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Evidence summaries

Risk of Morbidity and Mortality from Cardiovascular Disease Following Radiotherapy for Childhood Cancer

The risk of cardiovascular mortality appears to be increased after radiotherapy involving the heart region for childhood cancer, compared with the general population and patients who did not receive radiotherapy. Level of evidence: "B"

A systematic review 1 including 14 retrospective studies with a total of 14,417 subjects was abstracted in DARE. Four studies showed significantly increased standardized mortality ratios (SMRs) after radiotherapy in comparison with the general population. The pooled SMR of 28.4 was based on 4 studies. The absolute excess risk ranged from -0.4 to +17.7 excess cardiac deaths per 10,000 person-years adjusted for age, gender, race and calendar period (4 studies). The actuarial risk for CVM increased from 0.3% at 10 years to 10.2% after 25 years (2 studies). The RR of cardiovascular disease (both cardiovascular events and CVM) following radiation was reported in 3 studies. Two of the 3 studies showed a significantly increased risk with radiation compared with no radiation.

Comment: The quality of evidence is downgraded by retrospective study settings and upgraded by consistency of results.

    References

    • van der Pal HJ, van Dalen EC, Kremer LC, Bakker PJ, van Leeuwen FE. Risk of morbidity and mortality from cardiovascular disease following radiotherapy for childhood cancer: a systematic review. Cancer Treat Rev 2005 May;31(3):173-85. [PubMed][DARE]

Primary/Secondary Keywords