Late cardiac, thyroid, and pulmonary sequelae of mantle radiotherapy for hodgkin's disease

• Published in: International journal of radiation oncology, biology, physics Vol. 11; no. 11; pp. 1925 - 1931
• Main Authors: Morgan, Graeme W., Freeman, Anthony P., McLean, Richard G., Jarvie, Brian H., Giles, Robert W.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.1985; Elsevier
• Subjects: Adult; Biological and medical sciences; Carbon Monoxide - metabolism; Electrocardiography; Forced Expiratory Volume; Heart; Heart - diagnostic imaging; Heart - radiation effects; Hematologic and hematopoietic diseases; Hodgkin Disease - complications; Hodgkin Disease - radiotherapy; Hodgkin's disease; Humans; Hypothyroidism - etiology; Late sequelae; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lung; Lung - radiation effects; Mantle radiotherapy; Medical sciences; Radionuclide Imaging; Radiotherapy - adverse effects; Stroke Volume; Thallium; Thyroid; Thyroid Gland - radiation effects; Thyrotropin - blood; Thyrotropin-Releasing Hormone; Thyroxine - blood; Triiodothyronine - blood; Vital Capacity; Heart; Late sequelae; Lung; Hodgkin's disease; Mantle radiotherapy; Thyroid; Endocrinopathy; Human; Late; Respiratory disease; Cardiovascular disease; Hodgkin disease; Sequela; Hemopathy; Thyroid gland; Radiation injury; Mantle field radiotherapy
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/0360-3016(85)90273-1

Cardiac, thyroid and pulmonary function were evaluated in 25 patients aged 35 years or under, treated for Hodgkin's disease by mantle radiotherapy 5–16 years previously. No patient had symptoms of heart disease. Although thallium myocardial perfusion scintigraphy was normal in all patients, abnormalities of myocardial function were detected in 6 (24%) patients using gated equilibrium rest and exercise radionuclide ventriculography. Resting left ventricular ejection fraction (LVEF) was abnormal in 1 patient, and in 3 patients there was an abnormal LVEF response to exercise. All 6 patients had right ventricular dilatation. Apical hypokinesia was present in 4 of these patients. A small asymptomatic pericardial effusion was detected by M-Mode echocardiography in only 2 (8%) patients. Twenty-three (92%) patients had evidence of abnormal thyroid function. Two (8%) patients had become clinically hypothyroid. Serum TSH was elevated in 13 (52%) patients and TRH stimulation test was abnormal in a further 10 (40%) patients in whom TSH was normal. Pulmonary function studies showed a moderate decrease in diffusing capacity (72% of predicted) and a minor reduction in lung volume. Although a high incidence of cardiac, thyroid and pulmonary abnormalities was detected, only the 2 patients who had become hypothyroid were symptomatic. Modification of the irradiation technique may reduce the incidence of cardiac abnormalities, but is unlikely to alter significantly the thyroid or pulmonary sequelae.