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Query: UMLS:C0019829 (Hodgkin's disease)
 30,247 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The objectives of this study were to prospectively screen a cohort of asymptomatic long-term survivors of Hodgkin lymphoma (HL) treated with chest irradiation for occult cardiovascular disease (CVD), and correlate screen-detected disease with prospectively measured cardiovascular risk factors (CRFs). A total of 182 HL survivors treated with chest irradiation (median follow-up time 14.8 years) were enrolled and underwent prospective CRF measurement and resting and stress echocardiography to assess coronary artery disease (CAD)/valve disease and left ventricular systolic dysfunction (LVSD). Forty-seven (26%) patients had occult CAD/valve disease and/or LVSD. LVSD was not correlated with CRFs. Controlling for treatment factors, hypertension (odds ratio [OR] = 3.0) and elevated high-sensitivity C-reactive protein (hs-CRP) (OR = 2.7) increased the likelihood of occult CAD/valve disease. Risk of CAD/valve disease rose exponentially with increasing blood pressure (BP) values, even in the normal range. Our findings suggest that BP screening may be useful in determining those survivors at greatest risk for occult CVD.
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PMID:Blood pressure is associated with occult cardiovascular disease in prospectively studied Hodgkin lymphoma survivors after chest radiation. 2439 15

Hodgkin lymphoma has gone from an incurable disease to one for which the majority of patients will be cured. Combined chemotherapy and radiotherapy achieves the best disease control rates and results in many long-term survivors. As a result, a majority of long-term Hodgkin lymphoma survivors live to experience severe late treatment-related complications, especially cardiovascular disease and second malignancies. The focus of research and treatment for Hodgkin lymphoma is to maintain the current high rates of disease control while reducing treatment-related morbidity and mortality. Efforts to reduce late treatment complications focus on improvements in both systemic therapies and radiotherapy. Herein we review the basis for the benefits of proton therapy over conventional X-ray therapy. We review outcomes of Hodgkin lymphoma treated with proton therapy, and discuss the ability of protons to reduce radiation dose to organs at risk and the impact on the most significant late complications related to the treatment.
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PMID:Proton therapy for Hodgkin lymphoma. 2484 7

Hodgkin's lymphoma is affecting young adults and having exhibited a fairly constant frequency over the past few years. Hodgkin's lymphoma in a young adult has a good prognosis, with only approximately 10% of patients dying of disease. Hodgkin's lymphoma in an elderly patient is more difficult to treat. Cytostatic chemotherapy combined with radiotherapy is the treatment of choice. New recommendations involve a reduced volume of radiotherapy. In long-term follow-up, increased numbers of new cancers and cardiovascular disease are found in patients having had Hodgkin's lymphoma as compared with the reference population.
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PMID:[Hodgkin's lymphoma]. 2488 Nov 43

Higher mortality rates are reported because of cardiovascular diseases in individuals living in industrialized areas of the World. In cancer patients, cardiotoxic chemotherapeutic agents and/or mediastinal radiotherapy are additional risk factors for the development of coronary artery disease. An improved survival rate for patients with Hodgkin lymphoma was reported in recent decades. Determining and handling the long-term effects of cancer treatment have become more important nowadays, parallel to the good results reached in survival rates. Mediastinal radiotherapy and cardiotoxic chemotherapeutic agents are routinely used to treat Hodgkin lymphoma but are commonly associated with a variety of cardiovascular complications. Drugs used in cancer treatment and radiotherapy may cause deleterious effects on contractile capacity and conduction system of the heart. Approximately ten years after the completion of all therapies, the cardiovascular disease risk peaks in patients who survived from Hodgkin lymphoma. The value of coronary computed tomography angiography as a diagnostic tool in determining coronary artery disease as early as possible is underlined in this review, in patients who are in remission and carry the risk of coronary artery disease probably because of chemo/radiotherapy used in their treatment. Survivors of Hodgkin lymphoma especially treated with combined chemoradiotherapy at younger ages are candidates for coronary computed tomography angiography.
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PMID:Risks and diagnosis of coronary artery disease in Hodgkin lymphoma survivors. 2506 16

Analysis of data from the international Collaborative Transplant Study has revealed striking relationships between human leukocyte antigen mismatching and graft survival, the incidence of death from cardiovascular disease or infection, the occurrence of non-Hodgkin lymphoma, and onset of post-transplant osteoporosis and bone fracture following kidney transplantation from a deceased donor.
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PMID:HLA matching and kidney transplantation: beyond graft survival. 2509

Telomere length has been proposed as a marker of mitotic cell age and as a general index of human organism aging. Telomere shortening in peripheral blood lymphocytes has been linked to cardiovascular-related morbidity and mortality. The authors investigated the potential correlation of conventional risk factors, radiation dose and telomere shortening with the development of coronary artery disease (CAD) following radiation therapy in a large cohort of Hodgkin lymphoma (HL) patients. Multivariate analysis demonstrated that hypertension and telomere length were the only independent risk factors. This is the first study in a large cohort of patients that demonstrates significant telomere shortening in patients treated by radiation therapy who developed cardiovascular disease. Telomere length appears to be an independent prognostic factor that could help determine patients at high risk of developing CAD after exposure in order to implement early detection and prevention.
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PMID:Telomere shortening: a new prognostic factor for cardiovascular disease post-radiation exposure. 2527 33

The main objectives of follow-up studies after completion of treatment for Hodgkin lymphoma are detection of recurrence for salvage therapy and monitoring for sequelae of treatment. The focus of the follow-up shifts, with time after treatment, from detection of recurrence to long-term sequelae. A majority of recurrence is detected by history and physical examination. The yield for routine imaging studies and blood tests is low. Although routine surveillance CT scan can detect recurrence not detected by history and physical examination, its benefit in ultimate survival and cost-effectiveness is not well defined. Although PET scan is a useful tool in assessing response to treatment, its routine use for follow-up is not recommended. Long-term sequelae of treatment include secondary malignancy, cardiovascular disease, pneumonitis, reproductive dysfunction, and hypothyroidism. Follow-up strategies for these sequelae need to be individualized, as their risks in general depend on the dose and volume of radiation to these organs, chemotherapy, age at treatment, and predisposing factors for each sequela. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is either lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
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PMID:ACR appropriateness criteria follow-up of Hodgkin lymphoma. 2527 96

The cardiovascular sequelae of radiation exposure are an important cause of morbidity and mortality following radiation therapy for cancer, as well as after exposure to radiation after atomic bombs or nuclear accidents. In the United States, most of the data on radiation-induced heart disease (RIHD) come from patients treated with radiation therapy for Hodgkin disease and breast cancer. Additionally, people exposed to radiation from the atomic bombs in Hiroshima and Nagasaki, Japan, and the Chernobyl, Ukraine, nuclear accident have an increased risk of cardiovascular disease. The total dose of radiation, as well as the fractionation of the dose, plays an important role in the development of RIHD. All parts of the heart are affected, including the pericardium, vasculature, myocardium, valves, and conduction system. The mechanism of injury is complex, but one major mechanism is injury to endothelium in both the microvasculature and coronary arteries. This likely also contributes to damage and fibrosis within the myocardium. Additionally, various inflammatory and profibrotic cytokines contribute to injury. Diagnosis and treatment are not significantly different from those for conventional cardiovascular disease; however, screening for heart disease and lifelong cardiology follow-up is essential in patients with past radiation exposure.
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PMID:Cardiovascular complications of radiation exposure. 2529 Jul 29

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 early-detection 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 long-term 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.
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PMID:Current survivorship recommendations for patients with Hodgkin lymphoma: focus on late effects. 2542 19

The term "cancer survivor" refers to anyone living with a diagnosis of cancer. As the U.S. population ages, cancer screening increases, and cancer treatments improve, millions more Americans will be classified as cancer survivors in the future. Although many survivors wish to continue care with their oncologists, patients benefit from care provided by a family physician. Many survivors are older and have comorbidities, which should be addressed to optimize function and longevity. Common late effects of cancer and its treatment include second primary cancers, sexual dysfunction, and psychosocial issues. Cancer recurrence is a significant concern. After treatment for colorectal cancer, intensive surveillance, including colonoscopy, imaging, and serology, confers an overall survival benefit. Breast cancer survivors should receive annual mammography. Prostate cancer survivors should undergo prostate-specific antigen testing every six to 12 months. Melanoma survivors should be counseled on sun protection, including daily sunscreen use, and recognizing characteristics of potentially malignant skin lesions. Female survivors of Hodgkin lymphoma who were treated with chest or axillary radiation between 10 and 30 years of age are at high risk of breast cancer, and should be screened with mammography and magnetic resonance imaging annually starting eight to 10 years after the diagnosis. All cancer survivors treated with chest radiation are at increased risk of cardiovascular disease, and should be screened for other cardiovascular risk factors and treated as indicated.
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PMID:Surveillance of the adult cancer survivor. 2559 Nov 98


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