Late valvular and other cardiac diseases after different doses of mediastinal radiotherapy for hodgkin disease in children and adolescents: Report from the longitudinal GPOH follow-up project of the German-Austrian DAL-HD studies

Abstract

Our results indicate that lower MedRDs are less cardiotoxic. Consequently, reduction of cardiac late effects may be expected with the lower radiation doses used in current HD protocols. Longer follow-up is needed to confirm the present results.

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

“…The risk of cardiac disease is directly related to radiation doses. 23,24 In a study of 1132 pediatric HL survivors treated on 5 consecutive German-Austrian pediatric trials, the 25-year cumulative incidence of cardiac disease in the group with a mediastinal radiation dose of 36 Gy was 21% and the risk decreased significantly to 10%, 6%, 5%, and 3% in those with lower mediastinal radiation doses of 30, 25, 20, and 0 Gy, respectively (P , .001). 23 On multivariable analysis, mediastinal radiation dose was the only significant factor predicting for cardiac disease-free survival (P 5 .0025).…”

“…The largest cardiac screening experience is from Stanford University on 294 asymptomatic HL survivors who had received mantle radiation therapy to a median BLOOD, 27 NOVEMBER 2014 x VOLUME 124, NUMBER 23 …”

Some considerations for future research into the risks of radiation-induced cardiovascular diseases

“…The most important studies addressed the cardiovascular disease risk of patients who had been cured from breast cancer by postoperative radiotherapy [8,9]. Other radiotherapy studies explored more specific heart diseases, such as myocardial infarction or valvular diseases [10,11]. An increased mortality from heart diseases was also demonstrated among people who had been occupationally exposed to ionizing radiation [12,13].…”

“…Very few cohorts are available for such a study. By far the best option is the German Childhood Hodgkin Disease Study [11], which is a sequence of randomized clinical studies. In every subsequent study, the prescribed dose was reduced such that five different prescribed dose levels can be compared.…”

From heart to heart for breast cancer patients—cardiovascular toxicities in breast cancer radiotherapy

“…Investigations by Schellong et al [12] suggest that it is a critical late effect particularly after radiotherapy of children. No reliable data are available on dose thresholds for either conduction defects or valvular damage.…”