OC-0059: A radiation dose-response relationship for risk of heart failure in survivors of Hodgkin lymphoma

Aleman, B.M.P.; Nimwegen, Frederika A. van; Ntentas, Georgios; Darby, S C; Schaapveld, Michael; Hauptmann, Michael; Lugtenburg, P.J.; Janus, Cécile P.M.; Krol, Augustinus D.G.; Leeuwen, F.E. Van

doi:10.1016/s0167-8140(16)31308-1

Radiotherapy and Oncology

2016

DOI: 10.1016/s0167-8140(16)31308-1

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OC-0059: A radiation dose-response relationship for risk of heart failure in survivors of Hodgkin lymphoma

B.M.P. Aleman¹,

Frederika A. van Nimwegen²,

Georgios Ntentas³

et al.

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“…Three recent case-control studies addressed the shape of the radiation dose-response curve for CHD and VHD after HL treatment. [54][55][56] The first study included 325 patients diagnosed with CHD as their first cardiovascular event after HL. 56 Radiation charts and simulation radiographs were used to estimate mean heart dose for all cases and 1204 matched controls.…”

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“…Twenty-five year cumulative risks of HF following MLVDs of 0-15 Gy, 16-20 Gy, and $21 Gy were 4.4%, 6.2%, and 13.3%, respectively, in patients treated without anthracyclinecontaining chemotherapy, and 11.2%, 15.9%, and 32.9%, respectively, in patients treated with anthracyclines. 55 The establishment of a clear radiation dose-response for different CVDs implies substantially lower CVD risks for more recently treated HL patients who received involved-node or involved-site radiotherapy and lower radiation doses.…”

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Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment

Leeuwen

2016

Hematology

108

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Long-term survivors of Hodgkin lymphoma (HL) experience several late adverse effects of treatment, with second malignant neoplasms (SMNs) and cardiovascular diseases (CVDs) being the leading causes of death in these patients. Other late effects have also been identified, such as pulmonary dysfunction, endocrinopathies (thyroid dysfunction, infertility), neck muscle atrophy, and persistent fatigue. HL survivors have two-to fourfold increased risks to develop SMNs and CVD compared with the general population. With respect to SMNs, radiotherapy is associated with 1.5-to 15-fold increased risk of solid malignancies. The relative risk (RR) of solid tumors increases steadily with increasing follow-up time from 5 to 15 years since radiotherapy, and remains elevated for at least 40 years. The RR of solid SMNs increases strongly with younger age at first treatment. Risks of lung, breast, and gastrointestinal (GI) cancers increase with higher radiation dose. Alkylating agent chemotherapy, especially procarbazine, does not only increase risk of leukemia but also of solid malignancies, in particular, cancers of the lung and GI tract. In contrast, gonadotoxic chemotherapy decreases the risk of radiation-associated breast cancer, through induction of premature menopause. Smoking appears to multiply the radiation-and chemotherapy-associated risks of lung cancer. Both radiotherapy and chemotherapy for HL may cause cardiovascular toxicity. Radiotherapy increases the risk of coronary heart disease, valvular heart disease, congestive heart failure (HF), and pericarditis, whereas anthracycline-containing chemotherapy increases the risks of HF and valvular heart disease. Cardiovascular toxicity following radiotherapy is usually observed from 5 to at least 35 years after therapy, whereas anthracycline-related toxicity is already observed during treatment, up to at least 25 years. The joint effects of anthracyclines, radiotherapy, and conventional cardiovascular risk factors (eg, hypertension, smoking, and physical inactivity) appear to be additive rather than multiplicative. HL survivors need lifelong risk-based screening for selected SMNs and CVDs. Furthermore, preventive strategies should include lifestyle and drug-based interventions to minimize exposure to conventional risk factors for cancer and CVD. Learning Objectives• Know treatment-related risk factors for the development of second malignancy and CVDs after HL • Be aware of the content of use surveillance guidelines for HL survivors, aimed at reduction of morbidity and mortality from second malignancy and CVDs

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Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment

Leeuwen

2016

Hematology

108

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Improving Provision of Care for Long-term Survivors of Lymphoma

Ciavarella

Minoia

Quinto

et al. 2017

Clinical Lymphoma Myeloma and Leukemia

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OC-0059: A radiation dose-response relationship for risk of heart failure in survivors of Hodgkin lymphoma

Cited by 2 publications

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Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment

Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment

Improving Provision of Care for Long-term Survivors of Lymphoma

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