Clinically significant cardiac disease in patients with Hodgkin lymphoma treated with mediastinal irradiation.
This study assessed the cumulative incidence of clinically significant cardiac disease in 1279 Hodgkin lymphoma patients treated with mediastinal irradiation and quantified the standard incidence ratios (SIRs) and absolute excess risks of cardiac procedures compared with a normal matched population. Cox regression analysis was used to explore factors associated with cardiac complications. Poisson regression analysis of SIRs was used to estimate the excess risk of cardiac interventions from mediastinal irradiation. After a median follow-up of 14.7 years, 187 patients experienced 636 cardiac events and 89 patients required a cardiac procedure. 5-, 10-, 15-, and 20-year cumulative incidence rates of cardiac events were 2.2%, 4.5%, 9.6%, and 16%. SIRs for cardiac procedures were increased for coronary artery bypass graft (3.19), percutaneous intervention (1.55), implantable cardioverter defibrillator or pacemaker placement (1.9), valve surgery (9.19), and pericardial surgery (12.91). Absolute excess risks were 18.2, 19.3, 9.4, 14.1, and 4.7 per 10 000 person-years, respectively. Older age at diagnosis and male sex were predictors for cardiac events. However, younger age at diagnosis was associated with excess risk specifically from radiation therapy compared with the general population. These results may help guideline development for both the types and timing of cardiac surveillance in survivors of Hodgkin lymphoma.
Galper
Shira L
SL
Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
Yu
James B
JB
Mauch
Peter M
PM
Strasser
Jon F
JF
Silver
Barbara
B
Lacasce
Ann
A
Marcus
Karen J
KJ
Stevenson
Mary Ann
MA
Chen
Ming Hui
MH
Ng
Andrea K
AK
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006321:Heart / Q000528:radiation effects; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology*; D006689:Hodgkin Disease / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008479:Mediastinal Neoplasms / Q000532:radiotherapy*; D008482:Mediastinum / Q000528:radiation effects; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects*; D012307:Risk Factors; D055815:Young Adult