Morbidity of mediastinal irradiationDosimetric predictors of asymptomatic heart valvular dysfunction following mediastinal irradiation for Hodgkin’s lymphoma
Section snippets
Patient section
Data on 63 consecutive patients with Hodgkin’s disease undergoing post-chemotherapy supradiaphragmatic involved-field radiation therapy at the Department of Radiotherapy of the University “Federico II” of Naples between 2002 and 2008 were reviewed. Selection criteria included a minimum of a 30 months interval from HL therapy, the availability of cardiac evaluation with electrocardiography and echocardiography before chemotherapy (CHT), after CHT, and, periodically, after radiation therapy (RT)
Results
A total of 63 patients were analyzed in this study. Seven patients (11.1%) showed pre-existing cardiac abnormalities at the basal echocardiography and were consequently excluded from further evaluation. Demographic, disease and treatment characteristics of the remaining 56 patients are shown in Table 1. No electrocardiography abnormalities were detected in these patients.
At a median follow-up of 70.5 months (range, 36–110) after the end of radiation treatment, 18 out of 56 patients (32.1%)
Discussion
Hodgkin’s lymphoma survivors treated with mediastinal radiotherapy are particularly at risk of cardiovascular disease like myocardial infarction, angina pectoris, congestive heart failure, and valvular disorders. Despite the predominant role of radiation therapy on long-term cardiac effects [7], little information is available to date on preclinical heart disease following thoracic irradiation and dose–volume correlations. In the spectrum of cardiac pathology, asymptomatic valvular dysfunction
Conclusions
We have identified the cardiac chambers as critical target volumes for the development of asymptomatic heart valve defects in HL patients treated with sequential chemo-radiotherapy. We have also determined three dose–volume predictors of the risk of developing VD: LA-V25 = 63%, LV-V30 = 25%, and RV-V30 = 62% (dose fraction of 1.6 Gy). Although it is not possible to exclude that lower doses of radiation may be responsible of some valvular damage, the inclusion of these parameters in the treatment plan
Conflict of interest
The authors declare no conflict of interest.
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2021, JACC: CardioOncologyCitation Excerpt :In studies of patients with childhood cancers, LV doses correlated with heart failure (24) and increased left atrial volumes on cardiac magnetic resonance imaging (CMRI) (26). Other studies have found that doses to the ventricles correlate with outcomes such as decreased LV ejection fraction, valvular defects, acute coronary syndrome, and/or survival (19,20,22,27). In lung cancer, doses to the base of heart and its structures (atria and proximal great vessels) have repeatedly been found to correlate with cardiac outcomes and survival.