Hancock S L, Donaldson S S, Hoppe R T
Department of Radiation Oncology, Stanford University School of Medicine, CA.
J Clin Oncol. 1993 Jul;11(7):1208-15. doi: 10.1200/JCO.1993.11.7.1208.
Cardiac disease is second only to neoplastic disease as a cause of death after treatment for Hodgkin's disease. This study evaluates the risks of cardiac disease following treatment of Hodgkin's disease during childhood and adolescence.
We reviewed records of 635 patients treated for Hodgkin's disease before 21 years of age at Stanford University between 1961 and 1991. Mean age was 15.4 years; mean follow-up duration was 10.3 years, representing 6,564 person-years of observation. Relative risks (RRs) of death from cardiac diseases were calculated by comparison with age-, sex-, and race-matched general population rates from United States decennial life-tables.
Twelve patients have died of cardiac disease (RR, 29.6; 95% confidence interval [CI], 16.0 to 49.3), including seven deaths from acute myocardial infarction ([AMI] RR, 41.5; 95% CI, 18.1 to 82.1), three from valvular heart disease, and two from radiation pericarditis/pancarditis. Thus far, the risk of AMI death was comparable after radiation alone (RO) or after chemotherapy and radiation (CM) (RO-AMI RR, 52.2; 95% CI, 21.1 to 108.7; CM-AMI RR, 21.1; 95% CI, 0.0 to 104.4; P = .6). The risk for other cardiac death (CD) tended to be higher after combined treatment (RO-non-AMI RR, 7.4; 95% CI, 0.0 to 36.5; CM-non-AMI RR, 45.8; 95% CI, 14.4 to 110.6; P = .1). Deaths occurred 3 to 22 years after patients received 42 to 45 Gy to the mediastinum between 9 and 20 years of age. There have been no deaths among patients treated to lower mediastinal radiation doses or without mediastinal radiation. There are no clear trends in the latency of risk. One hundred six nonfatal abnormalities have also been diagnosed.
Mediastinal radiation of 40 to 45 Gy increases the risk of death from coronary artery and other cardiac diseases. The risk increases within 5 years of irradiation. These observations support combined-modality, low-dose irradiation regimens in children and adolescents and suggest the need for careful cardiac screening of treated patients.
在霍奇金病治疗后的死因中，心脏病仅次于肿瘤性疾病。本研究评估儿童和青少年霍奇金病治疗后发生心脏病的风险。
我们回顾了1961年至1991年间在斯坦福大学接受治疗的635例21岁前的霍奇金病患者的记录。平均年龄为15.4岁；平均随访时间为10.3年，相当于6564人年的观察期。通过与美国十年生命表中年龄、性别和种族匹配的一般人群发病率进行比较，计算心脏病死亡的相对风险（RRs）。
12例患者死于心脏病（RR，29.6；95%置信区间[CI]，16.0至49.3），其中7例死于急性心肌梗死（[AMI]RR，41.5；95%CI，18.1至82.1），3例死于瓣膜性心脏病，2例死于放射性心包炎/全心炎。到目前为止，单纯放疗（RO）或化疗加放疗（CM）后急性心肌梗死死亡风险相当（RO-AMI RR，52.2；95%CI，21.1至108.7；CM-AMI RR，21.1；95%CI，0.0至104.4；P = 0.6）。联合治疗后其他心脏病死亡（CD）风险往往更高（RO-非AMI RR，7.4；95%CI，0.0至36.5；CM-非AMI RR，45.8；95%CI，14.4至110.6；P = 0.1）。死亡发生在患者9至20岁时接受42至45 Gy纵隔放疗后的3至22年。接受较低纵隔放疗剂量或未接受纵隔放疗的患者中无死亡病例。风险潜伏期无明显趋势。还诊断出106例非致命性异常。
40至45 Gy的纵隔放疗会增加冠状动脉疾病和其他心脏病死亡的风险。风险在放疗后5年内增加。这些观察结果支持儿童和青少年采用联合低剂量放疗方案，并表明需要对接受治疗的患者进行仔细的心脏筛查。
