The Contribution of Thoracic Radiation Dose Volumes to Subsequent Development of Cardiovascular Disease in Cancer Survivors.
Carolyn Miller Reilly, Melinda Higgins, Javed Butler and 5 others
PMID 34238842WHAT IT FOUND
In 56 cancer survivors, thoracic radiation dose did not distinguish those who developed cardiovascular disease from matched controls.
Higher BMI and later cancer stage did distinguish them, so traditional risk factors mattered more than dose.
Key findings
01Radiation dose metrics, including dose to heart chambers, did not differ significantly between survivors who developed cardiovascular disease and matched controls.
02Cases had more traditional cardiovascular risk factors at cancer diagnosis, and a model retained cancer stage and BMI, not radiation dose or heart shape measures.
03Six of 28 cases had pre-existing cardiovascular disease, compared with none of 28 controls.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a small pilot with only 28 cases and 28 controls. It could detect moderate-to-large effects but not smaller ones. The study was retrospective and based on medical records and stored dose plans. It cannot prove that radiation dose caused or did not cause cardiovascular events. Cases and controls differed in traditional cardiovascular risk factors before cancer treatment. Six cases had pre-existing cardiovascular disease while no controls did. The authors did not correct all multiple pairwise comparisons. Some reported differences may be chance. The heart shape and radiomic differences were post-hoc and exploratory. No published norms exist for these measures. Cancer type matching was not perfect. Lung cases were matched to some controls with different cancer types.
Declared interests
The authors declared no conflicts of interest or financial disclosures. The paper is listed as supported by NIH extramural research funds.
The easy way to misread this
Do not conclude that thoracic radiation does not increase cardiovascular risk. This small retrospective pilot found no dose differences, but the cases already had more traditional risk factors and some had pre-existing cardiovascular disease, and the study was not powered to detect small effects.