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Netherlands Heart Journal

, Volume 18, Issue 2, pp 61–65 | Cite as

Cardiac surgery in patients irradiated for Hodgkin’s lymphoma

  • S. Siregar
  • F. de Heer
  • L. A. van Herwerden
original article
Cardiac Surgical Procedures Hodgkin Disease Radiotherapy 

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.)

References

  1. 1.
    Aleman BP. Optimizing treatment of patients with Hodgkin’s lymphoma [thesis]. Amsterdam: University of Amsterdam, 2007.Google Scholar
  2. 2.
    Hancock SL, Hoppe RT. Long-Term Complications of Treatment and Causes of Mortality After Hodgkin’s Disease. Semin Radiat Oncol. 1996;6:225–42.Google Scholar
  3. 3.
    Stewart JR, Fajardo LF. Radiation-induced heart disease: an update. Prog Cardiovasc Dis. 1984;27:173–94.Google Scholar
  4. 4.
    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.Google Scholar
  5. 5.
    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.Google Scholar
  6. 6.
    Comprehensive Cancer Centres and Comprehensive Cancer Centre Amsterdam. Prevalence figures (Noord-Holland & Flevoland). Document 13: Blood, bone marrow and lymph nodes.Google Scholar
  7. 7.
    Adams MJ, Hardenbergh PH, Constine LS, Lipshultz SE. Radiation-associated cardiovascular disease. Crit Rev Oncol Hematol. 2003;45:55–75.Google Scholar
  8. 8.
    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.Google Scholar
  9. 9.
    Veeragandham RS, Goldin MD. Surgical management of radiation-induced heart disease. Ann Thorac Surg. 1998;65:1014–9.Google Scholar
  10. 10.
    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.Google Scholar
  11. 11.
    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.Google Scholar
  12. 12.
    Reber D, Birnbaum DE, Tollenaere P. Heart diseases following mediastinal irradiation: surgical management. Eur J Cardiothorac Surg. 1995;9:202–5.Google Scholar
  13. 13.
    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.Google Scholar
  14. 14.
    Hicks GL Jr. Coronary artery operation in radiation-associated atherosclerosis: long-term follow-up. Ann Thorac Surg. 1992;53:670–4.Google Scholar
  15. 15.
    Handler CE, Livesey S, Lawton PA. Coronary ostial stenosis after radiotherapy: angioplasty or coronary artery surgery? Br Heart J. 1989;61:208–11.Google Scholar
  16. 16.
    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.Google Scholar
  17. 17.
    Jahangiri M, Edmondson SJ, Rees GM. Surgery for radiationinduced valvular disease. J Heart Valve Dis. 1995;4:288–90.Google Scholar
  18. 18.
    The Society of Cardiothoracic Surgeons. STS adult cardiac data specifications, version 2.61.Google Scholar
  19. 19.
    www.euroscore.org. Used on 1-6-2008
  20. 20.
    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.Google Scholar
  21. 21.
    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.Google Scholar
  22. 22.
    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.Google Scholar
  23. 23.
    Abid SH, Malhotra V, Perry MC. Radiation-induced and chemotherapy-induced pulmonary injury. Curr Opin Oncol 2001;13:242–8.Google Scholar
  24. 24.
    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.Google Scholar
  25. 25.
    Annest LS, Anderson RP, Li W, Hafermann MD. Coronary artery disease following mediastinal radiation therapy. J Thorac Cardiovasc Surg. 1983;85:257–63.Google Scholar
  26. 26.
    Khan MH, Ettinger SM. Post mediastinal radiation coronary artery disease and its effects on arterial conduits. Catheter Cardiovasc Interv. 2001;52:242–8.Google Scholar
  27. 27.
    Schulman HE, Korr KS, Myers TJ. Left internal thoracic artery graft occlusion following mediastinal radiation therapy. Chest. 1994;105:1881–2.Google Scholar
  28. 28.
    Girinsky T, Ghalibafian M. Radiotherapy of hodgkin lymphoma: indications, new fields, and techniques. Semin Radiat Oncol. 2007;17:206–22.Google Scholar
  29. 29.
    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.Google Scholar
  30. 30.
    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.Google Scholar

Copyright information

© Bohn Stafleu van Loghum 2010

Authors and Affiliations

  1. 1.Department of Cardio-Thoracic Surgery, Heart and Lung DivisionUniversity Medical Center UtrechtUtrechtthe Netherlands
  2. 2.

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