| Summary: | Hodgkin lymphoma (HL) survivors treated with radiotherapy and/or chemotherapy are known to have increased risks of heart failure (HF), but a radiation dose-response relationship has not previously been derived. A case-control study, nested in a cohort of 2,617 five-year survivors of HL diagnosed before age 51 years during 1965-1995, was conducted. Cases (n=91) had moderate or severe HF as their first cardiovascular diagnosis. Controls (n=278) were matched to cases on age, gender and HL diagnosis date. Treatment and follow-up information were abstracted from medical records. Mean Heart Doses (MHD) and Mean Left Ventricular Doses (MLVD) were estimated by reconstruction of individual treatments on representative computed tomography datasets. Average MLVD was 16.7 Gy for cases and 13.8 Gy for controls (pdifference=0.003). HF rate increased with MLVD: relative to 0 Gy, HF rates following MVLDs of 1-15, 16-20, 21-25 and ≥26 Gy were 1.27, 1.65, 3.84, and 4.39 respectively (ptrend<0.001). Anthracycline-containing chemotherapy increased HF rate by a factor of 2.83 (95%CI: 1.43-5.59), and there was no significant interaction with MLVD (pinteraction=0.09). Twenty-five year cumulative risks of HF following MLVDs of 0-15 Gy, 16-20 Gy, and ≥21 Gy were 4.4%, 6.2% and 13.3%, respectively, in patients treated without anthracycline-containing chemotherapy, and 11.2%, 15.9% and 32.9%, respectively, in patients treated with anthracyclines. We have derived quantitative estimates of HF risk in patients treated for HL following radiotherapy with or without anthracycline-containing chemotherapy. Our results enable estimation of HF risk for patients before treatment, during RT planning and during follow-up.
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