Document Detail

Cardiac dysfunction following spinal irradiation during childhood.
MedLine Citation:
PMID:  8501489     Owner:  NLM     Status:  MEDLINE    
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.
R I Jakacki; J W Goldwein; R L Larsen; G Barber; J H Silber
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
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:
Created Date:  1993-06-29     Completed Date:  1993-06-29     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8309333     Medline TA:  J Clin Oncol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1033-8     Citation Subset:  IM    
Division of Oncology and Cardiology, Children's Hospital of Philadelphia, PA 19104.
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MeSH Terms
Electrocardiography / radiation effects
Exercise Test
Heart / physiopathology,  radiation effects*
Radiotherapy / adverse effects*
Radiotherapy Dosage
Spinal Cord Neoplasms / radiotherapy*
Grant Support

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