Predicted risks of cardiovascular disease following chemotherapy and radiotherapy in the UK NCRI RAPID trial of positron emission tomography–directed therapy for early-stage Hodgkin lymphoma
<p><strong>Purpose</strong></p> The contemporary management of early-stage Hodgkin lymphoma (ES-HL) involves balancing the risk of late adverse effects of radiotherapy against the increased risk of relapse if radiotherapy is omitted. This study provides information on the ris...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Journal article |
| Language: | English |
| Published: |
American Society of Clinical Oncology
2021
|
| _version_ | 1826309284565090304 |
|---|---|
| author | Cutter, DJ Ramroth, J Diez, P Buckle, A Ntentas, G Popova, B Clifton-Hadley, L Hoskin, PJ Darby, SC Radford, J Illidge, T |
| author_facet | Cutter, DJ Ramroth, J Diez, P Buckle, A Ntentas, G Popova, B Clifton-Hadley, L Hoskin, PJ Darby, SC Radford, J Illidge, T |
| author_sort | Cutter, DJ |
| collection | OXFORD |
| description | <p><strong>Purpose</strong></p>
The contemporary management of early-stage Hodgkin lymphoma (ES-HL) involves balancing the risk of late adverse effects of radiotherapy against the increased risk of relapse if radiotherapy is omitted. This study provides information on the risk of radiation-related cardiovascular disease to help personalize the delivery of radiotherapy in ES-HL.
<p><strong>Methods</strong></p>
We predicted 30-year absolute cardiovascular risk from chemotherapy and involved field radiotherapy in patients who were positron emission tomography (PET)–negative following three cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy within a UK randomized trial of PET-directed therapy for ES-HL. Cardiac and carotid radiation doses and chemotherapy exposure were combined with established dose-response relationships and population-based mortality and incidence rates.
<p><strong>Results</strong></p>
Average mean heart dose was 4.0 Gy (range 0.1-24.0 Gy) and average bilateral common carotid artery dose was 21.5 Gy (range 0.6-38.1 Gy), based on individualized cardiovascular dosimetry for 144 PET-negative patients receiving involved field radiotherapy. The average predicted 30-year radiation-related absolute excess overall cardiovascular mortality was 0.56% (range 0.01%-6.79%; < 0.5% in 67% of patients and > 1% in 15%), whereas average predicted 30-year excess incidence was 6.24% (range 0.31%-31.09%; < 5% in 58% of patients and > 10% in 24%). For cardiac disease, the average predicted 30-year radiation-related absolute excess mortality was 0.42% (0.79% with mediastinal involvement and 0.05% without) and for stroke, it was 0.14%.
<p><strong>Conclusion</strong></p>
Predicted excess cardiovascular risk is small for most patients, so radiotherapy may provide net benefit. However, for a minority of patients receiving high doses of radiation to cardiovascular structures, it may be preferable to consider advanced radiotherapy techniques to reduce doses or to omit radiotherapy and accept the increased relapse risk. Individual assessment of cardiovascular and other risks before treatment would allow personalized decision making about radiotherapy in ES-HL. |
| first_indexed | 2024-03-07T07:31:55Z |
| format | Journal article |
| id | oxford-uuid:6da89956-3230-4481-8a41-fefef9c4abbe |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:31:55Z |
| publishDate | 2021 |
| publisher | American Society of Clinical Oncology |
| record_format | dspace |
| spelling | oxford-uuid:6da89956-3230-4481-8a41-fefef9c4abbe2023-02-03T15:13:48ZPredicted risks of cardiovascular disease following chemotherapy and radiotherapy in the UK NCRI RAPID trial of positron emission tomography–directed therapy for early-stage Hodgkin lymphomaJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:6da89956-3230-4481-8a41-fefef9c4abbeEnglishSymplectic ElementsAmerican Society of Clinical Oncology2021Cutter, DJRamroth, JDiez, PBuckle, ANtentas, GPopova, BClifton-Hadley, LHoskin, PJDarby, SCRadford, JIllidge, T<p><strong>Purpose</strong></p> The contemporary management of early-stage Hodgkin lymphoma (ES-HL) involves balancing the risk of late adverse effects of radiotherapy against the increased risk of relapse if radiotherapy is omitted. This study provides information on the risk of radiation-related cardiovascular disease to help personalize the delivery of radiotherapy in ES-HL. <p><strong>Methods</strong></p> We predicted 30-year absolute cardiovascular risk from chemotherapy and involved field radiotherapy in patients who were positron emission tomography (PET)–negative following three cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine chemotherapy within a UK randomized trial of PET-directed therapy for ES-HL. Cardiac and carotid radiation doses and chemotherapy exposure were combined with established dose-response relationships and population-based mortality and incidence rates. <p><strong>Results</strong></p> Average mean heart dose was 4.0 Gy (range 0.1-24.0 Gy) and average bilateral common carotid artery dose was 21.5 Gy (range 0.6-38.1 Gy), based on individualized cardiovascular dosimetry for 144 PET-negative patients receiving involved field radiotherapy. The average predicted 30-year radiation-related absolute excess overall cardiovascular mortality was 0.56% (range 0.01%-6.79%; < 0.5% in 67% of patients and > 1% in 15%), whereas average predicted 30-year excess incidence was 6.24% (range 0.31%-31.09%; < 5% in 58% of patients and > 10% in 24%). For cardiac disease, the average predicted 30-year radiation-related absolute excess mortality was 0.42% (0.79% with mediastinal involvement and 0.05% without) and for stroke, it was 0.14%. <p><strong>Conclusion</strong></p> Predicted excess cardiovascular risk is small for most patients, so radiotherapy may provide net benefit. However, for a minority of patients receiving high doses of radiation to cardiovascular structures, it may be preferable to consider advanced radiotherapy techniques to reduce doses or to omit radiotherapy and accept the increased relapse risk. Individual assessment of cardiovascular and other risks before treatment would allow personalized decision making about radiotherapy in ES-HL. |
| spellingShingle | Cutter, DJ Ramroth, J Diez, P Buckle, A Ntentas, G Popova, B Clifton-Hadley, L Hoskin, PJ Darby, SC Radford, J Illidge, T Predicted risks of cardiovascular disease following chemotherapy and radiotherapy in the UK NCRI RAPID trial of positron emission tomography–directed therapy for early-stage Hodgkin lymphoma |
| title | Predicted risks of cardiovascular disease following chemotherapy and radiotherapy in the UK NCRI RAPID trial of positron emission tomography–directed therapy for early-stage Hodgkin lymphoma |
| title_full | Predicted risks of cardiovascular disease following chemotherapy and radiotherapy in the UK NCRI RAPID trial of positron emission tomography–directed therapy for early-stage Hodgkin lymphoma |
| title_fullStr | Predicted risks of cardiovascular disease following chemotherapy and radiotherapy in the UK NCRI RAPID trial of positron emission tomography–directed therapy for early-stage Hodgkin lymphoma |
| title_full_unstemmed | Predicted risks of cardiovascular disease following chemotherapy and radiotherapy in the UK NCRI RAPID trial of positron emission tomography–directed therapy for early-stage Hodgkin lymphoma |
| title_short | Predicted risks of cardiovascular disease following chemotherapy and radiotherapy in the UK NCRI RAPID trial of positron emission tomography–directed therapy for early-stage Hodgkin lymphoma |
| title_sort | predicted risks of cardiovascular disease following chemotherapy and radiotherapy in the uk ncri rapid trial of positron emission tomography directed therapy for early stage hodgkin lymphoma |
| work_keys_str_mv | AT cutterdj predictedrisksofcardiovasculardiseasefollowingchemotherapyandradiotherapyintheukncrirapidtrialofpositronemissiontomographydirectedtherapyforearlystagehodgkinlymphoma AT ramrothj predictedrisksofcardiovasculardiseasefollowingchemotherapyandradiotherapyintheukncrirapidtrialofpositronemissiontomographydirectedtherapyforearlystagehodgkinlymphoma AT diezp predictedrisksofcardiovasculardiseasefollowingchemotherapyandradiotherapyintheukncrirapidtrialofpositronemissiontomographydirectedtherapyforearlystagehodgkinlymphoma AT bucklea predictedrisksofcardiovasculardiseasefollowingchemotherapyandradiotherapyintheukncrirapidtrialofpositronemissiontomographydirectedtherapyforearlystagehodgkinlymphoma AT ntentasg predictedrisksofcardiovasculardiseasefollowingchemotherapyandradiotherapyintheukncrirapidtrialofpositronemissiontomographydirectedtherapyforearlystagehodgkinlymphoma AT popovab predictedrisksofcardiovasculardiseasefollowingchemotherapyandradiotherapyintheukncrirapidtrialofpositronemissiontomographydirectedtherapyforearlystagehodgkinlymphoma AT cliftonhadleyl predictedrisksofcardiovasculardiseasefollowingchemotherapyandradiotherapyintheukncrirapidtrialofpositronemissiontomographydirectedtherapyforearlystagehodgkinlymphoma AT hoskinpj predictedrisksofcardiovasculardiseasefollowingchemotherapyandradiotherapyintheukncrirapidtrialofpositronemissiontomographydirectedtherapyforearlystagehodgkinlymphoma AT darbysc predictedrisksofcardiovasculardiseasefollowingchemotherapyandradiotherapyintheukncrirapidtrialofpositronemissiontomographydirectedtherapyforearlystagehodgkinlymphoma AT radfordj predictedrisksofcardiovasculardiseasefollowingchemotherapyandradiotherapyintheukncrirapidtrialofpositronemissiontomographydirectedtherapyforearlystagehodgkinlymphoma AT illidget predictedrisksofcardiovasculardiseasefollowingchemotherapyandradiotherapyintheukncrirapidtrialofpositronemissiontomographydirectedtherapyforearlystagehodgkinlymphoma |