Increased Risk of Stroke and Transient Ischemic Attack in 5-Year Survivors of Hodgkin Lymphoma

Bruin, Marie L. De; Dorresteijn, Lucille D.A.; Veer, M. B. Van't; Krol, Augustinus D.G.; Pal, Helena J. van der; Kappelle, A.C.; Boogerd, Willem; Aleman, Berthe M.P.; Leeuwen, Flora E. van

doi:10.1093/jnci/djp147

Cited by 202 publications

(139 citation statements)

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“…31,32 The absolute risk, however, appears to be low. In one study, the incidence of stroke after mantle irradiation for HL was estimated 109.8 per 100 000 personyears, or 0.1% per person per year.…”

Section: Cardiovascular Diseasementioning

confidence: 94%

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Current survivorship recommendations for patients with Hodgkin lymphoma: focus on late effects

2014

Blood

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Long-term survivors of Hodgkin lymphoma (HL) are at an increased risk for a range of late complications, with subsequent malignant neoplasm and cardiovascular disease representing the 2 leading causes of death in these patients. Raising awareness, close follow-up, and adoption of selected earlydetection and risk-reduction strategies may help to reduce the adverse impact of these late effects on patients. This chapter reviews known long-term complications of HL therapy, risk factors, and the timing of their occurrence. Where available, data on the efficacy of screening for selected late effects of HL are presented. Current evidence-based and consensus-based recommendations on follow-up of longterm HL survivors are also reviewed. As HL therapy evolves over time, late effects and implications on follow-up of patients treated in the contemporary era should be considered and opportunities for future research should be explored. (Blood. 2014; 124(23):3373-3379)

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Section: Cardiovascular Diseasementioning

confidence: 94%

“…31 The risk was significantly associated with radiation dose 27 and history of hypertension, diabetes mellitus, and hypercholesterolemia. 27,32 Endocrinopathies HL survivors can develop a variety of endocrinopathies after therapy. The risk of hypothyroidism is as high as 60% after neck irradiation.…”

Section: Cardiovascular Diseasementioning

confidence: 99%

Current survivorship recommendations for patients with Hodgkin lymphoma: focus on late effects

2014

Blood

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“…Further details are given elsewhere. 2,10,20 This study was approved by the ethics review board of The Netherlands Cancer Institute.…”

Section: Data Collectionmentioning

confidence: 99%

Risk of heart failure in survivors of Hodgkin lymphoma: effects of cardiac exposure to radiation and anthracyclines

Nimwegen

Ntentas

Darby

et al. 2017

Blood

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174

158

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Key Points• Risk of HF increases following cardiac radiation doses above 20 Gy.• Anthracyclines increase HF rate by threefold independently of radiation.Hodgkin lymphoma (HL) survivors treated with radiotherapy and/or chemotherapy are known to have increased risks of heart failure (HF), but a radiation dose-response relationship has not previously been derived. A case-control study, nested in a cohort of 2617 five-year survivors of HL diagnosed before age 51 years during 1965 to 1995, was conducted. Cases (n 5 91) had moderate or severe HF as their first cardiovascular diagnosis. Controls (n 5 278) were matched to cases on age, sex, and HL diagnosis date. Treatment and follow-up information were abstracted from medical records. Mean heart doses and mean left ventricular doses (MLVD) were estimated by reconstruction of individual treatments on representative computed tomography datasets. Average MLVD was 16.7 Gy for cases and 13.8 Gy for controls (P difference 5 .003). HF rate increased with MLVD: relative to 0 Gy, HF rates following MVLD of 1-15, 16-20, 21-25, and ‡26 Gy were 1.27, 1.65, 3.84, and 4.39, respectively (P trend < .001). Anthracyclinecontaining chemotherapy increased HF rate by a factor of 2.83 (95% CI: 1.43-5.59), and there was no significant interaction with MLVD (P interaction 5 .09). Twenty-five-year cumulative risks of HF following MLVDs of 0-15 Gy, 16-20 Gy, and ‡21 Gy were 4.4%, 6.2%, and 13.3%, respectively, in patients treated without anthracycline-containing chemotherapy, and 11.2%, 15.9%, and 32.9%, respectively, in patients treated with anthracyclines. We have derived quantitative estimates of HF risk in patients treated for HL following radiotherapy with or without anthracycline-containing chemotherapy. Our results enable estimation of HF risk for patients before treatment, during radiotherapy planning, and during follow-up. (Blood. 2017;129(16):2257-2265 Medscape Continuing

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“…Ryzyko udaru mózgu jest zwiększone, co najmniej 2-krotnie, po radioterapii celowanej na śródpiersie, szyję lub głowę [195]. W następstwie napromienienia małych naczyń mózgu może dojść do uszkodzenia śródbłonka i wytworzenia się skrzepliny [196].…”

Section: Udar Mózguunclassified

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

Zamorano¹,

Lancellotti²,

Muñoz³

et al. 2016

Kardiol Pol

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Increased Risk of Stroke and Transient Ischemic Attack in 5-Year Survivors of Hodgkin Lymphoma

Abstract: Patients treated for Hodgkin lymphoma experience a substantially increased risk of stroke and TIA, associated with radiation to the neck and mediastinum. Physicians should consider appropriate risk-reducing strategies.

Cited by 202 publications

References 31 publications

Current survivorship recommendations for patients with Hodgkin lymphoma: focus on late effects

Current survivorship recommendations for patients with Hodgkin lymphoma: focus on late effects

Risk of heart failure in survivors of Hodgkin lymphoma: effects of cardiac exposure to radiation and anthracyclines

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

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