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Long-term cardiac mortality following radiation therapy for Hodgkin's disease: analysis with the relative seriality
F Eriksson1, G Gagliardi, A Liedberg
1Department of Hospital Physics, Radiumhemmet Karolinska Hospital, Stockholm, Sweden.
Insights
Patients treated for Hodgkin
Area of Science:
- Radiation oncology
- Cardiovascular epidemiology
- Biophysical modeling
Background:
- Radiation therapy (RT) is a primary treatment for Hodgkin's disease (HD).
- Long-term survivors of HD treated with RT may face increased risks of secondary conditions.
- Ischemic heart disease (IHD) is a significant concern in this patient population.
Purpose of the Study:
- To evaluate the elevated risk of death from IHD in patients treated for HD with RT.
- To establish a dose-response relationship for IHD risk using a biophysical model.
Main Methods:
- Retrospective analysis of 157 HD patients treated with RT (1972-1985).
- Comparison with a general population control group.
- RT dose reconstruction and analysis using the relative seriality model and dose-volume histograms (DVH).
Main Results:
- A significantly higher incidence of IHD mortality was observed (Standardized Mortality Ratio = 5.0).
- IHD risk increased with higher radiation doses and larger irradiated heart volumes.
- Biophysical model parameters (D(50)=71 Gy, gamma=0.96, s=1.0) quantified the dose-response.
Conclusions:
- Radiation therapy for Hodgkin's disease is associated with a significantly increased risk of IHD death.
- The risk of IHD is dose-dependent and influenced by the irradiated heart volume.
- Findings highlight the importance of cardiac dose management in RT for HD.
Purpose:
(a) To assess the increased risk of death due to ischemic heart disease (IHD) in a group of patients treated for Hodgkin's disease (HD) with radiation therapy (RT) as the primary treatment. (b) To quantify the dose response of IHD using a biophysical model.
Materials And Methods:
Patient material consisted of 157 patients diagnosed for HD between 1972 and 1985 who received RT as the primary treatment at Radiumhemmet, Karolinska Hospital. The general population formed the control group. The RT treatments were reconstructed based on the individual treatment data and simulator films. Individual clinical and dosimetrical data were analyzed with the relative seriality model. The material was also analyzed grouping the material according to dose-volume constraints.
Results:
Of the 157 patients, 13 (8.3%) died due to IHD. The standardized mortality ratio (SMR) was 5.0 (95% CI, 2.7-8.6). Analysis of dose-volume histograms (DVH) showed an increasing risk with increasing dose to a larger volume fraction. The observed individual clinical complication data could not be modeled unambiguously. The group analysis resulted in the dose-response parameters: D(50)=71 Gy, gamma=0.96 and s=1.0.
Conclusions:
A significantly increased risk of death due to IHD following RT for HD was found. The risk was found to increase with higher dose and larger volume fraction irradiated.
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