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Radiation to treat Hodgkin's lymphoma increased risk for stroke, transient ischemic attack

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Survivors of Hodgkin’s lymphoma who were treated with radiation to the head and neck had more than twice the risk for stroke and more than three times the risk for transient ischemic attack compared with the general population, according to study results from the Netherlands.

Researchers found that the risk increased almost fourfold for stroke and almost eightfold from transient ischemic attack in patients treated with radiation before age 21.

The researchers collected data from 2,201 five-year Hodgkin’s lymphoma and performed a retrospective cohort study on the 96 who developed a stroke or transient ischemic attack. The median age of patients was 52. Fifty-five patients had stroke; 31 had TIAs; 10 had both.

Median follow-up was 17.5 years and median time to first cardiac event was 17.4 years.

The cumulative incidence of stroke was 5% and for transient ischemic attack it was 3%. When compared with the general population, survivors had a 2.2% increased risk for stroke (95% CI, 1.7-2.8) and a 3.1% increased risk for transient ischemic attack (95% CI, 2.2-4.2).

Multivariable Cox regression analysis showed that patients treated with neck irradiation and mediastinal irradiation had a 2.5% increased risk for ischemic stroke or transient ischemic attack compared with those treated with chemotherapy or infradiaphragmatic irradiation alone (HR=2.5; 95% CI, 1.1-5.6). There was no increased risk associated with chemotherapy.

In an accompany editorial, Dan L. Longo, MD, of the National Institute of Aging, Baltimore, Md., wrote that there is little reason to assign patients with Hodgkin’s lymphoma to radiation therapy considering the risks involved. He added that “political pressure to keep using radiation therapy has allowed hope to triumph over experience in our exercise of clinical judgment.

“With a risk to benefit ratio for the use of radiation therapy that is approaching infinity, it remains a puzzle that the vast majority of patients with Hodgkin’s disease are treated with combined modality therapy today,” Longo wrote.

For more information:

• De Bruin ML. J Natl Cancer Inst. 2009;101:928-937.