[The late cardiac sequelae after mantle-field irradiation. The results in Erlangen's patient caseload].
OBJECTIVE
We have retrospectively evaluated the cardiac function in patients after mantle-irradiation for Hodgkin's disease.


METHODS
Forty-three patients, mean age 39.8 +/- 13 years, who had been treated with mantle-irradiation from 1979 through 1984 at the University of Erlangen-Nürnberg, were examined. All of them were in first remission at 5 to 11 years (mean 8.1 years) after radiotherapy (n = 24) or combined modality treatment (n = 19). Mantle-irradiation had been administered through equally weighted anterioposterior-posterioanterior portals with 5 fractions of 2 Gy per week up to a total mediastinal dose of 41.8 +/- 7 Gy (including boost). The examination program included anamnesis, physical examination, Doppler echocardiography and ergometry. Hundred and twenty-two non-irradiated volunteers and cardiological patients were used as control group.


RESULTS
None of the patients suffered from clinical symptoms. Pericardial thickening was present in 26%. The left ventricular end-systolic diameter (31.3 +/- 5.5 mm, normal value 26 to 42 mm) and the thickness of the left ventricular posterior wall (8.1 +/- 1.8 mm, normal value 6 to 11 mm) were within the normal range. The left ventricular ejection fraction was also normal (67.1 +/- 8% in patients versus 67.0 +/- 8% in control subjects). Evaluation of diastolic parameters, however, revealed significant changes. The isovolumic relaxation time was significantly decreased as compared to the control group (38.8 +/- 17 ms versus 50.8 +/- 21 ms, p < 0.05). The same we found for the shortening fraction (33.6 +/- 6% versus 38.1 +/- 6%, p < 0.05). The most significant changes were found after combined modality therapy, especially after radiotherapy and anthracycline-based chemotherapy. 30% of the patients were tachycardic (pulse > 100/min) at rest. At ergometry, the frequency of signs of ischemia (5%), conduction disturbances (2%), and rhythm disturbances (7%) was not elevated.


CONCLUSIONS
In this retrospective investigation, patients after mantle irradiation with modern techniques showed only minimal cardiologic abnormalities within the first 10 years after treatment. The most sensitive parameters were the isovolumic relaxation times. The clinical relevance of such findings remains to be defined. Pathophysiologically, our findings (decreased relaxation time plus tachycardia) support the theory that myocardial damage after radiotherapy may result in subsequent increased beta-receptor density as proposed by Schultz-Hector et al. [21] on the basis of experimental data.
Friedrich
S A
SA
Strahlentherapeutische Klinik und Poliklinik, Universität Erlangen-Nürnberg.
Unverdorben
M
M
Kunkel
B
B
Dunst
J
J
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015150:Echocardiography, Doppler / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000187:drug effects / Q000503:physiopathology / Q000528:radiation effects*; D006689:Hodgkin Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology / Q000532:radiotherapy; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors
Kardiale Spätfolgen nach Mantelfeldbestrahlung. Ergebnisse im Erlanger Patientenkollektiv.