Radiation Dose-Response Relationship for Risk of Coronary Heart Disease in Survivors of Hodgkin Lymphoma

Nimwegen, Frederika A. van; Schaapveld, Michael; Cutter, David J.; Janus, Cécile P.M.; Krol, Augustinus D.G.; Hauptmann, Michael; Kooijman, Karen; Roesink, Judith M.; Maazen, Richard van der; Darby, Sarah C.; Aleman, Berthe M.P.; Leeuwen, Flora E. van

doi:10.1200/jco.2015.63.4444

Cited by 370 publications

(315 citation statements)

References 29 publications

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“…Ewolucja może być szybka, z ostrym zespołem wieńcowym lub nagłym zgonem jako pierwszym przejawem choroby, ale częściej choroba nie powoduje objawów przez długi czas [135,136]. Choroba serca związana z napromienianiem u pacjentów z chłoniakiem typowo ujawnia się 15-20 lat po początkowym leczeniu, a młodsi pacjenci są bardziej podatni na jej wystąpienie niż osoby starsze [137]. Wśród chorych, którzy przebyli chłoniaka Hodgkina, ryzyko CAD jest zwiększone 4-7-krotnie w porów-naniu z populacją ogólną, a skumulowana zapadalność na CVD po 40 latach od leczenia wynosi nawet 50% [138].…”

Section: Radioterapiaunclassified

“…Chorzy ci, którzy w momencie rozpoznania nowotworu są typowo w wieku 20-40 lat, często są poddani wielolekowej chemioterapii opartej na cisplatynie, w połącze-niu z radioterapią lub bez niej. Po prawie 20 latach obserwacji w porównaniu z pacjentami leczonymi tylko chirurgicznie wśród osób poddanych chemioterapii i/lub radioterapii (poniżej przepony) stwierdzono więcej czynników ryzyka CV oraz bezwzględne ryzyko incydentu niedokrwiennego wynoszące 8% [137].…”

Section: Postępowanie Diagnostyczne I Terapeutyczneunclassified

See 1 more Smart Citation

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

Zamorano¹,

Lancellotti²,

Muñoz³

et al. 2016

Kardiol Pol

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Section: Radioterapiaunclassified

Section: Postępowanie Diagnostyczne I Terapeutyczneunclassified

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

Zamorano¹,

Lancellotti²,

Muñoz³

et al. 2016

Kardiol Pol

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“…11,56 The above case-control study of risk factors for CHD after HL treatment showed that hypertension was an independent risk factor for CHD (RR 5 1.85), which added to the radiotherapy-associated risk but did not modify it. 56 However, a recent study in childhood cancer survivors showed that the combined effect of chest radiotherapy plus hypertension resulted in potentiation of risk for major cardiac events beyond that anticipated on the basis of an additive effect. 57 Two studies examined the effects of physical inactivity on CVD risk after HL.…”

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confidence: 98%

“…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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confidence: 99%

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

Leeuwen

2016

Hematology

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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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Assessment of Radiation Doses Delivered to Organs at Risk Among Patients With Early-Stage Favorable Hodgkin Lymphoma Treated With Contemporary Radiation Therapy

et al. 2020

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IMPORTANCE Response-adapted randomized trials have used positron emission tomographycomputed tomography to attempt to identify patients with early-stage favorable Hodgkin lymphoma (ESFHL) who could be treated with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) without radiation therapy (RT). While maximal efficacy is demonstrated with combined modality therapy, RT is often omitted in fear of late adverse effects; however, the application of modern RT could limit these toxic effects. OBJECTIVE To determine the radiation doses delivered to organs at risk with modern involved-site RT among patients with ESFHL treated with 20 Gy after 2 cycles of ABVD. DESIGN, SETTING, AND PARTICIPANTS This case series included 42 adult patients with ESFHL (according to the German Hodgkin Study Group criteria) who were treated between 2010 and 2019, achieved complete response by positron emission tomography-computed tomography (1-3 on 5-point scale) following 2 cycles of ABVD, and then received consolidative RT. The study was conducted at a single comprehensive cancer center. EXPOSURES 2 cycles of chemotherapy followed by 20-Gy involved-site RT. MAIN OUTCOMES AND MEASURES The medical records of patients with ESFHL were examined. Organs at risk were contoured, and doses were calculated. Progression-free survival, defined from date of diagnosis to disease progression, relapse, or death, and overall survival were estimated using the Kaplan-Meier method. RESULTS The cohort comprised 42 patients with ESFHL (median [range] age at diagnosis, 35 [18-74] years; 18 [43%] women; 24 [57%] with stage II disease). At a median follow-up of 44.6 (95% CI, 27.6-61.6) months, the 3-year progression-free survival and overall survival rates were 91.2% (95% CI, 74.9%-97.1%) and 97.0% (95% CI, 80.4%-99.6%), respectively. The mean heart dose was less than 5 Gy (mean, 0.8 Gy; SD, 1.5 Gy; range, 0-4.8 Gy) in all patients. The mean (SD) breast dose for both breasts was 0.1 (0.2) Gy (left breast range, 0-1.0 Gy; right breast range, 0-0.9 Gy). CONCLUSIONS AND RELEVANCE In this study, combined modality therapy with 2 cycles of ABVD and 20 Gy for ESFHL was highly effective and avoided excess doses to organs at risk, which may limit long-term toxic effects.

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Radiation Dose-Response Relationship for Risk of Coronary Heart Disease in Survivors of Hodgkin Lymphoma

Abstract: The linear radiation dose-response relationship identified can be used to predict CHD risk for future HL patients and survivors. Appropriate early management of CHD risk factors and stimulation of physical activity may reduce CHD risk in HL survivors.

Cited by 370 publications

References 29 publications

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

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

Assessment of Radiation Doses Delivered to Organs at Risk Among Patients With Early-Stage Favorable Hodgkin Lymphoma Treated With Contemporary Radiation Therapy

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