Cardiovascular morbidity after radiotherapy or chemoradiation in patients with cervical cancer

John Maduro, Heleen den Dekker, Elisabeth Pras, E.G. de Vries, A.G. van der Zee, W.J. Klokman, A.K. Reyners, F.E. van Leeuwen, J.A. Langendijk, G.H. de Bock, J.A. Gietema

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Abstract

PURPOSE: To evaluate the risk of cardiovascular events (CVE) in patients with cervical cancer treated with radiotherapy or chemoradiation.

METHODS AND MATERIALS: The incidence of CVE in patients treated between 1989 and 2002 by radiotherapy or chemoradiation was compared with a Dutch reference population. Standardized incidence ratios (SIRs) were calculated for myocardial infarction (MI), angina pectoris (AP), congestive heart failure (CHF), cerebrovascular accident (CVA) separately and for any cardiac event combined (MI, AP, and CHF).

RESULTS: In 277 patients with a median follow-up of 4.5 years (range, 0.1-17 years) and a median survival of 9.2 years, 27 cardiac events occurred. The 5-, 10-, and 15-year actuarial incidence of any cardiac event were 9, 14, and 16%, respectively. For the whole population, the SIR for MI was elevated (2.05, 95% CI: 1.12-3.43). The radiotherapy group (n = 132) was older and had more cardiovascular risk factors than the chemoradiation group (n = 145). The SIR for MI in the radiotherapy group was 2.88 (95% CI: 1.44-5.15) and in the chemoradiation group 1.00 (95% CI: 0.21-7.47). In multivariate analyses, there was no relation between treatment modality and the risk for MI.

CONCLUSIONS: In this cohort of cervical cancer patients, an increased risk for developing a MI was observed. This increased risk of MI, in combination with the high prevalence of cardiovascular risk factors in cervical cancer patients, urges the need to explore strategies to reduce their risk for cardiovascular morbidity.

Original languageEnglish
Pages (from-to)1337-1344
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume78
Issue number5
DOIs
Publication statusPublished - 1-Dec-2010

Keywords

  • Cervical cancer
  • Radiotherapy
  • Chemotherapy
  • Cardiovascular
  • Toxicity
  • LONG-TERM SURVIVORS
  • RADIATION-THERAPY
  • TESTICULAR CANCER
  • CONCURRENT CHEMOTHERAPY
  • UTERINE CERVIX
  • CASE SERIES
  • RISK
  • NETHERLANDS
  • CARCINOMA

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