Screening Hodgkin lymphoma survivors for radiotherapy induced cardiovascular disease

Leeuwen-Segarceanu, Elena M. van; Bos, Willem Jan W.; Dorresteijn, Lucille D.A.; Rensing, Benno J.; Heyden, Jan A.S. Van der; Vogels, O.J.M.; Biesma, Douwe H.

doi:10.1016/j.ctrv.2010.12.004

Cited by 66 publications

(35 citation statements)

References 81 publications

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“…In the meantime, long-term follow-up screening guidelines recommended by the Children's Oncology Group can be applied to the cardiovascular screening of childhood cancer survivors. 274 European studies 275 have recommended that patients treated with combined therapy and radiation for lymphomas be screened by coronary artery calcium score measurements or computed tomography (CT) angiography; they recommended that such monitoring should begin 10 years after radiotherapy. An ECG is recommended at each cardiovascular screening visit to detect arrhythmias or conduction abnormalities.…”

Section: Timing and Frequency Of Monitoringmentioning

confidence: 99%

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

Lipshultz¹,

Adams²,

Colan³

et al. 2013

Circulation

504

436

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Section: Timing and Frequency Of Monitoringmentioning

confidence: 99%

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

Lipshultz¹,

Adams²,

Colan³

et al. 2013

Circulation

504

436

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“…This technology may be useful in two respects: first, for evaluating the pericardium of patients that received radiation or surgical treatments to identify abnormal thickening and calcification of the pericardium, and second, to measure coronary artery calcium or directly visualize the coronary arteries (67). Although coronary artery calcium scores are elevated when mediastinal radiation is administered at doses >20 Gray (68,69), and anthracycline chemotherapy has been associated with accelerated atherosclerosis (69-72), in the absence of symptomatic CAD, there is currently insufficient data to recommend a routine use of coronary CT angiography or calcium scoring in patients who underwent high-dose radiation therapy. In addition, the presence of coronary artery calcification prior to treatment for cancer has not been shown to predict future CV risk upon receipt of chemotherapy, tyrosine kinase inhibitors or radiation therapy.…”

Section: Cardiac Computed Tomography (Cct)mentioning

confidence: 99%

Noninvasive Imaging of Cardiovascular Injury Related to the Treatment of Cancer

Kongbundansuk

Hundley

2014

JACC: Cardiovascular Imaging

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The introduction of multiple treatments for cancer, including chemotherapeutic agents and radiation therapy, has significantly reduced cancer-related morbidity and mortality. However, these therapies can promote a variety of toxicities, among the most severe being the ones involving the cardiovascular system. Currently, for many surviving cancer patients, cardiovascular (CV) events represent the primary cause of morbidity and mortality. Recent data suggests that CV injury occurs early during cancer treatment, creating a substrate for subsequent cardiovascular events. Researchers have investigated the utility of noninvasive imaging strategies to detect the presence of CV injury during and after completion of cancer treatment because it starts early during cancer therapy, often preceding the development of chemotherapy or cancer therapeutics related cardiac dysfunction. In this state of the art article, we review the utility of current clinical and investigative CV noninvasive modalities for the identification and characterization of cancer treatment-related CV toxicity.

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“…Severe CHD can be asymptomatic in HL survivors [27]. Thus, reliance on clinical history (i.e., symptoms of ischemia) or traditional risk factors for the CV follow-up care of these patients may be unsuitable, and screening for asymptomatic CHD in this high-risk group with stress testing or CT coronary angiography has been proposed [28,29].…”

Section: Adverse CV Consequences Of Hl Treatmentmentioning

confidence: 99%

Modulation of Cardiovascular Toxicity in Hodgkin Lymphoma: Potential Role and Mechanisms of Aerobic Training

Jones

2015

Future Cardiol.

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Hodgkin lymphoma (HL) outcomes have improved due to advances in cancer treatment. However, HL survivors remain at increased risk for cardiovascular (CV) morbidity and mortality related to the long-term cardiotoxicity of HL treatment, particularly anthracycline chemotherapy and mediastinal radiotherapy. The role of aerobic training for the prevention of CV disease in the general population has been well established. However the safety and efficacy of aerobic training on CV outcomes has not been well studied in HL survivors. The purpose of this paper is to provide an up-to-date summary of the treatment-related adverse CV effects in HL survivors, review the CV benefits of exercise and review the limited evidence on the potential CV benefit of aerobic training in HL survivors. Keywords• aerobic trainingHodgkin lymphoma (HL) is now a curable disease with a 5-year survival rate of 86%, and significant survival gains have been achieved through advances of multiagent chemotherapy and radiotherapy [1,2]. The specific treatment regimen for HL varies depending on the presenting stage and other prognostic factors, but anthracycline-based chemotherapy and radiotherapy have emerged as standard components of initial therapy for early stage HL [3]. Given the improved prognosis of HL survivors, the long-term consequences, particularly the cardiovascular (CV) late effects, of HL treatment are becoming an increasingly important aspect of long-term management of HL survivors.HL survivors are at markedly increased risk of cardiovascular disease (CVD) compared with the general population [4][5][6]. A robust series of studies indicate an increased risk of myocardial infarction, congestive heart failure and CVD-related mortality in HL survivors [7][8][9]. Of note, CVD is the leading nonmalignant cause of death among HL survivors, exceeded only by death related to HL or secondary malignancies [8]. The increased risk of CV events in HL survivors persists beyond 25 years from diagnosis, even when the background cardiac event rate in the general population starts to increase [10]. A major challenge in the management of HL patients is to develop strategies that minimize CV-related morbidity and mortality while maintaining the efficacy of anticancer regimens.Proposed strategies to minimize the CV events related to HL therapy include the use of modern irradiation techniques to reduce cardiac dose, omission of radiotherapy altogether, anthracycline dose reduction, use of liposomal anthracycline preparations and cardioprotective drugs such as iron chelators (e.g., dexrazoxane) [11][12][13][14]. There is concern, however, that some of the proposed strategies may diminish the anticancer efficacy of treatment [15,16]. In addition, these strategies have the potential to decrease, but not eliminate, the risk of CV toxicity related to HL treatment exposures.Physical activity is defined as any movement produced by skeletal muscles that results in energy expenditure, whereas exercise is defined as a regular regimen of physical activity performed for th...

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Screening Hodgkin lymphoma survivors for radiotherapy induced cardiovascular disease

Cited by 66 publications

References 81 publications

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions

Noninvasive Imaging of Cardiovascular Injury Related to the Treatment of Cancer

Modulation of Cardiovascular Toxicity in Hodgkin Lymphoma: Potential Role and Mechanisms of Aerobic Training

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