ArticleJournal of clinical oncology : official journal of the American Society of Clinical Oncology2023
Cardiac Substructure Radiation Dose and Risk of Late Cardiac Disease in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study.
Article in Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.
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Who cites it
24 citing papers in PubMed, 26 citations in OpenAlex.
- Review
- Estimation of Detailed Cardiac Doses for Pediatric Radiation Therapy Patients in National Wilms Tumor Study.International journal of radiation oncology, biology, physics · 2026Article
- Childhood cancer and future cardiometabolic health.npj metabolic health and disease · 2026Review
- Longitudinal Assessment of Cardiac Function After Craniospinal Irradiation in Pediatric Central Nervous System Tumor Survivors.JACC. Advances · 2026Article
- Association of age and primary treatment with risk of non-lymphoma-related death and long-term survival outcomes in adult patients with early-stage follicular lymphoma: a population-based analysis.Annals of hematology · 2026Article
- Heart Substructure Radiation Dose and Cardiac Outcomes: Contemporary Evidence and Actionable Opportunities: JACC CardioOncology State-of-the-Art Review.JACC. CardioOncology · 2026Review
- Consensus radiation therapy organ at risk constraints for NCTN trials in hematologic malignancies.Journal of the National Cancer Institute · 2026Article
- Recent Advances in Understanding the Mechanisms of Therapy-Related Cardiovascular Events in Pediatric Hematologic Malignancies.Reviews in cardiovascular medicine · 2026Review
- Cardiac radiosensitivity in the era of thoracic chemoradiotherapy and immunotherapy: a scoping review.The Lancet. Oncology · 2026Article
- Comparison of heart-sparing radiation techniques for left-sided breast cancer: DIBH combined with tangential 3D radiation vs. conventional and tangential VMAT techniques.Radiation oncology (London, England) · 2026Article
- Radiation-associated bioprosthetic valve dysfunction: an initial case-control analysis.Frontiers in cardiovascular medicine · 2026Article
- Radiation-Induced Valvular Heart Disease: A Narrative Review of Epidemiology, Diagnosis and Management.Journal of cardiovascular development and disease · 2025Review
- Cardiovascular and Oncologic Considerations in Adult Hodgkin Lymphoma: JACC: CardioOncology State-of the-Art Review.JACC. CardioOncology · 2025Review
- Comparison of Contemporary Radiation Therapy Approaches in Combined Modality Treatment on Pediatric High-Risk Classic Hodgkin Lymphoma Study: AHOD 1331.International journal of radiation oncology, biology, physics · 2025Article
- Colorectal-Specific Radiation Dose and Chemotherapy Risk for Subsequent Colorectal Malignancies in Childhood Cancer Survivors: A Childhood Cancer Survivor Study (CCSS) Report.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2025Article
- Polygenic risk of coronary artery disease for long-term survivors of breast cancer.Journal of the National Cancer Institute · 2025Article
- Comparison of proton and photon therapy in stereotactic arrhythmia radioablation for ventricular tachycardia.Physics and imaging in radiation oncology · 2025Article
- Cardiovascular Toxicity in Patients Treated for Childhood Cancer: A Scientific Statement From the American Heart Association.Circulation · 2025Review
- Prediction of breast cancer risk for adolescents and young adults with Hodgkin lymphoma.Journal of the National Cancer Institute · 2025Article
- CyberKnife in Pediatric Oncology: A Narrative Review of Treatment Approaches and Outcomes.Current oncology (Toronto, Ont.) · 2025Review
Corrections and comments
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Authors and funding
16 authors at 9 institutions in 2 countries.
Funding
Abstract
purposeRadiation-associated cardiac disease is a major cause of morbidity/mortality among childhood cancer survivors. Radiation dose-response relationships for cardiac substructures and cardiac diseases remain unestablished.
methodsUsing the 25,481 5-year survivors of childhood cancer treated from 1970 to 1999 in the Childhood Cancer Survivor Study, we evaluated coronary artery disease (CAD), heart failure (HF), valvular disease (VD), and arrhythmia. We reconstructed radiation doses for each survivor to the coronary arteries, chambers, valves, and whole heart. Excess relative rate (ERR) models and piecewise exponential models evaluated dose-response relationships.
resultsThe cumulative incidence 35 years from diagnosis was 3.9% (95% CI, 3.4 to 4.3) for CAD, 3.8% (95% CI, 3.4 to 4.2) for HF, 1.2% (95% CI, 1.0 to 1.5) for VD, and 1.4% (95% CI, 1.1 to 1.6) for arrhythmia. A total of 12,288 survivors (48.2%) were exposed to radiotherapy. Quadratic ERR models improved fit compared with linear ERR models for the dose-response relationship between mean whole heart and CAD, HF, and arrhythmia, suggesting a potential threshold dose; however, such departure from linearity was not observed for most cardiac substructure end point dose-response relationships. Mean doses of 5-9.9 Gy to the whole heart did not increase the risk of any cardiac diseases. Mean doses of 5-9.9 Gy to the right coronary artery (rate ratio [RR], 2.6 [95% CI, 1.6 to 4.1]) and left ventricle (RR, 2.2 [95% CI, 1.3 to 3.7]) increased risk of CAD, and to the tricuspid valve (RR, 5.5 [95% CI, 2.0 to 15.1]) and right ventricle (RR, 8.4 [95% CI, 3.7 to 19.0]) increased risk of VD.
conclusionAmong children with cancer, there may be no threshold dose below which radiation to the cardiac substructures does not increase the risk of cardiac diseases. This emphasizes their importance in modern treatment planning.
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