Mediastinal radiation increased risk of coronary disease in childhood Hodgkin’s lymphoma survivors

Using CT angiography, a significant association was found between mediastinal radiotherapy and the development of a coronary artery abnormality in survivors of childhood Hodgkin’s lymphoma aged 17 years to 28 years, leading researchers to conclude that CT angiography may be a useful tool to diagnosis coronary artery disease in this patient population.

Between January 2007 and December 2008, researchers conducted a prospective study examining 119 patients treated with chemotherapy or radiotherapy who were in remission for longer than two years after completion of therapy. The mean age of patients was 20 years.

Of the possible treatments, 92.4% of patients received chemoradiotherapy and 7.6% had chemotherapy alone. Doxorubicin was given to 77.3% of patients and 53.6% received mediastinal radiotherapy.

Coronary abnormalities were found in 16% of patients. There was an association between developing a coronary artery abnormality and having been treated with mediastinal radiotherapy (P=.02). In multivariate analysis, patients who received a dose greater than 20 Gy had a 6.8 times greater risk for developing a coronary artery abnormality than those who received a lesser dose (P=.009).

“Our study demonstrated that the risk of developing coronary artery disease in asymptomatic patients is 16% in the first 10 years,” the researchers wrote. “Although a reduction in radiation doses has been made in recent years clinicians must consider the toxic effect of radiation to the myocard. Radiotherapy protocols should be revised and especially the necessity of mediastinal radiotherapy must be discussed for all newly diagnosed patients with Hodgkin’s lymphoma.”

Kupeli S. J Clin Oncol. 2009;doi:10.1200/JCO.2009.25.2627.