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To the Editor: Dr Hull and colleagues¹ studied the incidence of long-term cardiovascular events in patients who were treated with radiation between 1962 and 1998. The authors concluded that, "Given the long latency period, it is probable that the frequency of these problems will increase as more patients, who were treated before the radiation dose reductions in the 1990s, reach their 20-year survival milestone."

We disagree with this conclusion. Although the authors did not report extensive detail about radiation therapy, treatment methods changed significantly between 1962 and 1998. Case reports published in the 1960s suggesting the possible cardiac effects of radiation therapy,² resulted in major changes in technique such as subcarinal shielding.³ This modification alone may have resulted in a significant reduction of the incidence of structural cardiac diseases.⁴ The number of survivors in the study by Hull et al who developed significant valvular disease, and who were treated prior . . . [Full Text of this Article]

Gabor Gyenes, MD, PhD
ggyenes@cha.ab.ca
Department of Cardiology
University of Alberta
Edmonton

George Gyenes, MD, DSc
National Institute of Oncology
Budapest, Hungary

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