title: Dosimetric predictors of asymptomatic heart valvular dysfunction following mediastinal irradiation for Hodgkin's lymphoma.
abstract: OBJECTIVE
  To identify dose-heart-volume constraints that correlate with the risk of developing asymptomatic valvular defects (VD) in Hodgkin's lymphoma (HL) patients treated with three-dimensional radiotherapy (RT).
  
  
  METHODS
  Fifty-six patients undergoing cytotoxic chemotherapy (CHT) and involved-field radiation treatment for HL were retrospectively analyzed. Electro-echocardiography was performed before CHT, after CHT, and after RT. For the entire heart, for right and left ventricle (RV, LV), right and left atrium (RA, LA) percentage of volume exceeding 5-30Gy in increment of 5Gy (V(x)), and dosimetric parameters were calculated using 1.6Gy fraction as reference. To evaluate clinical and dosimetric factors possibly associated with VD, univariate and multivariate logistic regression analyses were performed.
  
  
  RESULTS
  At a median follow up of 70.5 months, 32.1% of patients developed VD (regurgitation and/or stenosis): 25.0% developed mitral, 5.4% developed aortic, and 14.3% tricuspid VD. In particular the percentage of LA exceeding 25Gy (LA-V(25)) and the percentage of LV exceeding 30Gy (LV-V(30)) correlated with mitral and aortic VD with an odds ratio (OR) of 5.7 (LA-V(25)>63.0% vs. LA-V(25)≤63.0%) and OR of 4.4 (LV-V(30)>25% vs. LV-V(30)≤25%), respectively. RV-V(30) correlated with tricuspid VD (OR=7.2, RV-V(30)>65% vs. RV-V(30)≤65%).
  
  
  CONCLUSIONS
  LA-V(25), LV- and RV-V(30) prove to be predictors of asymptomatic alteration of valve functionality.
authors.affiliation: Institute of Biostructure and Bioimaging, National Research Council of Italy, Naples, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Cella
authors.forename: Raffaele
authors.initials: R
authors.lastname: Liuzzi
authors.forename: Manuel
authors.initials: M
authors.lastname: Conson
authors.forename: Gabriella
authors.initials: G
authors.lastname: Torre
authors.forename: Michele
authors.initials: M
authors.lastname: Caterino
authors.forename: Nicola
authors.initials: N
authors.lastname: De Rosa
authors.forename: Marco
authors.initials: M
authors.lastname: Picardi
authors.forename: Luigi
authors.initials: L
authors.lastname: Camera
authors.forename: Raffaele
authors.initials: R
authors.lastname: Solla
authors.forename: Antonio
authors.initials: A
authors.lastname: Farella
authors.forename: Marco
authors.initials: M
authors.lastname: Salvatore
authors.forename: Roberto
authors.initials: R
authors.lastname: Pacelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D004562:Electrocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000209:etiology*; D006689:Hodgkin Disease / Q000188:drug therapy / Q000532:radiotherapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008482:Mediastinum / Q000528:radiation effects*; D008875:Middle Aged; D012372:ROC Curve; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors