Long-Term Valvular Risks After Childhood Cancer Treatment
Survivors of childhood cancer face a heightened risk of developing severe valvular heart disease (VHD) many years after completing treatment. This is according to new research identifying key therapeutic risk factors. The study found that exposure to heart-directed radiation therapy (RT), anthracycline chemotherapy, and platinum-based agents significantly increased the likelihood of valvulopathy among long-term survivors.
Radiation Dose Strongly Correlates With Valvulopathy Risk
The analysis drew on data from over seven decades of European survivors, encompassing patients diagnosed between 1940 and 2009 who lived at least five years beyond their initial diagnosis. Researchers reconstructed individualized radiation doses using advanced voxel-based modeling.
Compared with survivors who did not receive heart RT, those exposed to a mean cardiac dose between 5 and 15 Gy had nearly a fivefold increase in VHD risk. The risk grew exponentially with higher doses, those receiving 30 Gy or more had more than a hundredfold higher odds of developing symptomatic VHD. The association intensified with time: the risk rose markedly after 20 to 30 years post-treatment, underscoring the enduring cardiovascular impact of early-life cancer therapy.
Chemotherapy Exposure Also Contributes to Cardiac Damage
Anthracyclines and platinum-based chemotherapies were also implicated. Cumulative anthracycline exposure of 400 mg/m² or greater tripled the risk of valvulopathy, while platinum-based agents showed a linear dose-response relationship. The study found no significant association between valvulopathy and other chemotherapies or radiation to organs such as the spleen.
Lifelong Cardiac Monitoring Recommended
The findings emphasize the need for continued cardiac surveillance well into adulthood for childhood cancer survivors, particularly those exposed to combined modalities of RT and anthracyclines. The authors note that early detection of valvular dysfunction could help prevent severe cardiac outcomes and improve long-term survivorship care.
Reference: Rivalin Aho G et al. Risk Factors for Valvulopathy Among Childhood Cancer Survivors. JAMA Oncol. 2025. doi: 10.1001/jamaoncol.2025.3863
