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. 1992 Jun;65(6):908–912. doi: 10.1038/bjc.1992.190

Late cardiopulmonary toxicity after treatment for Hodgkin's disease.

C Allavena 1, T Conroy 1, P Aletti 1, P Bey 1, P Lederlin 1
PMCID: PMC1977758  PMID: 1616862

Abstract

Cardiac and pulmonary functions were evaluated in 75 patients aged 50 years or under, treated for Hodgkin's disease by mantle radiotherapy at least 3 years earlier; all received the same mantle field radiotherapy: radiotherapy alone, MOPP chemotherapy plus radiotherapy, MOPP and ABVD chemotherapy plus radiotherapy. No patient had any symptom of heart disease. Only borderline abnormalities of ECG or echocardiogram were observed in 12 patients. One of them showed a moderate aortic stenosis which was known before the treatment; apical or septum hypokinesia were present in four patients and one patient had a slightly right ventricular dilatation. Twelve (16%) chest radiographs showed moderate or severe abnormalities, but there was no significant correlation between the results of pulmonary function tests and Xenon ventilation/perfusion scintigraphy, the clinical examination and the intensity of the radiological sequelae. Twenty-nine (64%) Xenon scintigraphies showed a reduction of lung perfusion in the irradiated areas without any symptom. The resting mean pulmonary function test was significantly lower for the patients than for the control group with regard to Total Capacity and Vital Capacity. The exercise tolerance, as indicated by analysis of blood gases, was below the one expected for only two patients who were dyspneic during the low level of exercise. We did not find any significant difference between the three treatment groups. We conclude that the treatment with mantle field under good technical conditions (high energy photons, moderate doses...) can result in minimal cardiopulmonary dysfunction.

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Selected References

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  1. Applefeld M. M., Slawson R. G., Spicer K. M., Singleton R. T., Wesley M. N., Wiernik P. H. Long-term cardiovascular evaluation of patients with Hodgkin's disease treated by thoracic mantle radiation therapy. Cancer Treat Rep. 1982 Apr;66(4):1003–1013. [PubMed] [Google Scholar]
  2. Bonadonna G., Zucali R., Monfardini S., De Lena M., Uslenghi C. Combination chemotherapy of Hodgkin's disease with adriamycin, bleomycin, vinblastine, and imidazole carboxamide versus MOPP. Cancer. 1975 Jul;36(1):252–259. doi: 10.1002/1097-0142(197507)36:1<252::aid-cncr2820360128>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  3. Brosius F. C., 3rd, Waller B. F., Roberts W. C. Radiation heart disease. Analysis of 16 young (aged 15 to 33 years) necropsy patients who received over 3,500 rads to the heart. Am J Med. 1981 Mar;70(3):519–530. doi: 10.1016/0002-9343(81)90574-x. [DOI] [PubMed] [Google Scholar]
  4. Burns R. J., Bar-Shlomo B. Z., Druck M. N., Herman J. G., Gilbert B. W., Perrault D. J., McLaughlin P. R. Detection of radiation cardiomyopathy by gated radionuclide angiography. Am J Med. 1983 Feb;74(2):297–302. doi: 10.1016/0002-9343(83)90631-9. [DOI] [PubMed] [Google Scholar]
  5. Carmel R. J., Kaplan H. S. Mantle irradiation in Hodgkin's disease. An analysis of technique, tumor eradication, and complications. Cancer. 1976 Jun;37(6):2813–2825. doi: 10.1002/1097-0142(197606)37:6<2813::aid-cncr2820370637>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  6. Cosset J. M., Henry-Amar M., Girinski T., Malaise E., Dupouy N., Dutreix J. Late toxicity of radiotherapy in Hodgkin's disease. The role of fraction size. Acta Oncol. 1988;27(2):123–129. doi: 10.3109/02841868809090332. [DOI] [PubMed] [Google Scholar]
  7. Devita V. T., Jr, Serpick A. A., Carbone P. P. Combination chemotherapy in the treatment of advanced Hodgkin's disease. Ann Intern Med. 1970 Dec;73(6):881–895. doi: 10.7326/0003-4819-73-6-881. [DOI] [PubMed] [Google Scholar]
  8. Evans R. F., Sagerman R. H., Ringrose T. L., Auchincloss J. H., Bowman J. Pulmonary function following mantle-field irradiation for Hodgkin's disease. Radiology. 1974 Jun;111(3):729–731. doi: 10.1148/111.3.729. [DOI] [PubMed] [Google Scholar]
  9. Gimenez M., Servera E., Candina R., Mohan Kumar T., Bonnassis J. B. Hypercapnia during maximal exercise in patients with chronic airflow obstruction. Bull Eur Physiopathol Respir. 1984 Mar-Apr;20(2):113–119. [PubMed] [Google Scholar]
  10. Gottdiener J. S., Katin M. J., Borer J. S., Bacharach S. L., Green M. V. Late cardiac effects of therapeutic mediastinal irradiation. Assessment by echocardiography and radionuclide angiography. N Engl J Med. 1983 Mar 10;308(10):569–572. doi: 10.1056/NEJM198303103081005. [DOI] [PubMed] [Google Scholar]
  11. Host H., Vale J. R. Lung function after mantle field irradiation in Hodgkin's disease. Cancer. 1973 Aug;32(2):328–332. doi: 10.1002/1097-0142(197308)32:2<328::aid-cncr2820320208>3.0.co;2-a. [DOI] [PubMed] [Google Scholar]
  12. LaMonte C. S., Yeh S. D., Straus D. J. Long-term follow-up of cardiac function in patients with Hodgkin's disease treated with mediastinal irradiation and combination chemotherapy including doxorubicin. Cancer Treat Rep. 1986 Apr;70(4):439–444. [PubMed] [Google Scholar]
  13. Larsson L. E., Lindahl J., Unsqaard B. Effects on the cardiovascular system of irradiation for malignant lymphoma. Acta Radiol Ther Phys Biol. 1976 Dec;15(6):529–540. doi: 10.3109/02841867609131977. [DOI] [PubMed] [Google Scholar]
  14. Lokich J. J., Bass H., Eberly F. E., Rosenthal D. S., Moloney W. C. The pulmonary effect of mantle irradiation in patients with Hodgkin's disease. Radiology. 1973 Aug;108(2):397–402. doi: 10.1148/108.2.397. [DOI] [PubMed] [Google Scholar]
  15. McReynolds R. A., Gold G. L., Roberts W. C. Coronary heart disease after mediastinal irradiation for Hodgkin's disease. Am J Med. 1976 Jan;60(1):39–45. doi: 10.1016/0002-9343(76)90531-3. [DOI] [PubMed] [Google Scholar]
  16. Morgan G. W., Freeman A. P., McLean R. G., Jarvie B. H., Giles R. W. Late cardiac, thyroid, and pulmonary sequelae of mantle radiotherapy for Hodgkin's disease. Int J Radiat Oncol Biol Phys. 1985 Nov;11(11):1925–1931. doi: 10.1016/0360-3016(85)90273-1. [DOI] [PubMed] [Google Scholar]
  17. Pohjola-Sintonen S., Tötterman K. J., Salmo M., Siltanen P. Late cardiac effects of mediastinal radiotherapy in patients with Hodgkin's disease. Cancer. 1987 Jul 1;60(1):31–37. doi: 10.1002/1097-0142(19870701)60:1<31::aid-cncr2820600107>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  18. Santoro A., Bonadonna G., Bonfante V., Valagussa P. Alternating drug combinations in the treatment of advanced Hodgkin's disease. N Engl J Med. 1982 Apr 1;306(13):770–775. doi: 10.1056/NEJM198204013061303. [DOI] [PubMed] [Google Scholar]
  19. Santoro A., Bonadonna G., Valagussa P., Zucali R., Viviani S., Villani F., Pagnoni A. M., Bonfante V., Musumeci R., Crippa F. Long-term results of combined chemotherapy-radiotherapy approach in Hodgkin's disease: superiority of ABVD plus radiotherapy versus MOPP plus radiotherapy. J Clin Oncol. 1987 Jan;5(1):27–37. doi: 10.1200/JCO.1987.5.1.27. [DOI] [PubMed] [Google Scholar]
  20. Smith L. M., Mendenhall N. P., Cicale M. J., Block E. R., Carter R. L., Million R. R. Results of a prospective study evaluating the effects of mantle irradiation on pulmonary function. Int J Radiat Oncol Biol Phys. 1989 Jan;16(1):79–84. doi: 10.1016/0360-3016(89)90013-8. [DOI] [PubMed] [Google Scholar]
  21. Tarbell N. J., Thompson L., Mauch P. Thoracic irradiation in Hodgkin's disease: disease control and long-term complications. Int J Radiat Oncol Biol Phys. 1990 Feb;18(2):275–281. doi: 10.1016/0360-3016(90)90089-3. [DOI] [PubMed] [Google Scholar]
  22. Teichholz L. E., Kreulen T., Herman M. V., Gorlin R. Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy. Am J Cardiol. 1976 Jan;37(1):7–11. doi: 10.1016/0002-9149(76)90491-4. [DOI] [PubMed] [Google Scholar]
  23. Tubiana M., Henry-Amar M., van der Werf-Messing B., Henry J., Abbatucci J., Burgers M., Hayat M., Somers R., Laugier A., Carde P. A multivariate analysis of prognostic factors in early stage Hodgkin's disease. Int J Radiat Oncol Biol Phys. 1985 Jan;11(1):23–30. doi: 10.1016/0360-3016(85)90358-x. [DOI] [PubMed] [Google Scholar]
  24. Watchie J., Coleman C. N., Raffin T. A., Cox R. S., Raubitschek A. A., Fahey T., Hoppe R. T., Van Kessel A. Minimal long-term cardiopulmonary dysfunction following treatment for Hodgkin's disease. Int J Radiat Oncol Biol Phys. 1987 Apr;13(4):517–524. doi: 10.1016/0360-3016(87)90066-6. [DOI] [PubMed] [Google Scholar]
  25. do Pico G. A., Wiley A. L., Jr, Rao P., Dickie H. A. Pulmonary reaction to upper mantle radiation therapy for Hodgkin's disease. Chest. 1979 Jun;75(6):688–692. doi: 10.1378/chest.75.6.688. [DOI] [PubMed] [Google Scholar]

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