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Published in: Netherlands Heart Journal 2/2010

01-02-2010 | original article

Cardiac surgery in patients irradiated for Hodgkin’s lymphoma

Authors: S. Siregar, F. de Heer, L. A. van Herwerden

Published in: Netherlands Heart Journal | Issue 2/2010

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Abstract

Background/Objectives. Therapy for Hodgkin’s lymphoma is disease specific and cannot be compared with treatment for other diseases. It often includes more extensive radiotherapy on the mediastinum than for other malignancies. Cardiac morbidity is known to occur in patients previously irradiated. This study describes the postoperative course after cardiac surgery of patients previously irradiated for Hodgkin’s lymphoma.
Methods. From January 1990 until June 2008, 12 patients underwent cardiac surgery in the University Medical Center Utrecht after previous irradiation for Hodgkin’s lymphoma. Data on radiotherapy, surgery and follow-up were collected retrospectively. The postoperative functional status was assessed by a telephone questionnaire.
Results. Atrial fibrillation (33%) and pleural effusion (25%) were the most common postoperative complications. After a mean followup of 2.6±2.9 years four patients had died. The remaining patients were all in a favourable New York Heart Association and Canadian Cardiothoracic Society class. The estimated one-, two- and four-year survival rates were 83, 69 and 46% respectively.
Conclusion. The early postoperative outcome of cardiac surgery in this population is reasonably good. The long-term results may prove to be disappointing, but the cohort is small. (Neth Heart J 2010;18:61–5.)
Literature
1.
go back to reference Aleman BP. Optimizing treatment of patients with Hodgkin’s lymphoma [thesis]. Amsterdam: University of Amsterdam, 2007. Aleman BP. Optimizing treatment of patients with Hodgkin’s lymphoma [thesis]. Amsterdam: University of Amsterdam, 2007.
2.
go back to reference Hancock SL, Hoppe RT. Long-Term Complications of Treatment and Causes of Mortality After Hodgkin’s Disease. Semin Radiat Oncol. 1996;6:225–42. Hancock SL, Hoppe RT. Long-Term Complications of Treatment and Causes of Mortality After Hodgkin’s Disease. Semin Radiat Oncol. 1996;6:225–42.
3.
go back to reference Stewart JR, Fajardo LF. Radiation-induced heart disease: an update. Prog Cardiovasc Dis. 1984;27:173–94. Stewart JR, Fajardo LF. Radiation-induced heart disease: an update. Prog Cardiovasc Dis. 1984;27:173–94.
4.
go back to reference Aleman BM, van den Belt-Dusebout AW, De Bruin ML, van ‘t Veer MB, Baaijens MH, de Boer JP, et al. Late cardiotoxicity after treatment for Hodgkin lymphoma. Blood. 2007;109:1878–86. Aleman BM, van den Belt-Dusebout AW, De Bruin ML, van ‘t Veer MB, Baaijens MH, de Boer JP, et al. Late cardiotoxicity after treatment for Hodgkin lymphoma. Blood. 2007;109:1878–86.
5.
go back to reference Chang AS, Smedira NG, Chang CL, Benavides MM, Myhre U, Feng J, et al. Cardiac surgery after mediastinal radiation: extent of exposure influences outcome. J Thorac Cardiovasc Surg. 2007;133:404–13. Chang AS, Smedira NG, Chang CL, Benavides MM, Myhre U, Feng J, et al. Cardiac surgery after mediastinal radiation: extent of exposure influences outcome. J Thorac Cardiovasc Surg. 2007;133:404–13.
6.
go back to reference Comprehensive Cancer Centres and Comprehensive Cancer Centre Amsterdam. Prevalence figures (Noord-Holland & Flevoland). Document 13: Blood, bone marrow and lymph nodes. Comprehensive Cancer Centres and Comprehensive Cancer Centre Amsterdam. Prevalence figures (Noord-Holland & Flevoland). Document 13: Blood, bone marrow and lymph nodes.
7.
go back to reference Adams MJ, Hardenbergh PH, Constine LS, Lipshultz SE. Radiation-associated cardiovascular disease. Crit Rev Oncol Hematol. 2003;45:55–75. Adams MJ, Hardenbergh PH, Constine LS, Lipshultz SE. Radiation-associated cardiovascular disease. Crit Rev Oncol Hematol. 2003;45:55–75.
8.
go back to reference Kleikamp G, Schnepper U, Korfer R. Coronary artery and aortic valve disease as a long-term sequel of mediastinal and thoracic irradiation. Thorac Cardiovasc Surg. 1997;45:27–31. Kleikamp G, Schnepper U, Korfer R. Coronary artery and aortic valve disease as a long-term sequel of mediastinal and thoracic irradiation. Thorac Cardiovasc Surg. 1997;45:27–31.
9.
go back to reference Veeragandham RS, Goldin MD. Surgical management of radiation-induced heart disease. Ann Thorac Surg. 1998;65:1014–9. Veeragandham RS, Goldin MD. Surgical management of radiation-induced heart disease. Ann Thorac Surg. 1998;65:1014–9.
10.
go back to reference Zevering L, Kofflard M, Griep C, van der Meulen J. Coronary stenosis following successful radiotherapy for Hodgkin disease. Ned Tijdschr Geneeskd. 1998;142:468–72. Zevering L, Kofflard M, Griep C, van der Meulen J. Coronary stenosis following successful radiotherapy for Hodgkin disease. Ned Tijdschr Geneeskd. 1998;142:468–72.
11.
go back to reference Piovaccari G, Ferretti RM, Prati F, Traini AM, Gobbi M, Caravita L, et al. Cardiac disease after chest irradiation for Hodgkin’s disease: incidence in 108 patients with long followup. Int J Cardiol. 1995;49:39–43. Piovaccari G, Ferretti RM, Prati F, Traini AM, Gobbi M, Caravita L, et al. Cardiac disease after chest irradiation for Hodgkin’s disease: incidence in 108 patients with long followup. Int J Cardiol. 1995;49:39–43.
12.
go back to reference Reber D, Birnbaum DE, Tollenaere P. Heart diseases following mediastinal irradiation: surgical management. Eur J Cardiothorac Surg. 1995;9:202–5. Reber D, Birnbaum DE, Tollenaere P. Heart diseases following mediastinal irradiation: surgical management. Eur J Cardiothorac Surg. 1995;9:202–5.
13.
go back to reference Orzan F, Brusca A, Conte MR, Presbitero P, Figliomeni MC. Severe coronary artery disease after radiation therapy of the chest and mediastinum: clinical presentation and treatment. Br Heart J. 1993;69:496–500. Orzan F, Brusca A, Conte MR, Presbitero P, Figliomeni MC. Severe coronary artery disease after radiation therapy of the chest and mediastinum: clinical presentation and treatment. Br Heart J. 1993;69:496–500.
14.
go back to reference Hicks GL Jr. Coronary artery operation in radiation-associated atherosclerosis: long-term follow-up. Ann Thorac Surg. 1992;53:670–4. Hicks GL Jr. Coronary artery operation in radiation-associated atherosclerosis: long-term follow-up. Ann Thorac Surg. 1992;53:670–4.
15.
go back to reference Handler CE, Livesey S, Lawton PA. Coronary ostial stenosis after radiotherapy: angioplasty or coronary artery surgery? Br Heart J. 1989;61:208–11. Handler CE, Livesey S, Lawton PA. Coronary ostial stenosis after radiotherapy: angioplasty or coronary artery surgery? Br Heart J. 1989;61:208–11.
16.
go back to reference Ali MK, Kahlil KG, Fuller LM, Leachman RD, Sullivan MP, Loh KK, et al. Radiation-related myocardial injury. Management of two cases. Cancer. 1976;38:1941–6. Ali MK, Kahlil KG, Fuller LM, Leachman RD, Sullivan MP, Loh KK, et al. Radiation-related myocardial injury. Management of two cases. Cancer. 1976;38:1941–6.
17.
go back to reference Jahangiri M, Edmondson SJ, Rees GM. Surgery for radiationinduced valvular disease. J Heart Valve Dis. 1995;4:288–90. Jahangiri M, Edmondson SJ, Rees GM. Surgery for radiationinduced valvular disease. J Heart Valve Dis. 1995;4:288–90.
18.
go back to reference The Society of Cardiothoracic Surgeons. STS adult cardiac data specifications, version 2.61. The Society of Cardiothoracic Surgeons. STS adult cardiac data specifications, version 2.61.
20.
go back to reference Akins CW, Miller DC, Turina MI, Kouchoukos NT, Blackstone EH, Grunkemeier GL, et al. Guidelines for reporting mortality and morbidity after cardiac valve interventions. Ann Thorac Surg. 2008;85:1490–5. Akins CW, Miller DC, Turina MI, Kouchoukos NT, Blackstone EH, Grunkemeier GL, et al. Guidelines for reporting mortality and morbidity after cardiac valve interventions. Ann Thorac Surg. 2008;85:1490–5.
21.
go back to reference Crestanello JA, McGregor CG, Danielson GK, Daly RC, Dearani JA, Orszulak TA, et al. Mitral and tricuspid valve repair in patients with previous mediastinal radiation therapy. Ann Thorac Surg. 2004;78:826–31. Crestanello JA, McGregor CG, Danielson GK, Daly RC, Dearani JA, Orszulak TA, et al. Mitral and tricuspid valve repair in patients with previous mediastinal radiation therapy. Ann Thorac Surg. 2004;78:826–31.
22.
go back to reference Handa N, McGregor CG, Danielson GK, Daly RC, Dearani JA, Mullany CJ, et al. Valvular heart operation in patients with previous mediastinal radiation therapy. Ann Thorac Surg. 2001;71:1880–4. Handa N, McGregor CG, Danielson GK, Daly RC, Dearani JA, Mullany CJ, et al. Valvular heart operation in patients with previous mediastinal radiation therapy. Ann Thorac Surg. 2001;71:1880–4.
23.
go back to reference Abid SH, Malhotra V, Perry MC. Radiation-induced and chemotherapy-induced pulmonary injury. Curr Opin Oncol 2001;13:242–8. Abid SH, Malhotra V, Perry MC. Radiation-induced and chemotherapy-induced pulmonary injury. Curr Opin Oncol 2001;13:242–8.
24.
go back to reference Durham SJ, Gold JP. Late complications of cardiac surgery. In: Cohn LH, editor. Cardiac surgery in the adult. New York: McGraw-Hill; 2008. p. 535–48. Durham SJ, Gold JP. Late complications of cardiac surgery. In: Cohn LH, editor. Cardiac surgery in the adult. New York: McGraw-Hill; 2008. p. 535–48.
25.
go back to reference Annest LS, Anderson RP, Li W, Hafermann MD. Coronary artery disease following mediastinal radiation therapy. J Thorac Cardiovasc Surg. 1983;85:257–63. Annest LS, Anderson RP, Li W, Hafermann MD. Coronary artery disease following mediastinal radiation therapy. J Thorac Cardiovasc Surg. 1983;85:257–63.
26.
go back to reference Khan MH, Ettinger SM. Post mediastinal radiation coronary artery disease and its effects on arterial conduits. Catheter Cardiovasc Interv. 2001;52:242–8. Khan MH, Ettinger SM. Post mediastinal radiation coronary artery disease and its effects on arterial conduits. Catheter Cardiovasc Interv. 2001;52:242–8.
27.
go back to reference Schulman HE, Korr KS, Myers TJ. Left internal thoracic artery graft occlusion following mediastinal radiation therapy. Chest. 1994;105:1881–2. Schulman HE, Korr KS, Myers TJ. Left internal thoracic artery graft occlusion following mediastinal radiation therapy. Chest. 1994;105:1881–2.
28.
go back to reference Girinsky T, Ghalibafian M. Radiotherapy of hodgkin lymphoma: indications, new fields, and techniques. Semin Radiat Oncol. 2007;17:206–22. Girinsky T, Ghalibafian M. Radiotherapy of hodgkin lymphoma: indications, new fields, and techniques. Semin Radiat Oncol. 2007;17:206–22.
29.
go back to reference Klimm B, Eich HT, Haverkamp H, Lohri A, Koch P, Boissevain F, et al. Poorer outcome of elderly patients treated with extended-field radiotherapy compared with involved-field radiotherapy after chemotherapy for Hodgkin’s lymphoma: an analysis from the German Hodgkin Study Group. Ann Oncol. 2007;18:357–63. Klimm B, Eich HT, Haverkamp H, Lohri A, Koch P, Boissevain F, et al. Poorer outcome of elderly patients treated with extended-field radiotherapy compared with involved-field radiotherapy after chemotherapy for Hodgkin’s lymphoma: an analysis from the German Hodgkin Study Group. Ann Oncol. 2007;18:357–63.
30.
go back to reference van der Girinsky T, Maazen R, Specht L, Aleman B, Poortmans P, Lievens Y, et al. Involved-node radiotherapy (INRT) in patients with early Hodgkin lymphoma: concepts and guidelines. Radiother Oncol. 2006;79:270–7. van der Girinsky T, Maazen R, Specht L, Aleman B, Poortmans P, Lievens Y, et al. Involved-node radiotherapy (INRT) in patients with early Hodgkin lymphoma: concepts and guidelines. Radiother Oncol. 2006;79:270–7.
Metadata
Title
Cardiac surgery in patients irradiated for Hodgkin’s lymphoma
Authors
S. Siregar
F. de Heer
L. A. van Herwerden
Publication date
01-02-2010
Publisher
Bohn Stafleu van Loghum
Published in
Netherlands Heart Journal / Issue 2/2010
Print ISSN: 1568-5888
Electronic ISSN: 1876-6250
DOI
https://doi.org/10.1007/BF03091739

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