Cardiac function in patients with Hodgkin’s lymphoma in long-term remission after chemotherapy and mediastinal irradiation using different fractionation regimens

«Radiation and Risk», 2009, vol. 18, no. 4, pp.82-96

Authors

Tsyb A.F. – Director, Academician of RAMS. Medical Radiological Research Center of the Russian Academy of Medical Sciences, Obninsk.
Nestaiko T.O. – Physician. Medical Radiological Research Center of the Russian Academy of Medical Sciences, Obninsk.
Bogatyreva T.I. – Leading Researcher, MD. Medical Radiological Research Center of the Russian Academy of Medical Sciences, Obninsk. Contacts: 4 Korolyov str., Obninsk, Kaluga region, Russia, 249036. Tel.: (48439) 6-17-32; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. .
Guseva Z.A. – Head of Department, Cand. Sc., Med. Medical Radiological Research Center of the Russian Academy of Medical Sciences, Obninsk.

Abstract

Total 69 patients with Hodgkin’s lymphoma in 2 to 15 years remission underwent an echocardio-graphic study to evaluate the risk of cardiac lesions after combined modality therapy. No patient had cardiac complaints at follow up. Mediastinal irradiation was performed using accelerated hyper-fractionation regimen to 20-22 Gy (group 1) or conventional fractionation to 20 Gy (group 2) and to 40 Gy (group 3). Doxorubicine-containing regimens were used in 86, 65 and 41% patients, respectively. Echocardiography was performed at rest and with exercise test. Total 3, 4 and 7 abnormal findings related to systolic dysfunction were observed In groups 1, 2 and 3, respectively, as compared with control group (p<0.05). The prevalence of lower quartile of the ejection fraction value (<60%) was significantly lower in patients of group 1 (13.6% against 40% и 55.6% in groups 2 and 3, р<0.05). Grade I-II cardiotoxicity (ejection fraction <55%) was observed only in groups 2 and 3 (6.2% and 29.6% of patients). Our data confirm the sparing effect of the non-conventional fractionation regimen with lower dose per fraction for the heart of patients receiving mediastinal irradiation. The exercise test is helpful for revealing patients with asymptomatic cardiac dysfunction for further monitoring.

Key words
Hodgkin’s lymphoma, accelerated hyperfractionation, echocardiography.

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