Cardiac risk after mediastinal irradiation for Hodgkin's disease

Glanzmann, Christoph; Kaufmann, Philipp A.; Jenni, Rolf; Hess, Othmar M; Huguenin, P

doi:10.1016/s0167-8140(97)00125-4

Cited by 178 publications

(103 citation statements)

References 41 publications

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“…Studies of cardiovascular function in symptomatic and asymptomatic HL survivors have shown increased frequency of valvular sclerosis and other aberrant findings. 6,[11][12][13][14][15] This is higher than reported in the general population. 16,17 It has been difficult to disentangle if these changes are clinically relevant and what investigations could be suitable for screening.…”

contrasting

confidence: 53%

Long‐term risk of cardiovascular disease in Hodgkin lymphoma survivors—Retrospective cohort analyses and a concept for prospective intervention

Andersson

Näslund

Tavelin

et al. 2009

Intl Journal of Cancer

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Previous studies have shown increased cardiovascular mortality as late side effects in Hodgkin lymphoma (HL) patients. This study identifies stratifying risk factors for surveillance and defines concepts for a clinical feasible and noninvasive prospective protocol for intervention of cardiovascular side effects. HL patients diagnosed between 1965 and 1995 (n 5 6.946) and their first-degree relatives (FDR) were identified through the Swedish Cancer Registry and the Swedish Multigeneration Registry. For the HL and FDR cohort, in-patient care for cardiovascular disease (CVD) was registered through the Hospital Discharge Registry, Sweden. Standard incidence ratios of developing CVD for the HL cohort were calculated. A markedly increased risk for in-patient care of CVD was observed in HL patients with HL diagnosed at age 40 years or younger and with more than 10 years follow-up. In the HL survivors, a family history of congestive heart failure (CHF) and coronary artery disease (CAD) increased the risk for these diseases. The Swedish Hodgkin Intervention and Prevention study started in 2007. In the pilot feasibility study for prospective intervention (47 patients), about 25% of the cases had side effects and laboratory abnormalities. These patients were referred to a cardiologist or general practitioner. In the prospective cohort, a positive family history for CHF or CAD could be a stratifying risk factor when setting up a surveillance model. The prospective on-going study presents an intervention model that screens and treats for comorbidity factors. This article also presents an overview of the study concept.

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contrasting

confidence: 53%

Long‐term risk of cardiovascular disease in Hodgkin lymphoma survivors—Retrospective cohort analyses and a concept for prospective intervention

Andersson

Näslund

Tavelin

et al. 2009

Intl Journal of Cancer

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“…It affects one or more valves and evolves gradually, either through worsening of pre-existing damage or appearance of new damage. 32 Clinically significant valvular dysfunction has been described, on average, 22 years after RT in survivors of Hodgkin's disease. 28 Consistently, more severe valvular lesions are present on the left side of the heart valves, as these areas have increased hemodynamic stress.…”

Section: Coronary Artery Diseasementioning

confidence: 99%

Cardiovascular effects of radiotherapy on the patient with cancer

Moreira

Silva²,

Ribeiro³

et al. 2016

Rev. Assoc. Med. Bras.

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Summary The incidence of cancer (CA) has increased globally and radiotherapy (RT) is a vital component in its treatment. Cardiovascular injuries induced by RT in the treatment of thoracic and cervical CA have been causing problems in clinical practice for decades, and are among the most serious adverse effects of radiation experienced by the growing number of cancer survivors. This article presentes a review on the Lilacs, Scielo and Pubmed databases of the main cardiovascular injuries, their mechanisms, clinical presentations, treatments and prevention proposals. Injuries caused by RT include diseases of the pericardium, coronary artery disease, valvular disease, myocardial disease with systolic and diastolic dysfunction, conduction disorders, and carotid artery and great vessels disease. Thoracic and cervical irradiation increases cardiovascular morbidity and mortality. Despite the great progress in the improvement of RT techniques, totally excluding prime areas of the cardiovascular system from the irradiation field is not yet possible. Guidelines must be created for monitoring, diagnosis and treatment of patients with CA treated with RT.

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“…28 However, the prevalence of these co-morbidities following HCT 14,15 potentially increases the magnitude of risk for premature cardiovascular disease among HCT survivors -an observation that has now been confirmed for arterial outcomes 10 and CHF. 8,9 Cardiac complications associated with exposure to conditioning regimens are often acute, with relatively short latency.…”

Section: 31mentioning

confidence: 99%

Section: Cardiovascular Disease After Hematopoietic Cell Transplantatmentioning

confidence: 99%

“…27,28 Among survivors of Hodgkin's lymphoma treated with mediastinal radiation, 40-60% have been reported to have valvular fibrosis or insufficiency, while conduction defects are present in as many as 75%. 19,28 Although clinically evident heart failure is rare following mediastinal radiation alone, when present, it is primarily in the form of diastolic dysfunction, as opposed to systolic disease seen following exposure to anthracyclines. 27 In a recent study of long-term survivors Hodgkin's lymphoma treated primarily with mediastinal radiotherapy (median dose 40 Gy), 54% had evidence of a left ventricular filling defect, and 30% were noted to have peak oxygen uptake (VO2max) during exercise of <20 mL/Kg/m 2 , a strong predictor of mortality in heart failure.…”

Section: Cardiovascular Disease After Hematopoietic Cell Transplantatmentioning

confidence: 99%

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Cardiovascular disease after hematopoietic cell transplantation - lessons learned

Armenian¹,

Bhatia²

2008

Haematologica

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H ematopoietic cell transplantation (HCT) has now become the treatment of choice for a large number of malignant and non-malignant diseases.1 It is quite clear that unless effective targeted therapy becomes available, HCT will continue to be offered as a curative therapeutic modality to patients diagnosed with a variety of malignant and non-malignant disorders. Among those who survive the first 2 years, nearly 80% of allogeneic HCT recipients 2,3 and 70% of autologous HCT recipients 4 are expected to become long-term survivors, with an attendant growth in such survivors. Due to improvements in survival rate, major issues for patients undergoing HCT have expanded to include the care and management of survivors, prevention of adverse outcomes, and maintenance of a good health-related quality of life. Some of the well-described complications in this population include subsequent malignancies, cataracts, pulmonary complications, endocrine dysfunction, osteonecrosis, chronic kidney disease, and impairment in functional status due to persistent, chronic graft-versus-host disease (GVHD).5-7 Details regarding cardiovascular dysfunction after HCT are now emerging. [8][9][10] In this issue of the journal, Tichelli et al. publish the results of their retrospective study designed to describe the magnitude of risk of and associated risk factors for the development of arterial events after allogeneic HCT. 10 The events of interest include coronary artery disease, cerebrovascular disease and peripheral artery disease. They report that the cumulative incidence of arterial events at 15 years is 6%, and identify older age at the time of HCT and presence of pre-established cardiovascular risk factors (diabetes, obesity, dyslipidemia, arterial hypertension) as being associated with an increased risk of these outcomes.In a recent study, we used a nested case-control study design to examine the independent role of pre-HCT exposure to therapeutic agents, transplant-related conditioning and co-morbidities in the development of congestive heart failure (CHF) after HCT. 8,9 We identified pre-HCT exposure to anthracyclines and the presence of post-HCT co-morbidities as being associated with delayed CHF after HCT.The best-described therapy-related late cardiac complications include valvular dysfunction, conduction abnormalities, pericarditis, and cardiomyopathy. [11][12][13] Arterial complications can occur as a result of damage to the entire vascular system and include coronary artery disease, cerebrovascular disease, and peripheral artery disease.14,15 While the latency period for many of these diseases can be short, survivors often do not have clinical evidence of disease until several years following HCT.14-16 As with most other complications observed after HCT, cardiovascular complications following HCT are due, in part, to the treatment prior to, during, and following HCT.Age at therapeutic exposure, gender, and past medical history are important considerations when identifying the potential risk of long-term cardiovascular disease. ...

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Cardiac risk after mediastinal irradiation for Hodgkin's disease

Cited by 178 publications

References 41 publications

Long‐term risk of cardiovascular disease in Hodgkin lymphoma survivors—Retrospective cohort analyses and a concept for prospective intervention

Long‐term risk of cardiovascular disease in Hodgkin lymphoma survivors—Retrospective cohort analyses and a concept for prospective intervention

Cardiovascular effects of radiotherapy on the patient with cancer

Cardiovascular disease after hematopoietic cell transplantation - lessons learned

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