Related Experiment Videos
Cardiac lesions after mediastinal irradiation for Hodgkin's disease
C Glanzmann1, P Huguenin, U M Lütolf
1Department of Radio-Oncology, University Hospital Zürich, Switzerland.
Insights
Modern radiotherapy for Hodgkin's disease may increase heart attack risk, especially in patients with existing risk factors. Managing these factors and considering cardiac risk in treatment decisions is crucial.
Area of Science:
- Cardiology
- Oncology
- Radiotherapy
Background:
- Hodgkin's disease treatment, particularly radiotherapy, can pose risks to cardiac health.
- Modern radiotherapy techniques aim to minimize cardiac exposure, but long-term effects require evaluation.
Purpose of the Study:
- To analyze the risk of myocardial infarctions and sudden cardiac death in Hodgkin's disease patients treated with radiotherapy.
- To identify factors influencing cardiac events and recommend appropriate follow-up strategies.
Main Methods:
- Retrospective analysis of 339 Hodgkin's disease patients treated with radiotherapy.
- Cardiac assessment including echocardiography, electrocardiogram, and myocardial scintigraphy in 112 patients.
- Evaluation of coronary artery disease (CAD) risk factors and cardiac valve function.
Main Results:
- A significantly increased risk of myocardial infarction or sudden death was observed in 10 patients.
- No cardiac events occurred in 215 non-smokers without hypertension and pre-existing CAD.
- Sclerosis of aortic and mitral valves was noted in 34 patients, with some developing stenosis or regurgitation.
Conclusions:
- Patients without pre-existing cardiac risk factors have a low risk of ischemic cardiac events after modern mediastinal radiotherapy for Hodgkin's disease.
- Eliminating known cardiac risk factors is recommended for patients.
- Routine echocardiography every 3-4 years is advised for cardiac monitoring.
Abstract:
We analysed the risk of myocardial infarctions in 339 patients with Hodgkin's disease treated with radiotherapy (rt) with or without chemotherapy. A total of 112 patients underwent cardiac testing with echocardiography, rest and exercise electrocardiogram and myocardial scintigraphy. Nearly all patients have been treated with < 2.0 Gy per fraction to the anterior cardiac region. A significantly increased risk of myocardial infarctions or of sudden death has been observed (10 patients). No cardia events have been observed in 215 non-smokers without hypertension and without coronary artery disease (CAD) already present before rt. In the heart study group (112 patients), there were 6 patients with probable or proven CAD. Five of these 6 patients had known risk factors for CAD. Echocardiography showed sclerosis of the aortic and or the mitral valves in 34 patients. Of these patients, 2 had a slight and 1 a moderate aortic stenosis, 5 had a slight and 1 a moderate mitral regurgitation. Evidence for a disturbance of the diastolic function has not been observed. No patient had a clinically relevant pericardial lesion. In patients without risk factors for CAD, there is only a low risk of ischaemic cardiac events after modern mediastinal rt for Hodgkin's disease. Patients should eliminate the known risk factors. There is a high incidence of sclerosis of the mitral and or the aortic valves developing into clinically important lesions in few patients. Decision on the treatment strategy and the rt technique should also involve consideration of the cardiac risk. For routine follow-up, we recommend inclusion of an echocardiography in intervals between 3 and 4 years.