Key result
Cranial radiation in childhood ALL survivors is linked to ~29% lower arterial compliance and subclinical LV dysfunction.
Why the study?
The role of cranial radiation therapy in the development of left ventricular dysfunction in anthracycline-treated childhood ALL survivors remains unclear.
Does past cranial radiation therapy (CRT) worsen subclinical left ventricular dysfunction and arterial compliance in young adult survivors of anthracycline-treated childhood ALL?
Cohort (n=42)
Does past cranial radiation therapy (CRT) worsen subclinical left ventricular dysfunction and arterial compliance in young adult survivors of anthracycline-treated childhood ALL?
Absolute Event Rate: 1% vs 1.4%
p-value: p=0.002
Cranial radiation therapy in childhood ALL survivors is associated with subclinical left ventricular dysfunction and reduced systemic arterial compliance, suggesting an additional mechanism for future heart failure risk beyond anthracycline cardiotoxicity.
May warrant enhanced surveillance in CRT-exposed ALL survivors; hypothesis-generating for additive mechanisms beyond anthracyclines.
Long-term survivors of acute lymphoblastic leukemia (ALL), the most common childhood malignancy, are at remarkably increased risk of heart failure (HF) in middle age, most likely due anthracycline cardiotoxicity. The role of cranial radiation therapy (CRT) in the development of left ventricular (LV) dysfunction, a predecessor of overt HF, remains unclear. Our aim was to compare LV function and systemic arterial properties according to past CRT in young adult survivors of anthracycline-treated ALL. We studied young adult survivors of childhood ALL at a median of 16 years from diagnosis treated with anthracycline-based chemotherapy, with (n = 12) or without (n = 30) CRT. In addition to fractional shortening (FS) and ejection fraction (EF), LV function was quantified by tissue Doppler imaging of the mitral annulus. Aortic strain/distensibility and arterial compliance were derived from echocardiography and simultaneously recorded pulse pressure. Despite similar FS and EF, peak mitral annular systolic velocity (median (interquartile range): 9.0 (7.5–10.0) vs. 10.0 (8.8–11.5) cm/s, p = 0.05), and early diastolic velocity (13.8 (13.0–14.8) vs. 15.5 (14.0–17.3), p = 0.01) were decreased after chemotherapy combined with CRT compared to chemotherapy without CRT. Systemic arterial compliance was lower in post-CRT subjects (1.0 (0.8–1.2 vs. 1.4 (1.1–1.7) mL/mmHg, p = 0.002). Aortic strain and distensibility were similar regardless of prior CRT. In conclusion, lower arterial compliance and subclinical LV dysfunction may be possible late consequences of past CRT in adult survivors of childhood ALL. Whether arterial stiffening is associated with future HF development in CRT-exposed ALL survivors remains to be investigated.
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Sulicka‐Grodzicka et al. (2019) conducted a cohort in Childhood acute lymphoblastic leukemia (n=42). Cranial radiation therapy vs. Chemotherapy without cranial radiation therapy was evaluated on Systemic arterial compliance (p=0.002). Past cranial radiation therapy in childhood ALL survivors was associated with lower systemic arterial compliance (1.0 vs 1.4 mL/mmHg, p=0.002) and subclinical left ventricular dysfunction.
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