Cardiotoxicity of radiation therapy for Hodgkin lymphoma and pediatric malignancies
- Lawrence B Marks, MD
Lawrence B Marks, MD
- Department of Radiation Oncology
- UNC Hospitals and University of North Carolina at Chapel Hill
- Louis S Constine, MD
Louis S Constine, MD
- Professor of Radiation Oncology and Pediatrics
- Vice Chair
- University of Rochester Medical Center
- M Jacob Adams, MD, MPH
M Jacob Adams, MD, MPH
- Associate Professor (retired)
- University of Rochester School of Medicine and Dentistry
- Section Editors
- William J McKenna, MD
William J McKenna, MD
- Section Editor — Myopericardial Disease
- Professor of Cardiology
- University College, London
- Steven E Schild, MD
Steven E Schild, MD
- Section Editor — Radiation Therapy
- Professor of Radiation Oncology
- Mayo Clinic College of Medicine
- Arnold S Freedman, MD
Arnold S Freedman, MD
- Section Editor — Lymphoproliferative Disorders
- Professor of Medicine
- Harvard Medical School
The use of radiation therapy (RT) has contributed to significant improvements in disease-specific survival for patients with Hodgkin lymphoma (HL) and other malignancies involving the thoracic region. (See "Treatment of favorable prognosis early (stage I-II) classical Hodgkin lymphoma".)
These successes with RT, used either alone or in combination with other modalities, resulted in large cohorts of cancer survivors who are subject to late complications from treatment. Analyses have shown that the therapeutic benefits from RT may be offset to some extent by delayed effects on the heart, thereby reducing the benefits of RT.
The treatment of HL frequently includes supradiaphragmatic RT portals that include portions of the heart, and HL survivors have a significantly increased incidence of cardiovascular complications. Clinical manifestations of cardiotoxicity include acute or delayed pericardial disease, myocardial ischemia or infarction, cardiomyopathy, heart failure, valvular abnormalities, or conduction defects. (See "Overview of the approach to the adult survivor of classical Hodgkin lymphoma", section on 'Cardiovascular disease'.)
The treatment of HL has evolved in tandem with our understanding of the long-term consequences of treatment, with the goal of decreasing the intensity of therapy without sacrificing long-term disease control. These efforts have included reduction in the volume and dose of incidental cardiac irradiation through modifications in RT techniques, and recognition of the relationship between efficacy, and dose and volume in the setting of combined modality therapy. These contemporary techniques appear to have substantially decreased the incidence of delayed complications, although whether or not there still is some residual risk remains uncertain.
The incidence of cardiotoxicity and its clinical manifestations secondary to RT in patients with HL or pediatric malignancies are discussed here. The pathophysiology of RT-induced cardiac injury and the role of RT-induced cardiotoxicity in other malignancies are discussed separately. (See "Cardiotoxicity of radiation therapy for breast cancer and other malignancies", section on 'Pathophysiology'.)
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