Long-Term Cause-Specific Mortality of Patients Treated for Hodgkin’s Disease

Aleman, Berthe M.P.; Belt-Dusebout, Alexandra W. van den; Klokman, Willem J.; Veer, M. B. Van't; Bartelink, Harry; Leeuwen, Flora E. van

doi:10.1200/jco.2003.07.131

Cited by 660 publications

(463 citation statements)

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“…There are known confounding factors in the development of cardiac mortality that were not accounted for in this work such as smoking, hypertension, obesity, and family history, all of which may play an important role with regard to heart disease. Chemotherapy affects both the risks of cardiotoxicity and developing secondary malignancies, while genetic susceptibility and age at irradiation may also affect the risks of developing secondary malignancies 3 , 5 , 13 . Radiation damage to the heart has been found to affect radiation‐induced lung damage (40) .…”

Section: Discussionmentioning

confidence: 99%

“…In such cases, five‐year overall survival is expected to approach approximately 95% (2) . However, it is now well established that, in the longer term, these patients are at risk for thoracic radiotherapy treatment‐related death, in particular due to cardiovascular events and secondary malignancies 3 , 4 , 5 . Cause‐specific mortality studies of patients with HL note secondary malignancy and cardiovascular failure as the second and third leading causes of death, respectively, after death due to HL (3) .…”

Section: Introductionmentioning

confidence: 99%

“…However, it is now well established that, in the longer term, these patients are at risk for thoracic radiotherapy treatment‐related death, in particular due to cardiovascular events and secondary malignancies 3 , 4 , 5 . Cause‐specific mortality studies of patients with HL note secondary malignancy and cardiovascular failure as the second and third leading causes of death, respectively, after death due to HL (3) . Following thoracic radiotherapy, one‐third or more young female patients will develop breast cancer 5 , 6 , 7 , 8 .…”

Section: Introductionmentioning

confidence: 99%

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Late radiation toxicity in Hodgkin lymphoma patients: proton therapy's potential

Toltz

Shin

Mitrou

et al. 2015

J Applied Clin Med Phys

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In 2010, all young patients treated for intrathoracic Hodgkin lymphoma (HL) at one of 10 radiotherapy centers in the province of Quebec received 3D conformal photon therapy. These patients may now be at risk for late effects of their treatment, notably secondary malignancies and cardiac toxicity. We hypothesized that more complex radiotherapy, including intensity‐modulated proton therapy (IMPT) and possibly IMRT (in the form of helical tomotherapy (HT)), could benefit these patients. With institutional review board approval at 10 institutions, all treatment plans for patients under the age of 30 treated for HL during a six‐month consecutive period of 2010 were retrieved. Twenty‐six patients were identified, and after excluding patients with extrathoracic radiation or treatment of recurrence, 20 patients were replanned for HT and IMPT. Neutron dose for IMPT plans was estimated from published measurements. The relative seriality model was used to predict excess risk of cardiac mortality. A modified linear quadratic model was used to predict the excess absolute risk for induction of lung cancer and, in female patients, breast cancer. Model parameters were derived from published data. Predicted risk for cardiac mortality was similar among the three treatment techniques (absolute excess risk of cardiac mortality was not reduced for HT or IMPT (p>0.05,p>0.05) as compared to 3D CRT). Predicted risks were increased for HT and reduced for IMPT for secondary lung cancer (p<0.001,p<0.001) and breast cancers (p<0.001,p<0.001) as compared to 3D CRT.PACS numbers: 87.55.dh, 87.55.dk

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Late radiation toxicity in Hodgkin lymphoma patients: proton therapy's potential

Toltz

Shin

Mitrou

et al. 2015

J Applied Clin Med Phys

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“…Heart mean dose and V30 were significantly reduced for all Nonco_IMRT plans compared with conventional AP–PA plans, which has been blamed for inducing late cardiac complications 18 , 19 . Nonco_IMRT was obviously superior for spinal cord sparing, and the mean dose of radiation delivered to normal tissue outside the PTV was 4% lower than in the AP–PA treatment.…”

Section: Discussionmentioning

confidence: 96%

“…High cure rates in mediastinal lymphoma result in long life expectancy; thus, reducing late complications, such as second cancers and cardiac toxicity, are important 18 , 19 …”

Section: Discussionmentioning

confidence: 99%

Noncoplanar intensity‐modulated radiation therapy for young female patients with mediastinal lymphoma

Chen

Jin

Wang

et al. 2012

J Applied Clin Med Phys

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The purpose of this study is to apply noncoplanar intensity‐modulated radiation therapy (Nonco_IMRT) to young female patients with mediastinal lymphoma. Nonco_IMRT was evaluated through a planning comparison study with coplanar IMRT (Co_IMRT) and conventional anteroposterior and posteroanterior fields (AP–PA) plans. Co_IMRT was performed with five equally spaced beams starting from a gantry angle of 216°. Nonco_IMRT used two noncoplanar beams in the sagittal plane to replace the Co_IMRT beams that directly irradiated the breasts. Nineteen young female patients were enrolled in the retrospective study. Dose coverage of the planning target volume (PTV) and the dose delivered to organs at risk (OARs) were analyzed. For all patients, PTV coverage and heart V30 were similar between the two IMRT techniques (p < 0.05). Compared to Co_IMRT, the mean dose delivered and regions receiving a low radiation dose were significantly reduced for bilateral breasts and lungs in Nonco_IMRT (p < 0.05). Breast V5 and lung V5 were relatively reduced by 21% and 12%, respectively. Compared with the conventional AP–PA plan, Nonco_IMRT had better PTV coverage and OARs sparing, except for being larger in V5 to breast and lung. In IMRT for young female patients with mediastinal lymphoma, using of Nonco_IMRT significantly reduces the radiation dose to the breasts and lungs compared with Co_IMRT, and consequently reduces the risk of breast second cancer and pulmonary toxicity. Besides young female patients, Nonco_IMRT can also benefit other mediastinal lymphoma patients.PACS number: 87.55.D‐

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