Cardiac disease after mediastinal irradiation for seminoma

Abstract

One hundred twenty-four patients with seminoma (119 primary testis, five primary extragonadal) were treated between 1968 and 1984 at the Joint Center for Radiation Therapy. Fifty-seven of the 124 patients were treated with irradiation to the mediastinum as well as to an infradiaphragmatic field. One patient received supradiaphragmatic radiotherapy only. The remaining patients had radiation treatment limited to the infradiaphragmatic field only. Median dose to the mediastinum among the 58 patients was 2400 cGy. Four patients developed heart disease (one fatal myocardial infarction, one uncomplicated myocardial infarction, one constrictive pericarditis resulting in permanent total body anasarca, and one patient requiring aortic valve replacement and coronary artery bypass grafting for atherosclerotic disease) and two died suddenly. The two sudden deaths were thought to be cardiac in origin by the patient's primary physicians. All six complications occurred in the group that received mediastinal irradiation. No cardiac disease was manifested in the group not treated with mediastinal irradiation. This difference in the incidence of cardiac disease between the two groups is statistically significant (two sided, P = 0.019). Neither group had a statistically significant difference in cardiac disease rate from a normal population (Framingham study), although the ratio of observed to expected cardiac disease was 1.97 in the group receiving mediastinal radiation. Further experience from this and other institutions is necessary to confirm this finding.

Predicted cardiovascular mortality and reported cardiovascular morbidity in testicular cancer survivors

“…Whereas mediastinal irradiation has been associated with increased CVD risk in TC patients [11][12][13][14], there are conflicting data regarding the association between infradiaphragmatic irradiation and CVD risk. Zagars et al [12] reported a 1.8-fold increased risk for cardiac death in seminoma patients treated with infradiaphragmatic radiotherapy alone with follow-up beyond 15 years.…”

“…Several studies have reported an association between cisplatin-based therapy and an unfavorable cardiovascular (CV) risk profile and CV morbidity [3][4][5][6][7][8][9][10][11]. Moreover, radiotherapy has also been associated with CV morbidity and mortality [10][11][12][13][14][15]. The interval between TC treatment and the occurrence of the first therapy-related cardiovascular disease (CVD) event appears to be decades rather than years [11].…”

Heart transplantation for radiation-associated end-stage heart failure

“…However, heart disease associated with MRT is a significant cause of late morbidity and mortality [2,6,11,13,15]. In Hodgkin's disease, heart disease is the second-most common cause of late death [6].…”

Long-Term Results of Radiotherapy for Early-Stage Testicular Seminoma

“…Prophylactic treatment to these sites was abandoned in the 1980s after reports demonstrated elimination of prophylactic RT to the mediastinum and SCL regions did not compromise survival but did increase the incidence in RTrelated cardiac disease. [1][2][3][4][5] In 1999, the Medical Research Council reported results evaluating RT to the paraaortic field alone (PAN) versus the traditional "dog-leg" treatment to the PAN and ipsilateral pelvis. Overall survival was not significantly different but local-regional recurrence was increased; patients who relapsed in the pelvis were successfully salvaged with chemotherapy.…”