@article{589c82d37ed4482ca939b9dab724ce1f,
title = "Cardiac remodeling after anthracycline and radiotherapy exposure in adult survivors of childhood cancer: A report from the St Jude Lifetime Cohort Study",
abstract = "Background: Limited data exist regarding left ventricular remodeling patterns observed in adult survivors of childhood cancer after therapy. Methods: Among 1190 adult survivors diagnosed with childhood cancer (median age at diagnosis, 9 years [interquartile range (IQR), 3.8-14.4 years]; age at evaluation, 35.6 years [IQR, 29.5-42.8 years]), treatment exposures included anthracyclines (n = 346), chest radiotherapy (n = 174), both (n = 245), or neither (n = 425). Prospective echocardiographic assessment compared survivors with 449 noncancer controls classified according to left ventricle geometric patterns. Associations between left ventricle geometric patterns and decreased exercise tolerance were assessed. Results: Overall, 28.2% of survivors (95% confidence interval [CI], 25.6%-30.8%) exhibited concentric remodeling, 2.4% (95% CI, 1.6%-3.5%) exhibited eccentric hypertrophy, and 1.1% (95% CI, 0.6%-1.9%) exhibited concentric hypertrophy. A greater proportion of survivors who received only chest radiotherapy (41%) had concentric remodeling compared with those who received only anthracyclines (24%), both (27%), or neither (27%; all P <.001), and all were greater than the proportions in noncancer controls (18%; all P <.05). Concentric remodeling was associated with radiation exposure, but not with anthracycline exposure, in multivariable models. Survivors who had concentric remodeling were more likely to have a maximal oxygen uptake peak <85% compared with those who had normal geometry (81.0% vs 66.3%; odds ratio, 1.75; 95% CI, 1.15-2.68). Conclusions: Chest radiation therapy, but not anthracycline therapy, increased the risk for concentric remodeling in survivors of childhood cancer. The presence of concentric remodeling was associated with increased exercise intolerance.",
keywords = "anthracycline, cancer, childhood, radiotherapy, remodeling, survivor",
author = "Jefferies, {John L.} and Mazur, {Wojciech M.} and Howell, {Carrie R.} and Plana, {Juan C.} and Ness, {Kirsten K.} and Zhenghong Li and Joshi, {Vijaya M.} and Green, {Daniel M.} and Mulrooney, {Daniel A.} and Towbin, {Jeffrey A.} and Martinez, {Hugo R.} and Goldberg, {Jason F.} and Howell, {Rebecca M.} and Srivastava, {Deo Kumar} and Robison, {Leslie L.} and Hudson, {Melissa M.} and Armstrong, {Gregory T.}",
note = "Funding Information: Kristen K. Ness reports institutional grants from the NIH outside the submitted work. Rebecca M. Howell reports a contract with the St Jude Lifetime Cohort to provide dosimetry. Deo Kumar Srivastava served as a scientific reviewer for General Dynamics Information Technology for grants submitted to Congressionally Directed Medical Research Programs outside the submitted work. Gregory T. Armstrong reports grants from the National Institutes of Health to St Jude Research Hospital outside the submitted work. The remaining authors made no disclosures. Funding Information: This work was supported by grants to St Jude Children's Research Hospital provided by the National Cancer Institute (R01 CA157838, Gregory T. Armstrong, Principal Investigator; U01 CA195547, Melissa M. Hudson and Leslie L. Robison, Principal Investigators), the Cancer Center Support grant (P30 CA21765; Charles Roberts, Principal Investigator), and the American Lebanese‐Syrian Associated Charities. Funding Information: This work was supported by grants to St Jude Children's Research Hospital provided by the National Cancer Institute (R01 CA157838, Gregory T. Armstrong, Principal Investigator; U01 CA195547, Melissa M. Hudson and Leslie L. Robison, Principal Investigators), the Cancer Center Support grant (P30 CA21765; Charles Roberts, Principal Investigator), and the American Lebanese-Syrian Associated Charities. Publisher Copyright: {\textcopyright} 2021 American Cancer Society.",
year = "2021",
month = dec,
day = "15",
doi = "10.1002/cncr.33860",
language = "English (US)",
volume = "127",
pages = "4646--4655",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "24",
}