TY - JOUR TI - Role of cancer treatment in long-term overall and cardiovascular mortality after childhood cancer AU - Tukenova, Markhaba AU - Guibout, Catherine AU - Oberlin, Odile AU - Doyon, Françoise AU - Mousannif, Abdeddahir AU - Haddy, Nadia AU - Guérin, Sylvie AU - Pacquement, Hélène AU - Aouba, Albertine AU - Hawkins, Mike AU - Winter, Dave AU - Bourhis, Jean AU - Lefkopoulos, Dimitri AU - Diallo, Ibrahima AU - de Vathaire, Florent T2 - Journal of clinical oncology: official journal of the American Society of Clinical Oncology AB - PURPOSE: The purpose of this study was to assess the role of treatment in long-term overall and cardiovascular mortality after childhood cancer. PATIENTS AND METHODS: We studied 4,122 5-year survivors of a childhood cancer diagnosed before 1986 in France and the United Kingdom. Information on chemotherapy was collected, and the radiation dose delivered to the heart was estimated for 2,870 patients who had received radiotherapy. RESULTS: After 86,453 person-years of follow-up (average, 27 years), 603 deaths had occurred. The overall standardized mortality ratio (SMR) was 8.3-fold higher (95% CI, 7.6-fold to 9.0-fold higher) in relation to the general populations in France and the United Kingdom. Thirty-two patients had died as a result of cardiovascular diseases (ie, 5.0-fold [95% CI, 3.3-fold to 6.7-fold] more than expected). The risk of dying as a result of cardiac diseases (n = 21) was significantly higher in individuals who had received a cumulative anthracycline dose greater than 360 mg/m(2) (relative risk [RR], 4.4; 95% CI, 1.3 to 15.3) and in individuals who received an average radiation dose that exceeded 5 Gy (RR, 12.5 and 25.1 for 5 to 14.9 Gy and > 15 Gy, respectively) to the heart. A linear relationship was found between the average dose of radiation to the heart and the risk of cardiac mortality (estimated excess [corrected] RR at 1 Gy, 60%). CONCLUSION: This study is the first, to our knowledge, to establish a relationship between the radiation dose received by the heart during radiotherapy for a childhood cancer and long-term cardiac mortality. This study also confirms a significant excess risk of cardiac mortality associated with a high cumulative dose of anthracyclines. DA - 2010/03/10/ PY - 2010 DO - 10.1200/JCO.2008.20.2267 DP - NCBI PubMed VL - 28 IS - 8 SP - 1308 EP - 1315 J2 - J. Clin. Oncol. LA - eng SN - 1527-7755 KW - Adolescent KW - Adult KW - Anthracyclines KW - Antineoplastic Agents KW - Cardiovascular Diseases KW - Child KW - Child, Preschool KW - Dose-Response Relationship, Drug KW - Dose-Response Relationship, Radiation KW - Female KW - Follow-Up Studies KW - France KW - Great Britain KW - Humans KW - Male KW - Middle Aged KW - Mortality KW - Multivariate Analysis KW - Neoplasms KW - Radiotherapy KW - Survivors ER -