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Risk Factors for Heart Failure Among Pan-European Childhood Cancer Survivors: A PanCareSurFup and ProCardio Cohort
Esmée C de Baat1, Elizabeth A M Feijen1, Raoul C Reulen2
1Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
Summary
Childhood cancer survivors treated with heart radiation therapy (RT) or anthracyclines face increased heart failure (HF) risk. Even low doses of RT (≥ 5 Gy) and higher anthracycline doses (≥ 100 mg/m²) significantly elevate HF risk, impacting future treatment and surveillance.
Area of Science:
- Cardiology
- Oncology
- Pediatric Oncology
Background:
- Childhood cancer treatment can lead to long-term cardiovascular complications, including heart failure (HF).
- Understanding the specific risks associated with low-dose treatments is crucial for improving survivor care.
- Current surveillance guidelines may need refinement based on detailed risk factor analysis.
Purpose of the Study:
- To evaluate the risk and identify risk factors for heart failure (HF) in a large cohort of long-term childhood cancer survivors.
- To investigate the impact of low-dose radiation therapy and cumulative anthracycline doses on HF risk.
- To inform updated treatment protocols and surveillance strategies for childhood cancer survivors.
Main Methods:
- Analysis of a large European cohort (N = 42,361) of ≥ 5-year childhood cancer survivors diagnosed between 1940 and 2009.
- Calculation of cumulative incidence of HF by age 50.
- Nested case-control study (n = 1,000) to assess detailed treatment-related risk factors, including heart radiation therapy (RT) dose and volume, and cumulative anthracycline dose.
Main Results:
- The cumulative incidence of HF by age 50 was 2%.
- Survivors receiving a mean heart RT dose of 5 to < 15 Gy had a 5.5-fold increased risk of HF, with risk escalating linearly with dose and larger heart volumes exposed.
- A cumulative anthracycline dose of ≥ 100 mg/m² was associated with a substantially increased HF risk, showing a quadratic dose-response relationship.
Conclusions:
- Childhood cancer survivors exposed to a mean heart RT dose of ≥ 5 Gy have an elevated HF risk, particularly with larger irradiated heart volumes.
- Anthracycline doses below 100 mg/m² did not show a significantly increased HF risk.
- These findings necessitate re-evaluation of current treatment protocols and cardiomyopathy surveillance guidelines for childhood cancer survivors.
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