Assessment of Valvular Disorders in Survivors of Hodgkin's Lymphoma Treated by Mediastinal Radiotherapy ± Chemotherapy

Bijl, Jesse M; Roos, Marleen M.; Leeuwen-Segarceanu, Elena M. van; Vos, Josephine M.I.; Bos, Willem Jan W.; Biesma, Douwe H.; Post, Marco C.

doi:10.1016/j.amjcard.2015.11.027

Cited by 48 publications

(42 citation statements)

References 26 publications

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“…Among patients who receive left sided chest and/or breast radiation or mantle radiation, there is a significantly increased risk of developing accelerated coronary artery disease and valvular dysfunction (especially aortic regurgitation). 33,34 Patients that receive head and neck radiation are at increased risk for carotid artery disease, stroke as well as autonomic dysfunction due to effects on baroreceptors in the carotid bulb and sinus. 35-37 In general, these are delayed toxicities, occurring several years to decades after exposure.…”

Section: Cardiotoxicity: Opportunities For Collaborationmentioning

confidence: 99%

Developing a comprehensive Cardio-Oncology Program at a Cancer Institute: the Moffitt Cancer Center experience

et al. 2017

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Cardio-oncology is a multidisciplinary field focusing on the management and prevention of cardiovascular complications in cancer patients and survivors. While the initial focus of this specialty was on heart failure associated with anthracycline use, novel anticancer agents are increasingly utilized and are associated with many other cardiotoxicities including hypertension, arrhythmias and vascular disease. Since its inception, the field has developed at a rapid pace with the establishment of programs at many major academic institutions and community practices. Given the complexities of this patient population, it is important for providers to possess knowledge of not only cardiovascular disease but also cancer subtypes and their specific therapeutics. Developing a cardio-oncology program at a stand-alone cancer center can present unique opportunities and challenges when compared to those affiliated with other institutions including resource allocation, cardiovascular testing availability and provider education. In this review, we present our experiences establishing the cardio-oncology program at Moffitt Cancer Center and provide guidance to those individuals interested in developing a program at a similar independent cancer institution.

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Section: Cardiotoxicity: Opportunities For Collaborationmentioning

confidence: 99%

Developing a comprehensive Cardio-Oncology Program at a Cancer Institute: the Moffitt Cancer Center experience

et al. 2017

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“…In addition, after 20 years of irradiation, the majority of HL survivors developed clinically important valve disease. Aortic regurgitation did not occur within 10 years after treatment in patients less than 40 years of age [11].…”

Section: Resultsmentioning

confidence: 78%

“…Most non-coronary heart diseases associated to radiation are valve diseases, being that besides VHD, other adverse events may be induced, like pericarditis, abnormalities in electrical conduction, accelerated atherosclerosis, myocardial systolic and diastolic dysfunction, coronary artery disease, difficulty in healing of myocardial and pericardial wounds, turning heart surgery even more challenging [8,11,14]. Patients exposed only to radiotherapy are more likely to present diastolic dysfunction, differing from those exposed to radiotherapy combined with administration of anthracyclines, these tend to evolve with systolic dysfunction [7,9,16].…”

mentioning

confidence: 99%

Heart Valve Injury Induced by Mediastinum Radiotherapy in Cancer Treatment

Paiva¹,

Soares²,

Pinheiro³

et al. 2018

JPP

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Radiotherapy as monotherapy or in combination with chemotherapy, has contributed to the drop in mortality rates related to neoplasms in the last 60 years. However, irradiation may promote heart damage and involvement is very common. As a result, VHD (valvular heart disease) is one of the earliest cardiovascular events post-radiotherapy. What it concerns to valve disease induced by chemotherapeutics, there are still only few studies. However, patients treated with chemotherapy in combination with radiotherapy had twice the risk of developing the disease when compared to those treated by radiotherapy alone. The heart injury caused by radiotherapy begins with damage to the endothelium and results in fibrosis and diffuses calcification primarily of the mitral and aortic valves. The echocardiography is the tool of choice to the patient's assessment and follow-up after exposure. Prevention is the best option to face the valve damage induced by radiation.

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“…13 Other studies have also reported a mean dose of 30-46 Gy associated with the development of RIV. 1,7,17 In the 1960s, patients with Hodgkin lymphoma received a total mantle field radiation of 35-45 Gy spreading to lymph nodes in the neck, mediastinum, and axillae, resulting overall in 27.5 Gy to the heart and >35 Gy to parts of the heart such as the pulmonary and aortic valves. 3,18 In 2004, involved-field radiotherapy, which requires a mean dose of 30 Gy, became the gold standard for early-stage Hodgkin lymphoma.…”

Section: Discussionmentioning

confidence: 99%

“…Hodgkin lymphoma is a common malignancy, especially in young adults, accounting for approximately 8,220 new cases diagnosed in the United States annually. 1 Since the introduction of chemotherapy and radiotherapy, patients with Hodgkin lymphoma have improved cure rates and prognosis compared to the era preceding the introduction of these interventions, with more than 80% of patients now achieving a 20-year survival. 2 Because of the increased life expectancy of these patients, healthcare providers are witnessing an increasing number of long-term side effects of these treatments.…”

Section: Introductionmentioning

confidence: 99%

Early-Onset Bilateral Severe Valvular Regurgitation After Mediastinal Radiotherapy in Hodgkin Lymphoma Survivors: Should We Screen Prior to 10 Years After Mediastinal Radiotherapy?

Mishra

Ahmed

Shokr

et al. 2019

TOJ

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Background: Radiation-induced valvulopathy (RIV) is a common complication of mediastinal radiotherapy and usually occurs at least 10 years after exposure to radiotherapy. Case Report: We report the case of a 37-year-old female with a history of stage IIIB Hodgkin lymphoma who was diagnosed with RIV after all other potential causes of shortness of breath and valvular dysfunction were excluded. The patient's presentation, 6 years after receiving chemotherapy and radiotherapy for Hodgkin lymphoma, was earlier than expected after mediastinal radiotherapy. The patient was started on a regimen of lisinopril, nifedipine, and metoprolol, and her symptoms improved significantly within 4 days of starting medical therapy. We review the literature, discuss the risk factors and determinants of developing RIV, and suggest the ideal timing to screen patients. Conclusion: This case is of educational value for internal medicine, oncology, and cardiology healthcare providers who should consider RIV as a cause of shortness of breath in patients who underwent mediastinal radiotherapy for Hodgkin lymphoma.

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Assessment of Valvular Disorders in Survivors of Hodgkin's Lymphoma Treated by Mediastinal Radiotherapy ± Chemotherapy

Cited by 48 publications

References 26 publications

Developing a comprehensive Cardio-Oncology Program at a Cancer Institute: the Moffitt Cancer Center experience

Developing a comprehensive Cardio-Oncology Program at a Cancer Institute: the Moffitt Cancer Center experience

Heart Valve Injury Induced by Mediastinum Radiotherapy in Cancer Treatment

Early-Onset Bilateral Severe Valvular Regurgitation After Mediastinal Radiotherapy in Hodgkin Lymphoma Survivors: Should We Screen Prior to 10 Years After Mediastinal Radiotherapy?

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