Guidelines for Complications of Cancer Treatment Vol VIII Part B

RESULTS: In the total group, the risk of fatal cardiac ischemicevents and/or of sudden unexpected death was significantlyhigher than expected with a relative risk of 4.2 for myocardialinfarction and 6.7 for myocardial infarction or sudden death.In female patients and in patients without other cardiovascularrisk factors, the risk of fatal or non-fatal ischemic cardiac eventswas not significantly different from the expected value. In thesubgroup with no cardiovascular risk factors and treatmentwithout Ct, there was no ischemic or other major cardiac event.Echocardiography showed valvular thickenings in a largeamount of the patients (the cumulative risk after 30-yearfollow-up was above 60%) but mostly without hemodynamicdisturbance. In patients without hypertension and withoutcoronary artery disease, findings of perfusion scintigraphy andechocardiographic evaluation of systolic and diastolic functionwere normal. Treatment with Ct was not a significant risk factorfor cardiac events but the number of patients whose treatmentincluded adriamycin and with a follow-up exceeding 10 yearsis to low for a definitive evaluation. CONCLUSIONS: Inpatients without the usual cardiovascular risk factors (smoking,hypertension, obesity, hypercholesterolemia, diabetes mellitus)the risk of serious cardiac lesions after conventionallyfractionated irradiation of the mediastinum with anintermediate total dose between 30 and 40 Gy is low. Also thecardiac risk of the combination of this irradiation with Ctincluding adriamycin with a total dose between 200 and 300mg/m2 seems low but further long-term observation isnecessary.Lancet Oncol. 2005 Aug;6(8):557-65Long-term mortality from heart disease and lung cancer afterradiotherapy for early breast cancer: prospective cohort studyof about 300,000 women in US SEER cancer registries.310