PMID- 34411296 OWN - NLM STAT- MEDLINE DCOM- 20220309 LR - 20220309 IS - 1097-0142 (Electronic) IS - 0008-543X (Print) IS - 0008-543X (Linking) VI - 127 IP - 24 DP - 2021 Dec 15 TI - Cardiac remodeling after anthracycline and radiotherapy exposure in adult survivors of childhood cancer: A report from the St Jude Lifetime Cohort Study. PG - 4646-4655 LID - 10.1002/cncr.33860 [doi] AB - BACKGROUND: Limited data exist regarding left ventricular remodeling patterns observed in adult survivors of childhood cancer after therapy. METHODS: Among 1190 adult survivors diagnosed with childhood cancer (median age at diagnosis, 9 years [interquartile range (IQR), 3.8-14.4 years]; age at evaluation, 35.6 years [IQR, 29.5-42.8 years]), treatment exposures included anthracyclines (n = 346), chest radiotherapy (n = 174), both (n = 245), or neither (n = 425). Prospective echocardiographic assessment compared survivors with 449 noncancer controls classified according to left ventricle geometric patterns. Associations between left ventricle geometric patterns and decreased exercise tolerance were assessed. RESULTS: Overall, 28.2% of survivors (95% confidence interval [CI], 25.6%-30.8%) exhibited concentric remodeling, 2.4% (95% CI, 1.6%-3.5%) exhibited eccentric hypertrophy, and 1.1% (95% CI, 0.6%-1.9%) exhibited concentric hypertrophy. A greater proportion of survivors who received only chest radiotherapy (41%) had concentric remodeling compared with those who received only anthracyclines (24%), both (27%), or neither (27%; all P < .001), and all were greater than the proportions in noncancer controls (18%; all P < .05). Concentric remodeling was associated with radiation exposure, but not with anthracycline exposure, in multivariable models. Survivors who had concentric remodeling were more likely to have a maximal oxygen uptake peak <85% compared with those who had normal geometry (81.0% vs 66.3%; odds ratio, 1.75; 95% CI, 1.15-2.68). CONCLUSIONS: Chest radiation therapy, but not anthracycline therapy, increased the risk for concentric remodeling in survivors of childhood cancer. The presence of concentric remodeling was associated with increased exercise intolerance. CI - (c) 2021 American Cancer Society. FAU - Jefferies, John L AU - Jefferies JL AUID- ORCID: 0000-0002-4046-2352 AD - The Cardiovascular Institute, University of Tennessee Health Science Center, Memphis, Tennessee. FAU - Mazur, Wojciech M AU - Mazur WM AD - Cardiovascular Service, The Christ Hospital, Cincinnati, Ohio. FAU - Howell, Carrie R AU - Howell CR AD - Department of Medicine, Division of Preventive Medicine, University of Alabama Birmingham, Birmingham, Alabama. FAU - Plana, Juan C AU - Plana JC AD - Division of Cardiology, Baylor College of Medicine, Houston, Texas. FAU - Ness, Kirsten K AU - Ness KK AUID- ORCID: 0000-0002-2084-1507 AD - Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee. FAU - Li, Zhenghong AU - Li Z AD - Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee. FAU - Joshi, Vijaya M AU - Joshi VM AD - Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee. FAU - Green, Daniel M AU - Green DM AUID- ORCID: 0000-0002-5156-5410 AD - Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee. AD - Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee. FAU - Mulrooney, Daniel A AU - Mulrooney DA AD - Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee. AD - Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee. FAU - Towbin, Jeffrey A AU - Towbin JA AD - Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee. FAU - Martinez, Hugo R AU - Martinez HR AD - Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee. FAU - Goldberg, Jason F AU - Goldberg JF AUID- ORCID: 0000-0001-8351-6376 AD - Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee. FAU - Howell, Rebecca M AU - Howell RM AD - Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. FAU - Srivastava, Deo Kumar AU - Srivastava DK AD - Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee. FAU - Robison, Leslie L AU - Robison LL AD - Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee. FAU - Hudson, Melissa M AU - Hudson MM AD - Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee. AD - Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee. FAU - Armstrong, Gregory T AU - Armstrong GT AD - Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee. LA - eng GR - R01 CA157838/CA/NCI NIH HHS/United States GR - American Lebanese-Syrian Associated Charities/ GR - P30 CA021765/CA/NCI NIH HHS/United States GR - U01 CA195547/CA/NCI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20210819 PL - United States TA - Cancer JT - Cancer JID - 0374236 RN - 0 (Anthracyclines) SB - IM MH - Adult MH - Anthracyclines/adverse effects MH - *Cancer Survivors MH - Child MH - Cohort Studies MH - Humans MH - *Neoplasms/drug therapy/radiotherapy MH - Prospective Studies MH - *Radiation Exposure MH - Survivors MH - Ventricular Remodeling PMC - PMC8664999 MID - NIHMS1737889 OTO - NOTNLM OT - anthracycline OT - cancer OT - childhood OT - radiotherapy OT - remodeling OT - survivor COIS- Disclosures: The authors declare no conflicts of interest and have no pertinent industry relations to disclose. EDAT- 2021/08/20 06:00 MHDA- 2022/03/11 06:00 PMCR- 2021/12/15 CRDT- 2021/08/19 17:36 PHST- 2021/06/03 00:00 [revised] PHST- 2021/03/12 00:00 [received] PHST- 2021/06/25 00:00 [accepted] PHST- 2021/08/20 06:00 [pubmed] PHST- 2022/03/11 06:00 [medline] PHST- 2021/08/19 17:36 [entrez] PHST- 2021/12/15 00:00 [pmc-release] AID - 10.1002/cncr.33860 [doi] PST - ppublish SO - Cancer. 2021 Dec 15;127(24):4646-4655. doi: 10.1002/cncr.33860. Epub 2021 Aug 19.