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Cardiac dysfunction following spinal irradiation during childhood
R I Jakacki1, J W Goldwein, R L Larsen
1Division of Oncology and Cardiology, Children's Hospital of Philadelphia, PA 19104.
Summary
Pediatric patients receiving spinal irradiation for CNS malignancies show increased cardiac dysfunction, including lower maximal cardiac index and higher posterior wall stress. This suggests spinal irradiation poses a significant risk to the heart in young cancer survivors.
Area of Science:
- Cardiology
- Pediatric Oncology
- Radiation Oncology
Background:
- Spinal irradiation for central nervous system (CNS) malignancies can encompass the heart within the radiation field.
- Cardiac effects following spinal irradiation have not been previously documented.
Purpose of the Study:
- To investigate potential cardiac dysfunction in pediatric patients treated with spinal irradiation.
- To compare cardiac outcomes in patients treated with spinal irradiation versus mediastinal/flank irradiation.
Main Methods:
- Retrospective comparison of pediatric patients treated with spinal irradiation (n=26) versus mediastinal/flank irradiation (n=47).
- All patients were evaluated at least 1 year post-radiation therapy.
- Cardiac evaluations included ECG, 24-hour ambulatory ECG, echocardiogram, and exercise testing.
Main Results:
- Patients receiving spinal irradiation showed a significantly lower maximal cardiac index (75% vs 32%, P = .007) on exercise testing.
- Spinal irradiation was associated with significantly higher left ventricular posterior wall stress (P = .002).
- Pathologic Q-waves were more frequent in the spinal irradiation group (31% vs 6.4%, P = .001).
Conclusions:
- Spinal irradiation for pediatric malignancies is linked to significant cardiac dysfunction.
- Asymmetric radiation to a developing heart may underlie these observed cardiac effects.