Related Experiment Videos
[The late cardiac sequelae after mantle-field irradiation. The results in Erlangen's patient caseload]
S A Friedrich1, M Unverdorben, B Kunkel
1Strahlentherapeutische Klinik und Poliklinik, Universität Erlangen-Nürnberg.
Insights
Mantle irradiation for Hodgkin
Area of Science:
- Cardiology
- Radiation Oncology
- Oncology
Background:
- Mantle irradiation is a common treatment for Hodgkin's disease.
- Cardiac function can be affected by radiation therapy.
- Long-term cardiac effects of mantle irradiation require evaluation.
Purpose of the Study:
- To retrospectively evaluate cardiac function in patients treated with mantle irradiation for Hodgkin's disease.
- To identify potential cardiac abnormalities following mantle irradiation.
Main Methods:
- Retrospective analysis of 43 Hodgkin's disease patients treated with mantle irradiation (1979-1984).
- Patients underwent anamnesis, physical examination, Doppler echocardiography, and ergometry.
- A control group of 122 non-irradiated volunteers and patients was used for comparison.
Main Results:
- No patients reported clinical symptoms of cardiac dysfunction.
- Left ventricular systolic function and dimensions were within normal limits.
- Significant decreases in isovolumic relaxation time and shortening fraction were observed, particularly after combined modality therapy.
Conclusions:
- Mantle irradiation with modern techniques resulted in minimal cardiac abnormalities within 10 years post-treatment.
- Isovolumic relaxation time was the most sensitive indicator of cardiac changes.
- Findings support the theory of radiotherapy-induced myocardial damage potentially leading to increased beta-receptor density.
Purpose:
We have retrospectively evaluated the cardiac function in patients after mantle-irradiation for Hodgkin's disease.
Patients And Methods:
Forty-three patients, mean age 39.8 +/- 13 years, who had been treated with mantle-irradiation from 1979 through 1984 at the University of Erlangen-Nürnberg, were examined. All of them were in first remission at 5 to 11 years (mean 8.1 years) after radiotherapy (n = 24) or combined modality treatment (n = 19). Mantle-irradiation had been administered through equally weighted anterioposterior-posterioanterior portals with 5 fractions of 2 Gy per week up to a total mediastinal dose of 41.8 +/- 7 Gy (including boost). The examination program included anamnesis, physical examination, Doppler echocardiography and ergometry. Hundred and twenty-two non-irradiated volunteers and cardiological patients were used as control group.
Results:
None of the patients suffered from clinical symptoms. Pericardial thickening was present in 26%. The left ventricular end-systolic diameter (31.3 +/- 5.5 mm, normal value 26 to 42 mm) and the thickness of the left ventricular posterior wall (8.1 +/- 1.8 mm, normal value 6 to 11 mm) were within the normal range. The left ventricular ejection fraction was also normal (67.1 +/- 8% in patients versus 67.0 +/- 8% in control subjects). Evaluation of diastolic parameters, however, revealed significant changes. The isovolumic relaxation time was significantly decreased as compared to the control group (38.8 +/- 17 ms versus 50.8 +/- 21 ms, p < 0.05). The same we found for the shortening fraction (33.6 +/- 6% versus 38.1 +/- 6%, p < 0.05). The most significant changes were found after combined modality therapy, especially after radiotherapy and anthracycline-based chemotherapy. 30% of the patients were tachycardic (pulse > 100/min) at rest. At ergometry, the frequency of signs of ischemia (5%), conduction disturbances (2%), and rhythm disturbances (7%) was not elevated.
Conclusions:
In this retrospective investigation, patients after mantle irradiation with modern techniques showed only minimal cardiologic abnormalities within the first 10 years after treatment. The most sensitive parameters were the isovolumic relaxation times. The clinical relevance of such findings remains to be defined. Pathophysiologically, our findings (decreased relaxation time plus tachycardia) support the theory that myocardial damage after radiotherapy may result in subsequent increased beta-receptor density as proposed by Schultz-Hector et al. [21] on the basis of experimental data.