 2.4% (95% CI, 1.6%-3.5%) exhibited eccentric hypertrophy, and 1.1% (95% CI, 0.6%-1.9%) exhibited concentric hypertrophy. A greater proportion of survivors who received only chest radiotherapy (41%) had concentric remodeling compared with those who received only anthracyclines (24%), both (27%), or neither (27%; all P < .001), and all were greater than the proportions in noncancer controls (18%; all P < .05). Concentric remodeling was associated with radiation exposure, but not with anthracycline exposure, in multivariable models. Survivors who had concentric remodeling were more likely to have a maximal oxygen uptake peak < 85% compared with those who had normal geometry (81.0% vs 66.3%; odds ratio, 1.75; 95% CI, 1.15-2.68).

CONCLUSIONS: Chest radiation therapy, but not anthracycline therapy, increased the risk for concentric remodeling in survivors of childhood cancer. The presence of concentric remodeling was associated with increased exercise intolerance.

Volume

127

Issue

24

First Page

4646

Last Page

4655

ISSN

1097-0142

Published In/Presented At

Jefferies, J. L., Mazur, W. M., Howell, C. R., Plana, J. C., Ness, K. K., Li, Z., Joshi, V. M., Green, D. M., Mulrooney, D. A., Towbin, J. A., Martinez, H. R., Goldberg, J. F., Howell, R. M., Srivastava, D. K., Robison, L. L., Hudson, M. M., & Armstrong, G. T. (2021). Cardiac remodeling after anthracycline and radiotherapy exposure in adult survivors of childhood cancer: A report from the St Jude Lifetime Cohort Study. Cancer, 127(24), 4646–4655. https://doi.org/10.1002/cncr.33860

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

34411296

Department(s)

Administration and Leadership

Document Type

Article