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

As the number of cancer survivors grows because of advances in therapy, it has become more important to understand the long-term complications of these treatments. This article presents the current knowledge of adverse cardiovascular effects of radiotherapy to the chest. Emphasis is on clinical presentations, recommendations for follow-up, and treatment of patients previously exposed to irradiation. Medline literature searches were performed, and abstracts related to this topic from oncology and cardiology meetings were reviewed. Potential adverse effects of mediastinal irradiation are numerous and can include coronary artery disease, pericarditis, cardiomyopathy, valvular disease and conduction abnormalities. Damage appears to be related to dose, volume and technique of chest irradiation. Effects may initially present as subclinical abnormalities on screening tests or as catastrophic clinical events. Estimates of relative risk of fatal cardiovascular events after mediastinal irradiation for Hodgkin's disease ranges between 2.2 and 7.2 and after irradiation for left-sided breast cancer from 1.0 to 2.2. Risk is life long, and absolute risk appears to increase with length of time since exposure. Radiation-associated cardiovascular toxicity may in fact be progressive. Long-term cardiac follow-up of these patients is therefore essential, and the range of appropriate cardiac screening is discussed, although no specific, evidence-based screening regimen was found in the literature.
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PMID:Radiation-associated cardiovascular disease. 1248 72

The authors describe the disease of a 22-year-old woman treated from the age of 13 years on account of Hodgkin's lymphoma by irradiation and cytostatic treatment. On account of a relapse of lymphoma at the age of 14 years megachemotherapy with subsequent transplantation of autologous bone marrow. In the course of eight years of the follow up gradual development of constrictive pericarditis with exsudate. Concurrently progression of mitral insufficiency based on valvular prolapse resulting from radiation. During the last two years refractory systemic hypertension resistant to treatment. At the peak of the disease development of cardiac tamponade and cardiac cachexia with anasarca. After anamnestic, clinical and haemodynamic analysis total pericardetomy was indicated and mitral valve replacement performed. The operation led to improvement of the patient's condition, systemic hypertension receded completely. The patient is in permanent remission.
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PMID:[Cardiac damage in a young woman with Hodgkin's disease and long term survival after combination therapy and bone marrow transplantation]. 1266 28

Irradiation of the heart incidental to the treatment of malignancies can cause a spectrum of cardiovascular complications. These include pericarditis, myocardial fibrosis, muscular dysfunction, valvular abnormalities, and conduction disturbances. Survivors of Hodgkin's disease and breast cancer survivors treated with radiotherapy after mastectomy appear to be the groups at highest risk for radiation-associated cardiovascular disease. Although modern techniques of chest radiotherapy have decreased its frequency by reducing the dose and volume of radiation exposure to the heart, survivors treated with radiation remain at increased risk of cardiovascular disease. The risk of fatal cardiovascular disease increases with younger age at treatment, longer follow-up, and higher dose volumes of exposure to the heart. Certain chemotherapeutic agents, such as anthracyclines, also increase the risk of damage to the heart. Cardiac damage associated with radiotherapy may be progressive. Screening of survivors may help identify those at highest risk for serious cardiovascular disease. The broad range of radiation-associated cardiovascular disease makes it necessary for survivors to be examined with multiple screening modalities, although data do not exist to support definitive recommendations on test frequency.
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PMID:Radiation-associated cardiovascular disease: manifestations and management. 1290 22

Irradiation of the heart begets different complications in which pericardial disease is the most common manifestation. Thoracic irradiation of lymphoma, Hodgkin's disease, lung and breast cancer could be complicated by adverse effects to every structure of the heart. Potential injury of mediastinal irradiation can include acute and late pericarditis, cardiomyopathy, valvular disease and conduction abnormalities. The pathophysiology of these various syndromes is probably similar, starting by prior microvascular injury that leads to subsequent myocardium ischemia, all of which cause late fibrous scars. Acute pericarditis is often asymptomatic and clear spontaneously. Late pericarditis affects approximately 5% of the patients when the irradiation dose exceeds 40 Gy. At this dose, the mortality rate is below than 1%. Cardiomyopathy is rare and often asymptomatic. A long time unrecognized, coronary artery disease, diagnosed in 5 to 10% of the patients, begets multifarious sequelae like myocardial infarction, valvular abnormalities and cardiac rhythm changes. This coronary artery disease is more likely to occur if the patient was young at the time of the irradiation (< or = 21 years) and/or if other cardiovascular risk factors are associated. Incidence and mortality rates of valvular defects are about 20 and 0.5%, respectively. Conduction dysfunctions can also be seen in 5% of the patients. Radiation-induced heart complications seem to be related to total dose (> 30 Gy), irradiated tissue volume and fraction size. Since cardiac complications appear months to years following incidental irradiation of the heart, appropriate screening and long-term cardiac follow-up of these patients is essential.
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PMID:[Radiation toxicity to the heart: physiopathology and clinical data]. 1589 21

Primary patients with stage II-III AB Hodgkin's disease (255) received either standard-fractionated mantle irradiation (SFMI), accelerated hyperfractionation (AHF) or combined treatment using polychemotherapy (CTPT) (1985-1997). Out of 110 patients, 33 (30.0%) were given radiotherapy alone and 77 (70.0%)--combined treatment. Out of 145 patients treated with AHF, that therapy alone was given to 48 (33.1%) and combined treatmento 97 (66.9%). Objective response to primary therapy was reported in 90.0% of SFMI-treated patients and 87.6% of AHF-treated patients. On the whole, the recurrence rates in the SFMI group were higher than in the AHF group (25.5% and 14.5%, respectively, p < 0.05). In the latter group, out of 28 (25.4%) cases of pulmonitis, 10 (30.3%) received radiotherapy alone and 18 (23.4%)--combined treatment. AHF patients developed 19 (13.1%) pulmonites which occurred in that group in 3 (6.3%) SFMI patients and in 16 (16.5%) combined treatment patients. Pericarditis was reported in 11 (4.3%): SFMI- 8 (7.3%), AHF -3-(2.1%), p=0 . 04. To summarize, daily fractionated regimes were followed both by lower rates of relapse and cardiopulmonary complications.
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PMID:[An experience gained with mantle irradiation in Hodgkin's disease vs. various regimes of dose fractionation]. 1622 9

We present our experience with a patient with effusive pericarditis and recurrent pleural effusion that first developed 23 yr after radiation treatment for the nodular sclerosis type of Hodgkin's disease. Extensive diagnostic work up including pericardial and pleural biopsy, excluded any other cause (than radiation) of the recurrent pleural effusion. Pericarditis and pleural effusion were not controlled with regimens including steroid and non-steroid anti-inflammatory agents. The fluid collections improved only with per os doxycycline (100 mg twice a day). Four episodes of recurrent pleural effusions were also controlled with per os doxycycline. Although the concentration of doxycycline in the pericardial and pleural fluid when given orally is smaller compared with that achieved by direct installation of the agent, the fact that all episodes of pleural effusion improved with an agent commonly used for pleurodesis is intriguing.
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PMID:Delayed effusive pericarditis and recurrent pleural effusion after radiation treatment for Hodgkin's disease responsive to per os doxycycline. 1640 42

A patient with a history of Hodgkin's lymphoma presented with recurrent left pleural effusions and dyspnea on exertion 27 years after radiation therapy. Further evaluation disclosed suspected radiation-induced constrictive pericarditis, aortic stenosis and regurgitation, and severe coronary artery disease. He underwent successful 3-vessel coronary artery bypass grafting, aortic valve replacement, and pericardiectomy.
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PMID:Three-vessel coronary artery disease, aortic stenosis, and constrictive pericarditis 27 years after chest radiation therapy: a case report. 1684 29

Because it is a systemic disorder, rheumatoid arthritis (RA) is known to predispose affected individuals to other organ manifestations as well as arthritic problems. The serious complications include pericarditis, pulmonary and cutaneous nodules, episcleritis, and rheumatoid vasculitis. Of late, a significantly increased incidence of lymphoma has also accumulated. The overall risk is about double than in the general population, but that in patients with the most severe arthritis is dramatically higher. Men with RA appear to have an extremely elevated risk of Hodgkin's disease, which has also been observed at a higher incidence among the children of affected patients. These lymphomas are not typically infected with EBV, though RA patients have a defective capacity to control systemic EBV infection. Increasing attention is being paid to the effect of RA treatments on development of lymphoma, and some patients with EBV-positive tumors who have been taking methotrexate have shown a positive response after just discontinuing this drug. More controversial is the question of whether anti-TNF alpha agents involve an increased risk of lymphoma; in light of the conflicting evidence this matter is still unresolved.
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PMID:[Link between rheumatoid arthritis and cancer]. 1700 50

Significantly lower frequency of relapse, incidence of pulmonitis and pericarditis, leukopenia and thrombocytopenia stage IV and longer recurrence-free survival were reported after acceleration of multifractionation of STD of 1.35Gy was used for treatment of patients with primary Hodgkin's disease, as compared with standard fractionation. When STD was reduced to 1.2Gy (modified multifractionation), subtotal exposure of lymph nodes was followed by a significant drop in frequency and severity of leukopenia and thrombocytopenia stage III-IV. The latter complications, rates decreased further, with perspective response to therapy, as irradiation was limited to that of areas exposed during modified multifractionation.
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PMID:[20-year experience with modified dose fractionation of radiotherapy in primary Hodgkin's disease]. 1894 16

Mediastinal irradiation for cancers, mainly breast cancer and Hodgkin's disease, has numerous potential adverse effects, including coronary artery disease, pericarditis, cardiomyopathy, valvular disease, and conduction abnormalities. The prevalence of valvular dysfunction is relatively low, and regurgitation is more common. We report the case of a 58-year-old woman with severe radiation-induced mitral stenosis and discuss the potential additional value of three-dimensional transesophageal echocardiography.
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PMID:Radiotherapy-induced mitral stenosis: a three-dimensional perspective. 1976 51


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