Long-term cardiac abnormalities after cranial radiotherapy in childhood cancer survivors

Background. Cardiac morbidity is an important late effect in long-term childhood cancer survivors (CCS) treated with cardiotoxic agents or radiotherapy (RT) on the chest. However, there is limited data on the long-term cardiac sequelae in CCS who only received cranial RT. We hypothesized that cranial RT might negatively influence cardiac structure and function. Methods and results. We studied 13 CCS [mean age 30.8 (18.1-39.3) years, 7 males] who received RT only on the head for a cranial tumor and 36 age-and sex-matched healthy sibling controls. Echocardiographic follow-up was performed at median 21.7 (12.6-30.8) years after diagnosis. CCS had lower indexed diastolic LV volumes [56.0 (31.4-68.3) vs. 60.5 (41.9-94.3) mL/m(2), p = 0.024]. CCS also had reduced LV systolic and diastolic function, reflected by lower systolic LV myocardial velocities (5.3 +/- 0.9 vs. 7.1 +/- 1.7 cm/s, p +/- 0.001) and longitudinal deformation (-17.3 +/- 3.1 vs. -20.7 +/- 2.0%, p < 0.001), as well as lower diastolic LV myocardial velocities (-10.7 +/- 1.7 vs. -12.2 +/- 1.5 cm/s, p = 0.006) and deformation speed (1.1 +/- 0.3 vs. 1.5 +/- 0.2 1/s, p = 0.005). Additionally, in CCS insulin-like growth factor levels [15.4 (9.2-34.6) vs. 24.4 (14.8-55.5) nmol/L, p = 0.007] were lower. Conclusion. Cranial RT in CCS is associated with smaller cardiac volumes and reduced systolic and diastolic LV function. This off target effect of RT might be related to lower insulin-like growth factor levels.