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


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.


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.


1. Bova A.A. Functional diagnostics in the practice of a physician-therapist. MIA, 2007. 240 p.

2. Bogatyreva TI Combined and radiation treatment of primary and recurrent Hodgkin's lymphoma on the basis of intensive dose fractionation regimes: Author's abstract. dis. ... Doct. honey. sciences. Obninsk, 2006. 40 p.

3. Bogatyreva T.I., Kravchenko T.V., Afanasova N.V. et al. Reduction of the total dose during irradiation of chemoresistant foci of Hodgkin's lymphoma in the regime of accelerated hyperfractionation (prospective randomized study). Oncology questions. 2006. Vol. 52, no. 5. PP. 544-549.

4. Daryalova S.L., Boyko A.V., Chernichenko A.V. Modern possibilities of radiotherapy for malignant tumors. Russian Oncological Journal. 2000. No. 1. PP. 48-55.

5. Ilyin N.V., Vinogradova Yu.N., Nikolaeva E.N. et al. The value of multifraction radiation dose during primary radiation treatment of patients with Hodgkin lymphoma. Oncohematology. 2007. No. 4. PP. 47-52.

6. Loseva MP, Purtova LA, Gavalova RF Morphofunctional state of the heart with limfogranulomatosis at remote times after chemoradiotherapy. Ter. archive. 2000. No. 10. PP. 64-67.

7. Matyash M.G., Kravchuk T.L., Vysotskaya V.V. et al. Anthracycline-induced cardiotoxicity: mechanisms of development and clinical manifestations. Siberian Oncological Journal. 2008. No. 6 (30). PP. 66-75.

8. Minko B.A., Vanjula O.R., Simonova O.N. and others Cardiovascular disorders in patients with malignant lymphomas at different times after specific treatment. Oncology. 2006. Vol. 52, no. 3. PP. 357-360.

9. Nasibov O.M., Pivnik A.V., Pasha S.P. et al. The state of the cardiovascular system in patients with lymphogranulomatosis in the stage of long-term remission. Ter. archive. 2002. No. 12. PP. 68-71.

10. Shiller N., Osipov MA Clinical echocardiography. Moscow, 1993.

11. Shishkin I.P., Barabanova A.V., Metleeva N.A. The state of the cardiovascular system at a remote time after radiotherapy. Med. radiology. 1984. No. 9. PP. 46-50.

12. Adams M.J., Lipsitz S.R., Colan S.D. et al. Cardiovascular status in long-term survivors of Hodgkin's disease treated with chest radiotherapy. J. Clin. Oncol. 2004. Vol. 22. PP. 3139-3148.

13. Elbl l., Vasova I., Tomaskova I. et al. Cardiopulmonary exercise testing in the evaluation of functional capacity after treatment of lymphomas in adults. Leuk. Lymphoma. 2006. Vol. 47, no. 5. PP. 843-851.

14. Glanzmann C., Kaufmann P., Jenni R. et al. Cardiac risk after mediastinal irradiation for Hodgkin's dis-ease. Radiother. and Oncol. 1998. Vol. 46. PP. 51-62.

15. Hequet O., Le Q.H., Moullet I. et al. Subclinical late cardiomyopathy after doxorubicin therapy for lymphoma in adults. J. Clin. Oncol. 2004. V. 22. PP. 1864-1871.

16. Kremer L.C.M., van der Pal H.J.H., Offringa M. et al. Frequency and risk factors of subclinical cardiotoxic-ity after anthracycline therapy in children: a systematic review. Ann. Oncol. 2002. Vol. 13. PP. 819-829.

17. LENT SOMA Tables. Radiother. Oncol. 1995. Vol. 35. PP. 17-60.

18. Pihkala J., Saarinen U.M., Lundstrom U. et al. Myocardial function in children and adolescent after therapy with antracyclines and chest irradiation. Eur. J. Cancer. 1996. Vol. 32. PP. 97-103.

19. Tsyb A.F., Korobchenko Z.A., Sobol Yu.S. et al. Impairment of left ventricular kinetics in lymphogranulo-matosis with involvement of lymphatic mediastinal nodes. Cor et Vasa. 1986. Vol. 28, No. 5. PP. 369-372.

20. Withers H.R. Biological basis for altered fractionation schemes. Cancer. 1985. Vol. 55. PP. 2086-2095.

Full-text article (in Russian)