| Cardiac dysfunction following spinal irradiation during childhood. | |
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MedLine Citation:
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PMID: 8501489 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: Although spinal irradiation used in the treatment of CNS malignancies includes a portion of the heart in the radiation field, cardiac effects have not been previously reported. PATIENTS AND METHODS: We compared patients treated for malignancy in childhood with spinal irradiation (n = 26) with patients treated with mediastinal/flank irradiation (n = 47) that included the heart in the radiation field. All patients were more than 1 year from completion of radiation therapy. Patients underwent at least two of the following cardiac evaluations: (1) ECG; (2) 24-hour ambulatory ECG; (3) echocardiogram; and (4) exercise-testing using cycle ergometry. RESULTS: Twelve of 16 patients (75%) in the spinal irradiation group with an assessable exercise test achieved a maximal cardiac index (MCI) below the fifth percentile as compared with 13 of 40 patients (32%) who had received mediastinal/flank irradiation (P = .007). Furthermore, after adjusting for normal heart growth, radiation and anthracycline doses, and follow-up time, the group of patients who received spinal irradiation had significantly higher estimated posterior wall stress (P = .002), expressed as the natural logarithm of the ratio of end-diastolic left ventricular internal diameter (LVID) to left ventricular posterior wall thickness (LVPWT), than the group who had received mediastinal/flank irradiation. Finally, eight of 26 patients (31%) in the spinal group had pathologic Q-waves in the inferior leads versus three of 47 (6.4%) in the mediastinal/flank group (P = .001). CONCLUSION: Patients who have received spinal irradiation for pediatric malignancies appear to be at risk for significant cardiac dysfunction. The asymmetric distribution of radiation to a growing heart, as given with spinal irradiation, may be the cause of these findings. |
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Authors:
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R I Jakacki; J W Goldwein; R L Larsen; G Barber; J H Silber |
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Publication Detail:
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Type: Journal Article; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Journal of clinical oncology : official journal of the American Society of Clinical Oncology Volume: 11 ISSN: 0732-183X ISO Abbreviation: J. Clin. Oncol. Publication Date: 1993 Jun |
Date Detail:
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Created Date: 1993-06-29 Completed Date: 1993-06-29 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 8309333 Medline TA: J Clin Oncol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1033-8 Citation Subset: IM |
Affiliation:
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Division of Oncology and Cardiology, Children's Hospital of Philadelphia, PA 19104. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Child Echocardiography Electrocardiography / radiation effects Exercise Test Female Heart / physiopathology, radiation effects* Humans Male Radiotherapy / adverse effects* Radiotherapy Dosage Spinal Cord Neoplasms / radiotherapy* |
| Grant Support | |
ID/Acronym/Agency:
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K04-CA01480/CA/NCI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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