[Coronary stenosis following successful radiotherapy for Hodgkin disease]

Three male patients, aged 43, 41 and 44 years, were referred to the cardiologist because of complaints of angina pectoris; one of them also had an aortic valve stenosis. Nine to 22 years before, they had received radiotherapy on the mediastinum because of Hodgkin's disease. Coronary angiography showed severe stenoses of the ostium of the right coronary artery or of the main left coronary artery, following which the patients were treated with coronary artery bypass surgery, aortic valve replacement and (or) drugs. These locations are very unusual in patients with angina who did not receive any radiation therapy, but they are seen frequently in patients who have received radiotherapy on the mediastinum. The pathogenesis of these lesions is not exactly known. The normal risk factors for atherosclerosis plus free oxygen radicals are probably involved. The free oxygen radicals, generated by radiation, locally activate coagulation via various hypothetical mechanisms. The damaging effect of radiotherapy could therefore be prevented by antioxidants. However, the therapeutic effect of radiation would most likely decrease as well. A more rational approach to prevent these vascular lesions would be to reduce the radiation load, to treat the risk factors for atherosclerosis and to give platelet aggregation inhibitors such as acetylsalicylic acid.