title: Risk of developing cardiovascular disease after involved node radiotherapy versus mantle field for Hodgkin lymphoma.
abstract: OBJECTIVE
  Hodgkin lymphoma (HL) survivors are known to have increased cardiac mortality and morbidity. The risk of developing cardiovascular disease after involved node radiotherapy (INRT) is currently unresolved, inasmuch as present clinical data are derived from patients treated with the outdated mantle field (MF) technique.
  
  
  METHODS
  We included all adolescents and young adults with supradiaphragmatic, clinical Stage I-II HL treated at our institution from 2006 to 2010 (29 patients). All patients were treated with chemotherapy and INRT to 30 to 36 Gy. We then simulated a MF plan for each patient with a prescribed dose of 36 Gy. A logistic dose-response curve for the 25-year absolute excess risk of cardiovascular disease was derived and applied to each patient using the individual dose-volume histograms.
  
  
  RESULTS
  The mean doses to the heart, four heart valves, and coronary arteries were significantly lower for INRT than for MF treatment. However, the range in doses with INRT treatment was substantial, and for a subgroup of patients, with lymphoma below the fourth thoracic vertebrae, we estimated a 25-year absolute excess risk of any cardiac event of as much as 5.1%.
  
  
  CONCLUSIONS
  Our study demonstrates a potential for individualizing treatment by selecting the patients for whom INRT provides sufficient cardiac protection for current technology; and a subgroup of patients, who still receive high cardiac doses, who would benefit from more advanced radiation technique.
authors.affiliation: Department of Radiation Oncology, Rigshospitalet, Copenhagen, Denmark. dra.maraldo@gmail.com
authors.forename: Maja V
authors.initials: MV
authors.lastname: Maraldo
authors.forename: Nils Patrik
authors.initials: NP
authors.lastname: Brodin
authors.forename: Ivan R
authors.initials: IR
authors.lastname: Vogelius
authors.forename: Marianne C
authors.initials: MC
authors.lastname: Aznar
authors.forename: Per
authors.initials: P
authors.lastname: Munck Af Rosenschöld
authors.forename: Peter M
authors.initials: PM
authors.lastname: Petersen
authors.forename: Lena
authors.initials: L
authors.lastname: Specht
mesh_terms: D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology*; D003331:Coronary Vessels / Q000528:radiation effects; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006321:Heart / Q000528:radiation effects; D006689:Hodgkin Disease / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D015182:Lymphatic Irradiation / Q000009:adverse effects / Q000379:methods; D008297:Male; D058958:Organs at Risk / Q000528:radiation effects*; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D011879:Radiotherapy Dosage; D012306:Risk; D055815:Young Adult