Survivors of Hodgkin lymphoma are at risk of developing various late complications, the heart being one of the organs most often affected. Now, in a recently published paper (Lancet Haematology. doi:10.1016/S2352-3026(15)00153-2), researchers showed that an increased risk of cardiovascular disease is quantified at specific dose levels of radiation as well as anthracycline exposure.
Early diagnosis, targeted therapeutics, and more personalized multimodal treatments have boosted survival rates of patients with cancer and have led to a large and rapidly increasing number of cancer survivors. This is particularly true for patients with Hodgkin lymphoma, where successive trials by the European Organisation for Research and Treatment of Cancer (EORTC) have registered continuous progress in the development of treatment strategies for the disease.
Here, the EORTC researchers were able to perform a detailed analysis of 9 collaborative EORTC-LYSA trials conducted between 1964 and 2004 by the EORTC Lymphoma Group and from 1993 by the Groupe d’Etude des Lymphomes de l’Adulte (GELA, now renamed as LYSA) across 13 European countries. Information on primary treatment was complete for 6039 survivors of Hodgkin lymphoma at a median follow-up of 9 years, and this allowed for more individualized analysis of cardiovascular disease risk.
The study found, among 1238 first cardiovascular events recorded in 703 patients, most were ischemic disease, congestive heart failure, arrhythmia, and valvular disease. The significant predictors of cardiovascular disease were the mean heart radiation dose per 1 Gy increase and the dose of anthracyclines per 50 mg/m2 increase in cumulative dose.
“These study results are exciting. They should allow physicians to optimize the combination of systemic therapy and radiation and thereby balance the risks and benefits of different regimens in individual patients,” said corresponding author Maja V. Maraldo, PhD, of Rigshospitalet in Copenhagen, Denmark.