Cardiac and pulmonary late side effects after Hodgkin lymphoma
Abstract
Current treatment of childhood cancers has developed as a risk-oriented approach considering clinical, biological, genetic factors and treatment response. Cardiac diseases are the most common cause of non-cancer death in long-term childhood cancer patients. Cardiomyopathy, congestive heart failure, pericardial effusion, constrictive pericarditis, coronary artery disease, myocardial infarction, and arrhythmias may develop with the toxic effects of chemotherapy and radiotherapy. Pulmonary complications such as radiation pneumonitis, pulmonary fibrosis and spontaneous pneumothorax, which are seen in previous years due to high dose radiotherapy are currently rarely seen. Long-term follow-up of patients who are treated with mediastinal radiotherapy and/or cardiotoxic agents, such as patients with Hodgkin lymphoma, is of vital importance. Left ventricular and heart valve functions should be monitored by echocardiography, QTc and rhythm abnormalities should be monitored by electrocardiography and other factors that may affect cardiovascular health and pulmonary function tests should be evaluated periodically. Computerized tomography angiography has a role of in the early identification of possible coronary abnormalities in Hodgkin lymphoma patients at risk for coronary artery disease due to the treatments they received, especially mediastinal radiotherapy.
Keywords
Cardiac late effects,pulmonary late effects,Hodgkin lymphoma,children
Kaynakça
- 1. Hodgson DC. Hodgkin lymphoma: The follow-up of long term survivors. Hematol Oncol Clin N Am. 2008; 22:233-244.
- 2. Metzger ML, Krasin MJ, Choi JK, Hudson MM. Hodgkin lymphoma. In: Principles and practice of pediatric oncology, 7th edition. Pizzo PA, Poplack DG editors. Wolters Kluwer, Philadelphia, 2016, pp: 568-586.
- 3. Gilladoga AC, Manuel C, Tan CT, Wollner N, Sternberg SS, Murphy ML. The cardiotoxicity of adriamycin and daunomycin in children. Cancer. 1976;37(suppl):1070–1078.
- 4. Brosius FC 3rd, Waller BF, Roberts WC. Radiation heart disease: analysis of 16 young (aged 15 to 33 years) necropsy patients who received over 3,500 rads to the heart. Am J Med. 1981;70:519–530.
- 5. Armstrong GT, Liu Q, Yasui Y, Neglia JP, Leisenring W, Robison LL, Mertens AC. Late mortality among 5-year survivors of childhood cancer: a summary from the Childhood Cancer Survivor Study. J Clin Oncol. 2009;27:2328–2338.
- 6. Lipshultz SE, Adams MJ, Colan SD, Constine LS, Herman EH, Hsu DT. Long-term cardiovascular toxicity in children, adolescents, and young adults who receive cancer therapy: pathophysiology, course, monitoring, management, prevention, and research directions: a scientific statement from the American Heart Association. Circulation. 2013;128:1927-1995.
- 7. Meyer RM, Gospodarowicz MK, Connors JM, Pearcey RG, Wells WA, Winter JN. ABVD alone versus radiation-based therapy in limited-stage Hodgkin's lymphoma. N Engl J Med. 2012;366:399-408.
- 8. Fulbright JM. Review of cardiotoxicity in pediatric cancer patients: during and after therapy. Cardiol Res Pract. 2011;2011:942090.
- 9. Fajardo LF, Berthrong M. Vascular lesions following radiation. Pathol Annu. 1988; 23:297-330.
- 10. Hull MC, Morris CG, Pepine CJ, Mendenhall NP. Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of Hodgkin lymphoma treated with radiation therapy. JAMA. 2003; 290:2831-2837.
