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Jahng JWS, Little MP, No HJ, Loo BW, Wu JC. Consequences of ionizing radiation exposure to the cardiovascular system. Nat Rev Cardiol 2024:10.1038/s41569-024-01056-4. [PMID: 38987578 DOI: 10.1038/s41569-024-01056-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/12/2024]
Abstract
Ionizing radiation is widely used in various industrial and medical applications, resulting in increased exposure for certain populations. Lessons from radiation accidents and occupational exposure have highlighted the cardiovascular and cerebrovascular risks associated with radiation exposure. In addition, radiation therapy for cancer has been linked to numerous cardiovascular complications, depending on the distribution of the dose by volume in the heart and other relevant target tissues in the circulatory system. The manifestation of symptoms is influenced by numerous factors, and distinct cardiac complications have previously been observed in different groups of patients with cancer undergoing radiation therapy. However, in contemporary radiation therapy, advances in treatment planning with conformal radiation delivery have markedly reduced the mean heart dose and volume of exposure, and these variables are therefore no longer sole surrogates for predicting the risk of specific types of heart disease. Nevertheless, certain cardiac substructures remain vulnerable to radiation exposure, necessitating close monitoring. In this Review, we provide a comprehensive overview of the consequences of radiation exposure on the cardiovascular system, drawing insights from various cohorts exposed to uniform, whole-body radiation or to partial-body irradiation, and identify potential risk modifiers in the development of radiation-associated cardiovascular disease.
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Affiliation(s)
- James W S Jahng
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Mark P Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA
- Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Oxford, UK
| | - Hyunsoo J No
- Department of Radiation Oncology, Southern California Permanente Medical Group, Los Angeles, CA, USA
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
- Greenstone Biosciences, Palo Alto, CA, USA.
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2
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Birch S, Otton J. Cardio-oncology and radiation oncology: How collaboration between cardiologists and oncologists can be realised in radiation oncology. J Med Imaging Radiat Oncol 2024. [PMID: 38874328 DOI: 10.1111/1754-9485.13724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 06/02/2024] [Indexed: 06/15/2024]
Abstract
Increased survivorship, improvements in cancer treatments, and the potential for cardiac side effects from cancer treatments have resulted in increased collaboration between oncologists and cardiologists and the development of cardio-oncology clinics. This collaboration is important given its role in ensuring greater patient satisfaction, aiding teams of clinicians in making complex treatment decision, and ensuring cardiac complications are diagnosed at an early stage. The particularities of implementing this collaboration in the field of radiation oncology and how this setting is different from other areas of cardio-oncology have not been well detailed in the literature. This paper will discuss what is currently understood about the need for and role of cardio-oncology and what a cardio-oncology services involves, with a particular emphasis on patient and clinician needs in the field of radiation oncology. The literature and recent guidelines do advocate for a detailed baseline assessment of cancer patients undergoing radiotherapy, especially patients with treatment or patient risk factors that increase their risk of cancer-therapy related cardiotoxicity. Advancements in cardiac imaging techniques will be discussed as these may help to diagnose cardiac side effects of certain cancer treatments, including radiotherapy, at an early stage. A multi-disciplinary and collaborative approach is well received by patients and such an approach, guided by the aim of maintaining a patient's cancer treatment wherever possible, should be the cornerstone of cardio-oncology clinics regardless of the patient's treatment regime.
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Affiliation(s)
- Samuel Birch
- Cardiology Department, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - James Otton
- Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia
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3
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Schiffer W, Pedersen LN, Lui M, Bergom C, Mitchell JD. Advances in Screening for Radiation-Associated Cardiotoxicity in Cancer Patients. Curr Cardiol Rep 2023; 25:1589-1600. [PMID: 37796395 PMCID: PMC10682284 DOI: 10.1007/s11886-023-01971-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE OF REVIEW Radiation is foundational to the treatment of cancer and improves overall survival. Yet, it is important to recognize the potential cardiovascular effects of radiation therapy and how to best minimize or manage them. Screening-both through imaging and with biomarkers-can potentially identify cardiovascular effects early, allowing for prompt initiation of treatment to mitigate late effects. RECENT FINDINGS Cardiac echocardiography, magnetic resonance imaging (MRI), computed tomography, and measurements of troponin and natriuretic peptides serve as the initial screening tests of choice for RICD. Novel imaging applications, including positron emission tomography and specific MRI parameters, and biomarker testing, including myeloperoxidase, growth differentiation factor 15, galectin 3, micro-RNA, and metabolomics, hold promise for earlier detection and more specific characterization of RICD. Advances in imaging and novel applications of biomarkers have potential to identify subclinical RICD and may reveal opportunities for early intervention. Further research is needed to elucidate optimal imaging screening modalities, biomarkers, and surveillance strategies.
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Affiliation(s)
- Walter Schiffer
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, CB 8086, St. Louis, MO, 63110, USA
- Cardio-Oncology Center of Excellence, Washington University School of Medicine, St. Louis, MO, USA
| | - Lauren N Pedersen
- Cardio-Oncology Center of Excellence, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew Lui
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, CB 8086, St. Louis, MO, 63110, USA
| | - Carmen Bergom
- Cardio-Oncology Center of Excellence, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA
| | - Joshua D Mitchell
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, CB 8086, St. Louis, MO, 63110, USA.
- Cardio-Oncology Center of Excellence, Washington University School of Medicine, St. Louis, MO, USA.
- Alvin J. Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO, USA.
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4
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Lopez-Mattei J, Yang EH, Baldassarre LA, Agha A, Blankstein R, Choi AD, Chen MY, Meyersohn N, Daly R, Slim A, Rochitte C, Blaha M, Whelton S, Dzaye O, Dent S, Milgrom S, Ky B, Iliescu C, Mamas MA, Ferencik M. Cardiac computed tomographic imaging in cardio-oncology: An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT). Endorsed by the International Cardio-Oncology Society (ICOS). J Cardiovasc Comput Tomogr 2023; 17:66-83. [PMID: 36216699 DOI: 10.1016/j.jcct.2022.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/01/2022] [Accepted: 09/12/2022] [Indexed: 11/21/2022]
Abstract
Cardio-Oncology is a rapidly growing sub-specialty of medicine, however, there is very limited guidance on the use of cardiac CT (CCT) in the care of Cardio-Oncology patients. In order to fill in the existing gaps, this Expert Consensus statement comprised of a multidisciplinary collaboration of experts in Cardiology, Radiology, Cardiovascular Multimodality Imaging, Cardio-Oncology, Oncology and Radiation Oncology aims to summarize current evidence for CCT applications in Cardio-Oncology and provide practice recommendations for clinicians.
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Affiliation(s)
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Ali Agha
- Department of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Ron Blankstein
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrew D Choi
- Division of Cardiology and Department of Radiology, The George Washington University School of Medicine, Washington, DC, USA
| | - Marcus Y Chen
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nandini Meyersohn
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, USA
| | - Ryan Daly
- Franciscan Health Indianapolis, Indianapolis, IN, USA
| | | | - Carlos Rochitte
- InCor Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Michael Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Seamus Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Susan Dent
- Duke Cancer Institute, Department of Medicine, Duke University, Durham, NC, USA
| | - Sarah Milgrom
- Department of Radiation Oncology, University of Colorado, Boulder, CO, USA
| | - Bonnie Ky
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Cezar Iliescu
- Heart and Vascular Institute, Lee Health, Fort Myers, FL, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, UK
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
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5
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Guseh JS, Parakh A, Chen YLE, Sundt TM, Fitzsimons MG, Stathatos N, Harris C. Case 40-2022: A 38-Year-Old Man with Exertional Chest Discomfort. N Engl J Med 2022; 387:2450-2460. [PMID: 36577103 DOI: 10.1056/nejmcpc2211360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J Sawalla Guseh
- From the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Harvard Medical School - both in Boston
| | - Anushri Parakh
- From the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Harvard Medical School - both in Boston
| | - Yen-Lin E Chen
- From the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Harvard Medical School - both in Boston
| | - Thoralf M Sundt
- From the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Harvard Medical School - both in Boston
| | - Michael G Fitzsimons
- From the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Harvard Medical School - both in Boston
| | - Nikolaos Stathatos
- From the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Harvard Medical School - both in Boston
| | - Cynthia Harris
- From the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Massachusetts General Hospital, and the Departments of Medicine (J.S.G., N.S.), Radiology (A.P.), Radiation Oncology (Y.-L.E.C.), Surgery (T.M.S.), Anesthesia, Critical Care, and Pain Medicine (M.G.F.), and Pathology (C.H.), Harvard Medical School - both in Boston
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6
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Melo MDTD, Paiva MG, Santos MVC, Rochitte CE, Moreira VDM, Saleh MH, Brandão SCS, Gallafrio CC, Goldwasser D, Gripp EDA, Piveta RB, Silva TO, Santo THCE, Ferreira WP, Salemi VMC, Cauduro SA, Barberato SH, Lopes HMC, Pena JLB, Rached HRS, Miglioranza MH, Pinheiro AC, Vrandecic BALM, Cruz CBBV, Nomura CH, Cerbino FME, Costa IBSDS, Coelho Filho OR, Carneiro ACDC, Burgos UMMC, Fernandes JL, Uellendahl M, Calado EB, Senra T, Assunção BL, Freire CMV, Martins CN, Sawamura KSS, Brito MM, Jardim MFS, Bernardes RJM, Diógenes TC, Vieira LDO, Mesquita CT, Lopes RW, Segundo Neto EMV, Rigo L, Marin VLS, Santos MJ, Grossman GB, Quagliato PC, Alcantara MLD, Teodoro JAR, Albricker ACL, Barros FS, Amaral SID, Porto CLL, Barros MVL, Santos SND, Cantisano AL, Petisco ACGP, Barbosa JEM, Veloso OCG, Spina S, Pignatelli R, Hajjar LA, Kalil Filho R, Lopes MACQ, Vieira MLC, Almeida ALC. Brazilian Position Statement on the Use Of Multimodality Imaging in Cardio-Oncology - 2021. Arq Bras Cardiol 2021; 117:845-909. [PMID: 34709307 PMCID: PMC8528353 DOI: 10.36660/abc.20200266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
| | | | | | - Carlos Eduardo Rochitte
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital do Coração (HCOR), São Paulo, SP - Brasil
| | | | - Mohamed Hassan Saleh
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | - Daniel Goldwasser
- Hospital Federal de Ipanema, Rio de Janeiro, RJ - Brasil
- Hospital Copa D'Or, Rio de Janeiro, RJ - Brasil
- Casa de Saúde São José, Rio de Janeiro, RJ - Brasil
| | - Eliza de Almeida Gripp
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Antônio Pedro, Rio de Janeiro, RJ - Brasil
| | | | - Tonnison Oliveira Silva
- Hospital Cardio Pulmonar - Centro de Estudos em Cardiologia, Salvador, BA - Brasil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
| | | | | | - Vera Maria Cury Salemi
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Silvio Henrique Barberato
- CardioEco Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brasil
- Quanta Diagnóstico, Curitiba, PR - Brasil
| | | | | | | | - Marcelo Haertel Miglioranza
- Instituto de Cardiologia do Rio Grande do Sul - Laboratório de Pesquisa e Inovação em Imagem Cardiovascular, Porto Alegre, RS - Brasil
- Hospital Mãe de Deus, Porto Alegre, RS - Brasil
| | | | | | | | - César Higa Nomura
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Fernanda Mello Erthal Cerbino
- Clínica de Diagnóstico por Imagem, Rio de Janeiro, RJ - Brasil
- Diagnósticos da América AS, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Juliano Lara Fernandes
- Radiologia Clínica de Campinas, Campinas, SP - Brasil
- Instituto de Ensino e Pesquisa José Michel Kalaf, Campinas, SP - Brasil
| | - Marly Uellendahl
- Diagnósticos da América AS, Rio de Janeiro, RJ - Brasil
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
| | | | - Tiago Senra
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
- Hospital Sírio-Libanês, São Paulo, SP - Brasil
| | - Bruna Leal Assunção
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Claudia Maria Vilas Freire
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil
- ECOCENTER, Belo Horizonte, MG - Brasil
| | | | - Karen Saori Shiraishi Sawamura
- Hospital do Coração (HCOR), São Paulo, SP - Brasil
- Hospital Universitário Antônio Pedro, Rio de Janeiro, RJ - Brasil
- Instituto da Criança da Universidade de São Paulo (USP), São Paulo, SP - Brasil
| | - Márcio Miranda Brito
- Universidade Federal do Tocantins - Campus de Araguaina, Araguaina, TO - Brasil
- Hospital Municipal de Araguaina, Araguaina, TO - Brasil
| | | | | | | | | | - Claudio Tinoco Mesquita
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brasil
- Hospital Vitória, Rio de Janeiro, RJ - Brasil
| | | | | | - Letícia Rigo
- Hospital Beneficência Portuguesa, São Paulo, SP - Brasil
| | | | | | - Gabriel Blacher Grossman
- Clínica Cardionuclear, Porto Alegre, RS - Brasil
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | | | - Monica Luiza de Alcantara
- Americas Medical City, Rio de Janeiro, Rio de Janeiro, RJ - Brasil
- Americas Serviços Médicos, Rio de Janeiro, RJ - Brasil
- Rede D'Or, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Simone Nascimento Dos Santos
- Hospital Brasília - Ecocardiografia, Brasília, DF - Brasil
- Eccos Diagnóstico Cardiovascular Avançado, Brasília, DF - Brasil
| | | | | | | | | | | | - Ricardo Pignatelli
- Texas Children's Hospital, Houston, Texas - EUA
- Baylor College of Medicine, Houston, Texas - EUA
| | - Ludhmilla Abrahão Hajjar
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Roberto Kalil Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Universidade de São Paulo Instituto do Câncer do Estado de São Paulo, São Paulo, SP - Brasil
| | - Marcelo Antônio Cartaxo Queiroga Lopes
- Hospital Alberto Urquiza Wanderley - Hemodinâmica e Cardiologia Intervencionista, João Pessoa, PB - Brasil
- Hospital Metropolitano Dom José Maria Pires, João Pessoa, PB - Brasil
- Sociedade Brasileira de Cardiologia, Rio de Janeiro, RJ - Brasil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - André Luiz Cerqueira Almeida
- Santa Casa de Misericórdia de Feira de Santana - Cardiologia, Feira de Santana, BA - Brasil
- Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia, São Paulo, SP - Brasil
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7
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Bergom C, Bradley JA, Ng AK, Samson P, Robinson C, Lopez-Mattei J, Mitchell JD. Past, Present, and Future of Radiation-Induced Cardiotoxicity: Refinements in Targeting, Surveillance, and Risk Stratification. JACC CardioOncol 2021; 3:343-359. [PMID: 34604796 PMCID: PMC8463722 DOI: 10.1016/j.jaccao.2021.06.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 12/13/2022] Open
Abstract
Radiation therapy is an important component of cancer therapy for many malignancies. With improvements in cardiac-sparing techniques, radiation-induced cardiac dysfunction has decreased but remains a continued concern. In this review, we provide an overview of the evolution of radiotherapy techniques in thoracic cancers and associated reductions in cardiac risk. We also highlight data demonstrating that in some cases radiation doses to specific cardiac substructures correlate with cardiac toxicities and/or survival beyond mean heart dose alone. Advanced cardiac imaging, cardiovascular risk assessment, and potentially even biomarkers can help guide post-radiotherapy patient care. In addition, treatment of ventricular arrhythmias with the use of ablative radiotherapy may inform knowledge of radiation-induced cardiac dysfunction. Future efforts should explore further personalization of radiotherapy to minimize cardiac dysfunction by coupling knowledge derived from enhanced dosimetry to cardiac substructures, post-radiation regional dysfunction seen on advanced cardiac imaging, and more complete cardiac toxicity data.
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Key Words
- CAC, coronary artery calcium
- CAD, coronary artery disease
- CMRI, cardiac magnetic resonance imaging
- CT, computed tomography
- HL, Hodgkin lymphoma
- LAD, left anterior descending artery
- LV, left ventricular
- MHD, mean heart dose
- NSCLC, non–small cell lung cancer
- RICD, radiation-induced cardiovascular disease
- RT, radiation therapy
- SBRT, stereotactic body radiation therapy
- breast cancer
- cancer survivorship
- childhood cancer
- esophageal cancer
- imaging
- lung cancer
- lymphoma
- radiation physics
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Affiliation(s)
- Carmen Bergom
- Department of Radiation Oncology, Washington University, Saint Louis, Missouri, USA
- Cardio-Oncology Center of Excellence, Washington University, St. Louis, Missouri, USA
- Alvin J. Siteman Center, Washington University, St. Louis, Missouri, USA
| | - Julie A. Bradley
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida, USA
| | - Andrea K. Ng
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Pamela Samson
- Department of Radiation Oncology, Washington University, Saint Louis, Missouri, USA
- Alvin J. Siteman Center, Washington University, St. Louis, Missouri, USA
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University, Saint Louis, Missouri, USA
- Alvin J. Siteman Center, Washington University, St. Louis, Missouri, USA
- Division of Cardiology, Department of Medicine, Washington University, St. Louis, Missouri, USA
| | - Juan Lopez-Mattei
- Departments of Cardiology and Thoracic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joshua D. Mitchell
- Cardio-Oncology Center of Excellence, Washington University, St. Louis, Missouri, USA
- Alvin J. Siteman Center, Washington University, St. Louis, Missouri, USA
- Division of Cardiology, Department of Medicine, Washington University, St. Louis, Missouri, USA
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8
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Buglione M, Guerini AE, Filippi AR, Spiazzi L, Pasinetti N, Magli A, Toraci C, Borghetti P, Triggiani L, Alghisi A, Costantino G, Bertagna F, Giaj Levra N, Pegurri L, Magrini SM. A Systematic Review on Intensity Modulated Radiation Therapy for Mediastinal Hodgkin's Lymphoma. Crit Rev Oncol Hematol 2021; 167:103437. [PMID: 34358649 DOI: 10.1016/j.critrevonc.2021.103437] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 05/20/2021] [Accepted: 07/28/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Secondary malignant neoplasms (SMNs) and cardiovascular diseases induced by chemotherapy and radiotherapy represent the main cause of excess mortality for early-stage Hodgkin lymphoma patients, especially when the mediastinum is involved. Conformal radiotherapy techniques such as Intensity-Modulated Radiation Therapy (IMRT) could allow a reduction of the dose to the organs-at-risk (OARs) and therefore limit long-term toxicity. METHODS We performed a systematic review of the current literature regarding comparisons between IMRT and conventional photon beam radiotherapy, or between different IMRT techniques, for the treatment of mediastinal lymphoma. RESULTS AND CONCLUSIONS IMRT allows a substantial reduction of the volumes of OARs exposed to high doses, reducing the risk of long-term toxicity. This benefit is conterbalanced by the increase of volumes receiving low doses, that could potentially increase the risk of SMNs. Treatment planning should be personalized on patient and disease characteristics. Dedicated techniques such as "butterfly" VMAT often provide the best trade-off.
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Affiliation(s)
- Michela Buglione
- Università degli Studi di Brescia, Department of Radiation Oncology, Brescia University, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Andrea Emanuele Guerini
- Università degli Studi di Brescia, Department of Radiation Oncology, Brescia University, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Andrea Riccardo Filippi
- Radiation Oncology, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy.
| | - Luigi Spiazzi
- Department of Radiation Oncology, ASST Spedali Civili di Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Nadia Pasinetti
- Università degli Studi di Brescia, Department of Radiation Oncology, Brescia University, P.le Spedali Civili 1, 25123 Brescia, Italy; Radiation Oncology Service, ASST Valcamonica Esine, Italy.
| | - Alessandro Magli
- Department of Radiation Oncology, Udine General Hospital, Udine, Italy.
| | - Cristian Toraci
- Department of Radiation Oncology, ASST Spedali Civili di Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Paolo Borghetti
- Department of Radiation Oncology, ASST Spedali Civili di Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Luca Triggiani
- Università degli Studi di Brescia, Department of Radiation Oncology, Brescia University, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Alessandro Alghisi
- Department of Radiation Oncology, Alessandro Manzoni Hospital, Lecco, Italy.
| | | | - Francesco Bertagna
- Nuclear Medicine Department, University of Brescia and Spedali Civili of Brescia, Brescia, Italy.
| | - Niccolò Giaj Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Italy.
| | - Ludovica Pegurri
- Department of Radiation Oncology, ASST Spedali Civili di Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy.
| | - Stefano Maria Magrini
- Università degli Studi di Brescia, Department of Radiation Oncology, Brescia University, P.le Spedali Civili 1, 25123 Brescia, Italy.
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9
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Rosmini S, Aggarwal A, Chen DH, Conibear J, Davies CL, Dey AK, Edwards P, Guha A, Ghosh AK. Cardiac computed tomography in cardio-oncology: an update on recent clinical applications. Eur Heart J Cardiovasc Imaging 2021; 22:397-405. [PMID: 33555007 DOI: 10.1093/ehjci/jeaa351] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/08/2020] [Indexed: 01/07/2023] Open
Abstract
Chemotherapy and radiotherapy have drastically improved cancer survival, but they can result in significant short- and long-term cardiovascular complications, most commonly heart failure from chemotherapy, whilst radiotherapy increases the risk of premature coronary artery disease (CAD), valve, and pericardial diseases. Cardiac computed tomography (CT) with calcium scoring has a role in screening asymptomatic patients for premature CAD, cardiac CT angiography (CTCA) allows the identification of significant CAD, also in the acute settings where concerns exist towards invasive angiography. CTCA integrates the diagnostic work-up and guides surgical/percutaneous management of valvular heart diseases and allows the assessment of pericardial conditions, including detection of effusion and pericardial calcification. It is a widely available and fast imaging modality that allows a one-step evaluation of CAD, myocardial, valvular, and pericardial disease. This review aims to provide an update on its current use and accompanying evidence-base for cardiac CT in the management of cardio-oncology patients.
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Affiliation(s)
- Stefania Rosmini
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Ankita Aggarwal
- Department of Internal Medicine, Wayne State University, Providence Hospital, Rochester, MI, USA
| | - Daniel H Chen
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK.,Cardio-Oncology Service, University College London Hospital, London, UK.,Hatter Cardiovascular Institute, University College London, London, UK
| | - John Conibear
- Oncology Department, Barts Cancer Centre, St Bartholomew's Hospital London, UK
| | - Ceri L Davies
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Amit Kumar Dey
- National Heart, Lung and Blood Institute, Bethesda, USA.,Department of Internal Medicine, Georgetown University, Washington, DC, USA
| | - Paula Edwards
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Avirup Guha
- Harrington Heart and Vascular Institute, Cleveland, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Arjun K Ghosh
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK.,Cardio-Oncology Service, University College London Hospital, London, UK.,Hatter Cardiovascular Institute, University College London, London, UK
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10
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Is radiation-induced arteriopathy in long-term breast cancer survivors an underdiagnosed situation?: Critical and pragmatic review of available literature. Radiother Oncol 2021; 157:163-174. [PMID: 33515666 DOI: 10.1016/j.radonc.2021.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 01/01/2021] [Accepted: 01/10/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Although considered exceptional, radiation-induced arteriopathy in long-term breast cancer survivors involves three main arterial domains in the irradiated volume, namely axillary-subclavian, coronary, and carotid. Stenosis of medium-large arteries is caused by "accelerated" atherosclerosis, particularly beyond 10 years after long-forgotten radiotherapy. The present review aims at summarizing what is known about arteriopathy, as well as the state of the art in terms of diagnosis and therapeutic management. DIAGNOSIS Pauci-symptomatic over years, the usual clinical presentation of arteriopathy involves arm pain with coldness due to subacute or critical ischemia (arterial occlusion), wrongly attributed to an exclusive neurological disorder, and more rarely transient ischemic accident or angina. Evaluation of the supra-aortic trunks by computed tomography and/or magnetic resonance angiography visualizes artery lesions, while Doppler ultrasonography in expert hands assesses diagnosis and downstream functional impact. In severe cases, more invasive angiography directly visualizes long irregular arterial stenosis (full-field radiotherapy), allowing accurate prognosis and treatment. MANAGEMENT Requires early diagnosis to enable initiation of medical treatment that increases blood flow (aspirin) as soon as moderate stenosis is detected, combined with correction of vascular risk factors. In intermediate cases, these therapeutic measures are completed by revascularization strategies using transluminal angioplasty-stenting (wall thickness). Antifibrotic treatment is useful in advanced cases with combined radiation injuries. CONCLUSION In follow-up of long-term breast cancer survivors with node irradiation, myocardial infarction is treated even if radiotherapy is forgotten, while recognition and diagnosis of chronic arm ischemia due to subclavian artery stenosis needs to be improved for appropriate therapeutic management.
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11
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M'kacher R, Colicchio B, Marquet V, Borie C, Najar W, Hempel WM, Heidingsfelder L, Oudrhiri N, Al Jawhari M, Wilhelm-Murer N, Miguet M, Dieterlen A, Deschênes G, Tabet AC, Junker S, Grynberg M, Fenech M, Bennaceur-Griscelli A, Voisin P, Carde P, Jeandidier E, Yardin C. Telomere aberrations, including telomere loss, doublets, and extreme shortening, are increased in patients with infertility. Fertil Steril 2020; 115:164-173. [PMID: 33272625 DOI: 10.1016/j.fertnstert.2020.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To test the hypothesis that telomere shortening and/or loss are risk factors for infertility. DESIGN Retrospective analysis of the telomere status in patients with infertility using conventional cytogenetic data collected prospectively. SETTING Academic centers. PATIENT(S) Cytogenetic slides with cultured peripheral lymphocytes from 50 patients undergoing fertility treatment and 150 healthy donors, including 100 donors matched for age. INTERVENTION(S) Cytogenetic slides were used to detect chromosomal and telomere aberrations. MAIN OUTCOME MEASURE(S) Telomere length and telomere aberrations were analyzed after telomere and centromere staining. RESULT(S) The mean telomere length of patients consulting for infertility was significantly less than that of healthy donors of similar age. Moreover, patients with infertility showed significantly more extreme telomere loss and telomere doublet formation than healthy controls. Telomere shortening and/or telomere aberrations were more pronounced in patients with structural chromosomal aberrations. Dicentric chromosomes were identified in 6/13 patients, with constitutional chromosomal aberrations leading to chromosomal instability that correlated with chromosomal end-to-end fusions. CONCLUSION(S) Our findings demonstrate the feasibility of analyzing telomere aberrations in addition to chromosomal aberrations, using cytogenetic slides. Telomere attrition and/or dysfunction represent the main common cytogenetic characteristic of patients with infertility, leading to potential implications for fertility assessment. Pending further studies, these techniques that correlate the outcome of assisted reproduction and telomere integrity status may represent a novel and useful diagnostic and/or prognostic tool for medical care in this field.
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Affiliation(s)
- Radhia M'kacher
- Cell Environment, DNA Damage Research & Development, Paris, France.
| | - Bruno Colicchio
- Institut de Recherche en Informatique, Mathématiques, Automatique et Signal, Université de Haute-Alsace, Mulhouse, France
| | - Valentine Marquet
- Service de Cytogénétique, Génétique Médicale, et Biologie de la Reproduction Hôpital de la Mère et de l'Enfant, Centre hospitalo-universitaire Dupuytren, Limoges, France
| | - Claire Borie
- Assitance Pubique-Hopitaux de Paris (APHP)-Service d'hématologie-Oncohématologie Moléculaire et Cytogénétique Hôpital Paul Brousse Université Paris Saclay/INSERM 935, Villejuif, France
| | - Wala Najar
- Cell Environment, DNA Damage Research & Development, Paris, France; Faculté de médecine Paris Centre, Université de Paris, Paris, France
| | - William M Hempel
- Cell Environment, DNA Damage Research & Development, Paris, France
| | | | - Noufissa Oudrhiri
- Assitance Pubique-Hopitaux de Paris (APHP)-Service d'hématologie-Oncohématologie Moléculaire et Cytogénétique Hôpital Paul Brousse Université Paris Saclay/INSERM 935, Villejuif, France
| | | | - Nadège Wilhelm-Murer
- Service de génétique Groupe Hospitalier de la Région de Mulhouse et Sud Alsace, Mulhouse, France
| | - Marguerite Miguet
- Service de génétique Groupe Hospitalier de la Région de Mulhouse et Sud Alsace, Mulhouse, France
| | - Alain Dieterlen
- Institut de Recherche en Informatique, Mathématiques, Automatique et Signal, Université de Haute-Alsace, Mulhouse, France
| | | | | | - Steffen Junker
- Institute of Biomedicine, University of Aarhus, Aarhus, Denmark
| | - Michael Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Antoine Béclère, Clamart, France
| | - Michael Fenech
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia; Genome Health Foundation, North Brighton, South Australia, Australia
| | - Annelise Bennaceur-Griscelli
- Assitance Pubique-Hopitaux de Paris (APHP)-Service d'hématologie-Oncohématologie Moléculaire et Cytogénétique Hôpital Paul Brousse Université Paris Saclay/INSERM 935, Villejuif, France
| | - Philippe Voisin
- Cell Environment, DNA Damage Research & Development, Paris, France
| | - Patrice Carde
- Department of Hematology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Eric Jeandidier
- Service de génétique Groupe Hospitalier de la Région de Mulhouse et Sud Alsace, Mulhouse, France
| | - Catherine Yardin
- Service de Cytogénétique, Génétique Médicale, et Biologie de la Reproduction Hôpital de la Mère et de l'Enfant, Centre hospitalo-universitaire Dupuytren, Limoges, France; CNRS, XLIM, UMR 7252, University of Limoges, Limoges, France
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12
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Čelutkienė J, Pudil R, López‐Fernández T, Grapsa J, Nihoyannopoulos P, Bergler‐Klein J, Cohen‐Solal A, Farmakis D, Tocchetti CG, Haehling S, Barberis V, Flachskampf FA, Čeponienė I, Haegler‐Laube E, Suter T, Lapinskas T, Prasad S, Boer RA, Wechalekar K, Anker MS, Iakobishvili Z, Bucciarelli‐Ducci C, Schulz‐Menger J, Cosyns B, Gaemperli O, Belenkov Y, Hulot J, Galderisi M, Lancellotti P, Bax J, Marwick TH, Chioncel O, Jaarsma T, Mullens W, Piepoli M, Thum T, Heymans S, Mueller C, Moura B, Ruschitzka F, Zamorano JL, Rosano G, Coats AJ, Asteggiano R, Seferovic P, Edvardsen T, Lyon AR. Role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies: a position statement on behalf of the
H
eart
F
ailure
A
ssociation (
HFA
), the
E
uropean
A
ssociation of
C
ardiovascular
I
maging (
EACVI
) and the
Cardio‐Oncology C
ouncil of the
E
uropean
S
ociety of
C
ardiology (
ESC
). Eur J Heart Fail 2020; 22:1504-1524. [DOI: 10.1002/ejhf.1957] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 06/08/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jelena Čelutkienė
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University Vilnius Lithuania
- State Research Institute Centre For Innovative Medicine Vilnius Lithuania
| | - Radek Pudil
- First Department of Medicine ‐ Cardioangiology Charles University Prague, Medical Faculty and University Hospital Hradec Králové Hradec Kralove Czech Republic
| | | | - Julia Grapsa
- Department of Cardiology St Bartholomew Hospital, Barts Health Trust London UK
| | - Petros Nihoyannopoulos
- Unit of Inherited Cardiovascular Diseases/Heart Center of the Young and Athletes, First Department of Cardiology Hippokrateion General Hospital, National and Kapodistrian University of Athens Athens Greece
- National Heart and Lung Institute Imperial College London, Hammersmith Hospital London UK
| | | | - Alain Cohen‐Solal
- UMR‐S 942, Cardiology Department Hôpital Lariboisière, AP‐HP, Université de Paris Paris France
| | - Dimitrios Farmakis
- University of Cyprus Medical School Nicosia Cyprus
- Cardio‐Oncology Clinic, Heart Failure Unit, Department of Cardiology Athens University Hospital Attikon, National and Kapodistrian University of Athens Athens Greece
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences, and Interdepartmental Center for Clinical and Translational Research (CIRCET) Federico II University Naples Italy
| | - Stephan Haehling
- Department of Cardiology and Pneumology University of Göttingen Medical Centre Göttingen Germany
| | | | - Frank A. Flachskampf
- Department of Medical Sciences Uppsala University, Clinical Physiology and Cardiology, Akademiska Hospital Uppsala Sweden
| | - Indrė Čeponienė
- Department of Cardiology, Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania
| | - Eva Haegler‐Laube
- Department of Cardiology, Inselspital University of Bern Bern Switzerland
| | - Thomas Suter
- Department of Cardiology, Inselspital University of Bern Bern Switzerland
| | - Tomas Lapinskas
- Department of Cardiology, Medical Academy Lithuanian University of Health Sciences Kaunas Lithuania
| | - Sanjay Prasad
- Department of Cardiac Magnetic Resonance Royal Brompton Hospital London UK
- National Heart and Lung Institute, Imperial College London UK
| | - Rudolf A. Boer
- Department of Cardiology University Medical Center Groningen, University of Groningen Groningen The Netherlands
| | | | - Markus S. Anker
- Division of Cardiology and Metabolism, Department of Cardiology, Charité; and Berlin Institute of Health Center for Regenerative Therapies (BCRT); and DZHK (German Centre for Cardiovascular Research), partner site Berlin; and Department of Cardiology, Charité Campus Benjamin Franklin Berlin Germany
| | - Zaza Iakobishvili
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Tel Aviv‐Jaffa District, Clalit Health Services Tel Aviv Israel
| | - Chiara Bucciarelli‐Ducci
- Bristol Heart Institute, Bristol NIHR Biomedical Research Centre and Clinical Research and Imaging Centre (CRIC) Bristol University Hospitals Bristol NHS Trust and University of Bristol Bristol UK
| | - Jeanette Schulz‐Menger
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center a joint cooperation between the Charité ‐ Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max‐Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology Berlin Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin Berlin Germany
| | - Bernard Cosyns
- Department of Cardiology CHVZ (Centrum voor Hart en Vaatziekten), ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Universitair Ziekenhuis Brussel Brussels Belgium
| | | | - Yury Belenkov
- I.M. Sechenov's First Moscow State Medical University of Ministry of Health (Sechenov University) Moscow Russia
| | - Jean‐Sébastien Hulot
- Université de Paris, CIC1418, Paris Cardiovascular Research Center, INSERM Paris France
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences Federico II University Hospital Naples Italy
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, CHU SartTilman Liège Belgium
| | - Jeroen Bax
- Department of Cardiology Leiden University Medical Centre Leiden The Netherlands
| | | | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases C.C. Iliescu Bucuresti Romania
- University of Medicine Carol Davila Bucuresti Romania
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht and Utrecht University Utrecht The Netherlands
| | | | - Massimo Piepoli
- Heart Failure Unit, Cardiology Guglielmo da Saliceto Hospital Piacenza Italy
- University of Parma Parma Italy
| | - Thomas Thum
- Hannover Medical School, Institute of Molecular and Translational Therapeutic Strategies (IMTTS) Hannover Germany
| | - Stephane Heymans
- Department of Cardiology, CARIM School for Cardiovascular Diseases Faculty of Health, Medicine and Life Sciences Maastricht University Maastricht The Netherlands
- William Harvey Research Institute, Barts Heart Centre, Queen Mary University of London, Charterhouse Square London UK
- Department of Cardiovascular Sciences Centre for Molecular and Vascular Biology, KU Leuven Leuven Belgium
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital Basel, University of Basel Basel Switzerland
| | - Brenda Moura
- Cardiology Department, Military Hospital, and CINTESIS, CardioCare, Faculty of Medicine Porto University Porto Portugal
| | - Frank Ruschitzka
- University Heart Center, Department of Cardiology University Hospital Zurich Zurich Switzerland
| | - Jose Luis Zamorano
- Cardiology Department University Hospital Ramón y Cajal Madrid Spain
- University Alcala Madrid Spain
- CIBERCV, Instituto de Salud Carlos III (ISCIII) Madrid Spain
| | - Giuseppe Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences IRCCS San Raffaele Pisana Rome Italy
| | | | | | - Petar Seferovic
- University of Belgrade Faculty of Medicine and Serbian Academy of Sciences and Arts Belgrade Serbia
| | - Thor Edvardsen
- Department of Cardiology Oslo University Hospital, Rikshospitalet Oslo Norway
- Faculty of Medicine University of Oslo Oslo Norway
| | - Alexander R. Lyon
- National Heart and Lung Institute, Imperial College London UK
- Cardio‐Oncology Service, Royal Brompton Hospital London UK
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13
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M’kacher R, Colicchio B, Borie C, Junker S, Marquet V, Heidingsfelder L, Soehnlen K, Najar W, Hempel WM, Oudrhiri N, Wilhelm-Murer N, Miguet M, Arnoux M, Ferrapie C, Kerbrat W, Plesch A, Dieterlen A, Girinsky T, Voisin P, Deschenes G, Tabet AC, Yardin C, Bennaceur-Griscelli A, Fenech M, Carde P, Jeandidier E. Telomere and Centromere Staining Followed by M-FISH Improves Diagnosis of Chromosomal Instability and Its Clinical Utility. Genes (Basel) 2020; 11:E475. [PMID: 32349350 PMCID: PMC7291161 DOI: 10.3390/genes11050475] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/11/2022] Open
Abstract
Dicentric chromosomes are a relevant marker of chromosomal instability. Their appearance is associated with telomere dysfunction, leading to cancer progression and a poor clinical outcome. Here, we present Telomere and Centromere staining followed by M-FISH (TC+M-FISH) for improved detection of telomere dysfunction and the identification of dicentric chromosomes in cancer patients and various genetic syndromes. Significant telomere length shortening and significantly higher frequencies of telomere loss and deletion were found in the peripheral lymphocytes of patients with cancer and genetic syndromes relative to similar age-matched healthy donors. We assessed our technique against conventional cytogenetics for the detection of dicentric chromosomes by subjecting metaphase preparations to both approaches. We identified dicentric chromosomes in 28/50 cancer patients and 21/44 genetic syndrome patients using our approach, but only 7/50 and 12/44, respectively, using standard cytogenetics. We ascribe this discrepancy to the identification of the unique configuration of dicentric chromosomes. We observed significantly higher frequencies of telomere loss and deletion in patients with dicentric chromosomes (p < 10-4). TC+M-FISH analysis is superior to classical cytogenetics for the detection of chromosomal instability. Our approach is a relatively simple but useful tool for documenting telomere dysfunction and chromosomal instability with the potential to become a standard additional diagnostic tool in medical genetics and the clinic.
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Affiliation(s)
- Radhia M’kacher
- Cell Environment, DNA Damage R&D, 75020 Paris, France; (K.S.); (W.N.); (W.M.H.); (P.V.)
| | - Bruno Colicchio
- IRIMAS, Institut de Recherche en Informatique, Mathématiques, Automatique et Signal, Université de Haute-Alsace, 68093 Mulhouse, France; (B.C.); (A.D.)
| | - Claire Borie
- APHP-Service D’hématologie Oncohématologie Moléculaire et Cytogénétique Hôpital Paul Brousse Université Paris Saclay/ Inserm UMR 935, 94800 Villejuif, France; (C.B.); (N.O.); (M.A.); (C.F.); (W.K.); (A.B.-G.)
| | - Steffen Junker
- Institute of Biomedicine, University of Aarhus, DK-8000 Aarhus, Denmark;
| | - Valentine Marquet
- Service de Cytogénétique, Génétique Médicale, et Biologie de la Reproduction Hôpital de la Mère et de l’Enfant, CHU Dupuytren, 87042 Limoges, France; (V.M.); (C.Y.)
| | | | - Kevin Soehnlen
- Cell Environment, DNA Damage R&D, 75020 Paris, France; (K.S.); (W.N.); (W.M.H.); (P.V.)
| | - Wala Najar
- Cell Environment, DNA Damage R&D, 75020 Paris, France; (K.S.); (W.N.); (W.M.H.); (P.V.)
- IRIMAS, Institut de Recherche en Informatique, Mathématiques, Automatique et Signal, Université de Haute-Alsace, 68093 Mulhouse, France; (B.C.); (A.D.)
- APHP-Service D’hématologie Oncohématologie Moléculaire et Cytogénétique Hôpital Paul Brousse Université Paris Saclay/ Inserm UMR 935, 94800 Villejuif, France; (C.B.); (N.O.); (M.A.); (C.F.); (W.K.); (A.B.-G.)
- Institute of Biomedicine, University of Aarhus, DK-8000 Aarhus, Denmark;
- Service de Cytogénétique, Génétique Médicale, et Biologie de la Reproduction Hôpital de la Mère et de l’Enfant, CHU Dupuytren, 87042 Limoges, France; (V.M.); (C.Y.)
- MetaSystems GmbH, Robert-Bosch-Str., 6 D-68804 Altlussheim, Germany; (L.H.); (A.P.)
- Faculté de Médicine, Université Paris Descartes, 75005 Paris, France
| | - William M. Hempel
- Cell Environment, DNA Damage R&D, 75020 Paris, France; (K.S.); (W.N.); (W.M.H.); (P.V.)
| | - Noufissa Oudrhiri
- APHP-Service D’hématologie Oncohématologie Moléculaire et Cytogénétique Hôpital Paul Brousse Université Paris Saclay/ Inserm UMR 935, 94800 Villejuif, France; (C.B.); (N.O.); (M.A.); (C.F.); (W.K.); (A.B.-G.)
| | - Nadège Wilhelm-Murer
- Service de Génétique Groupe Hospitalier de la Région de Mulhouse et Sud Alsace Mulhouse, 68070 Mulhouse, France; (N.W.-M.); (M.M.); (E.J.)
| | - Marguerite Miguet
- Service de Génétique Groupe Hospitalier de la Région de Mulhouse et Sud Alsace Mulhouse, 68070 Mulhouse, France; (N.W.-M.); (M.M.); (E.J.)
| | - Micheline Arnoux
- APHP-Service D’hématologie Oncohématologie Moléculaire et Cytogénétique Hôpital Paul Brousse Université Paris Saclay/ Inserm UMR 935, 94800 Villejuif, France; (C.B.); (N.O.); (M.A.); (C.F.); (W.K.); (A.B.-G.)
| | - Catherine Ferrapie
- APHP-Service D’hématologie Oncohématologie Moléculaire et Cytogénétique Hôpital Paul Brousse Université Paris Saclay/ Inserm UMR 935, 94800 Villejuif, France; (C.B.); (N.O.); (M.A.); (C.F.); (W.K.); (A.B.-G.)
| | - Wendy Kerbrat
- APHP-Service D’hématologie Oncohématologie Moléculaire et Cytogénétique Hôpital Paul Brousse Université Paris Saclay/ Inserm UMR 935, 94800 Villejuif, France; (C.B.); (N.O.); (M.A.); (C.F.); (W.K.); (A.B.-G.)
| | - Andreas Plesch
- MetaSystems GmbH, Robert-Bosch-Str., 6 D-68804 Altlussheim, Germany; (L.H.); (A.P.)
| | - Alain Dieterlen
- IRIMAS, Institut de Recherche en Informatique, Mathématiques, Automatique et Signal, Université de Haute-Alsace, 68093 Mulhouse, France; (B.C.); (A.D.)
| | - Theodore Girinsky
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, 94800 Villejuif, France;
| | - Philippe Voisin
- Cell Environment, DNA Damage R&D, 75020 Paris, France; (K.S.); (W.N.); (W.M.H.); (P.V.)
| | - Georges Deschenes
- Nephrology Department, APHP-Hopital Robert Debré, 75019 Paris, France;
| | - Anne-Claude Tabet
- Cytogenetic Laboratory, APHP-Hopital Robert Debré, 75019 Paris, France;
| | - Catherine Yardin
- Service de Cytogénétique, Génétique Médicale, et Biologie de la Reproduction Hôpital de la Mère et de l’Enfant, CHU Dupuytren, 87042 Limoges, France; (V.M.); (C.Y.)
| | - Annelise Bennaceur-Griscelli
- APHP-Service D’hématologie Oncohématologie Moléculaire et Cytogénétique Hôpital Paul Brousse Université Paris Saclay/ Inserm UMR 935, 94800 Villejuif, France; (C.B.); (N.O.); (M.A.); (C.F.); (W.K.); (A.B.-G.)
| | - Michael Fenech
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA 5000, Australia;
- Genome Health Foundation, North Brighton, SA 5048, Australia
| | - Patrice Carde
- Department of Hematology, Gustave Roussy Cancer Campus, 94800 Villejuif, France;
| | - Eric Jeandidier
- Service de Génétique Groupe Hospitalier de la Région de Mulhouse et Sud Alsace Mulhouse, 68070 Mulhouse, France; (N.W.-M.); (M.M.); (E.J.)
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14
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Guinobert I, Blondeau C, Colicchio B, Oudrhiri N, Dieterlen A, Jeandidier E, Deschenes G, Bardot V, Cotte C, Ripoche I, Carde P, Berthomier L, M’Kacher R. The Use of Natural Agents to Counteract Telomere Shortening: Effects of a Multi-Component Extract of Astragalus mongholicus Bunge and Danazol. Biomedicines 2020; 8:biomedicines8020031. [PMID: 32059353 PMCID: PMC7168059 DOI: 10.3390/biomedicines8020031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 12/16/2022] Open
Abstract
A link between telomere shortening and oxidative stress was found in aging people and patients with cancer or inflammatory diseases. Extracts of Astragalus spp. are known to stimulate telomerase activity, thereby compensating telomere shortening. We characterized a multi-component hydroethanolic root extract (HRE) of Astragalus mongholicus Bunge and assessed its effects on telomeres compared to those of danazol. Astragalosides I to IV, flavonoids, amino acids and sugars were detected in the HRE. Samples of peripheral blood lymphocytes with short telomeres from 18 healthy donors (mean age 63.5 years; range 32–86 years) were exposed to a single dose of 1 µg/mL HRE or danazol for three days. Telomere length and telomerase expression were then measured. Significant elongation of telomeres associated to a less toxicity was observed in lymphocytes from 13/18 donors following HRE treatment (0.54 kb (0.15–2.06 kb)) and in those from 9/18 donors after danazol treatment (0.95 kb (0.06–2.06 kb)). The rate of cells with short telomeres (<3 kb) decreased in lymphocytes from all donors after exposure to either HRE or danazol, telomere elongation being telomerase-dependent. These findings suggest that the HRE could be used for the management of age-related diseases.
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Affiliation(s)
- Isabelle Guinobert
- Groupe PiLeJe, 37 Quai de Grenelle, 75015 Paris Cedex 15, Naturopôle, Les Tiolans, 03800 Saint-Bonnet de Rochefort, France; (I.G.); (C.B.); (V.B.); (C.C.)
| | - Claude Blondeau
- Groupe PiLeJe, 37 Quai de Grenelle, 75015 Paris Cedex 15, Naturopôle, Les Tiolans, 03800 Saint-Bonnet de Rochefort, France; (I.G.); (C.B.); (V.B.); (C.C.)
| | - Bruno Colicchio
- IRIMAS, Institut de Recherche en Informatique, Mathématiques, Automatique et Signal, Université de Haute-Alsace, 68093 Mulhouse, France; (B.C.); (A.D.)
| | - Noufissa Oudrhiri
- Service d’Hématologie Moléculaire et Cytogénétique Paul Brousse CHU Paris Sud, Université Paris Sud, Inserm UMRS935, 94800 Villejuif, France;
| | - Alain Dieterlen
- IRIMAS, Institut de Recherche en Informatique, Mathématiques, Automatique et Signal, Université de Haute-Alsace, 68093 Mulhouse, France; (B.C.); (A.D.)
| | - Eric Jeandidier
- Service de Génétique Médicale, Groupe Hospitalier de la Région de Mulhouse et Sud-Alsace, 68070 Mulhouse, France;
| | - Georges Deschenes
- Service de Néphrologie, APHP-Hôpital Robert Debré, 75019 Paris, France;
| | - Valérie Bardot
- Groupe PiLeJe, 37 Quai de Grenelle, 75015 Paris Cedex 15, Naturopôle, Les Tiolans, 03800 Saint-Bonnet de Rochefort, France; (I.G.); (C.B.); (V.B.); (C.C.)
| | - César Cotte
- Groupe PiLeJe, 37 Quai de Grenelle, 75015 Paris Cedex 15, Naturopôle, Les Tiolans, 03800 Saint-Bonnet de Rochefort, France; (I.G.); (C.B.); (V.B.); (C.C.)
| | - Isabelle Ripoche
- Institut de Chimie de Clermont-Ferrand, Université Clermont Auvergne, CNRS, SIGMA Clermont, BP 10448, 63000 Clermont-Ferrand, France; (I.R.); (L.B.)
| | - Patrice Carde
- Département d’hématologie, Gustave Roussy Cancer Campus, université Paris Saclay, 94808 Villejuif, France;
| | - Lucile Berthomier
- Institut de Chimie de Clermont-Ferrand, Université Clermont Auvergne, CNRS, SIGMA Clermont, BP 10448, 63000 Clermont-Ferrand, France; (I.R.); (L.B.)
| | - Radhia M’Kacher
- Cell Environment, DNA damage R&D, 75020 Paris, France
- Correspondence: ; Tel.: +33-01-48-81-30-38
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15
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Cardiotoxicity of mediastinal radiotherapy. Rep Pract Oncol Radiother 2019; 24:629-643. [PMID: 31719801 DOI: 10.1016/j.rpor.2019.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/21/2019] [Indexed: 12/16/2022] Open
Abstract
Aim To explore available recent literature related to cardiotoxicity following mediastinal radiation. Background Radiotherapy-related heart injury is well documented, with no apparent safety threshold dose. The number of long-term cancer survivors exposed to mediastinal radiotherapy at some point of their treatment is increasing. Heart dosimetric parameters are of great importance in developing a treatment plan, but few data are available regarding radiosensitivity and dose-volume constraints for specific heart structures. Materials and Methods In October 2018, we identified articles published after 1990 through a PubMed/MEDLINE database search. The authors examined rough search results and manuscripts not relevant for the topic were excluded. We extracted clinical outcomes following mediastinal radiotherapy of childhood cancers, lymphoma, medulloblastoma, thymic cancers and hematopoietic cell transplantation survivors and evaluated treatment planning data, whenever available. Results A total of 1311 manuscripts were identified in our first-round search. Of these manuscripts, only 115 articles, matching our selection criteria, were included. Conclusions Studies uniformly show a linear radiation dose-response relationship between mean absorbed dose to the heart (heart-Dmean) and the risk of dying as a result of cardiac disease, particularly when heart-Dmean exceeds 5 Gy. Limited data are available regarding dose-volume predictors for heart substructures and the risk of subsequent cardiac toxicity. An individual patient's cardiotoxicity risk can be modified with advanced treatment planning techniques, including deep inspiration breath hold. Proton therapy is currently showing advantages in improving treatment planning parameters when compared to advanced photon techniques in lymphoma, thymic malignancies, malignant mesothelioma and craniospinal irradiation.
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Key Words
- 2D-RT, two-dimensional radiotherapy
- 3D-CRT, three-dimensional conformal radiation therapy
- CI, confidence interval
- CSI, craniospinal irradiation
- CVD, Cardiovascular disease
- Cardiotoxicity
- Dmax, maximum absorbed dose in a specified volume
- Dmean, mean absorbed radiation dose in a specified volume
- Dose-volume predictors
- EQD2, equivalent dose in 2 Gy fractions
- G, grade
- Gy, Gray
- HR, hazard ratio
- HT, Helical tomotherapy
- IFRT, involved field radiotherapy
- IMRT, intensity modulated radiation therapy
- INRT, involved node radiotherapy
- ISRT, involved site radiotherapy
- LAD, left anterior descending artery
- Mediastinal radiotherapy
- Mediastinal tumours
- Mv, megavoltage
- NTCP, normal tissue complication probability
- Normal tissue complication probability
- OAR, organs at risk
- OR, odds ratio
- PTV, planning target volume
- RR, relative risks
- TBI, total body irradiation
- VMAT, volumetric modulated arc therapy
- Vx, receiving at last x Gy
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16
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Cardiovascular Complications Associated with Mediastinal Radiation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:31. [DOI: 10.1007/s11936-019-0737-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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17
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Niska JR, Thorpe CS, Allen SM, Daniels TB, Rule WG, Schild SE, Vargas CE, Mookadam F. Radiation and the heart: systematic review of dosimetry and cardiac endpoints. Expert Rev Cardiovasc Ther 2018; 16:931-950. [DOI: 10.1080/14779072.2018.1538785] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Joshua R. Niska
- Mayo Clinic - Department of Radiation Oncology, Phoenix, AZ, USA
| | | | - Sorcha M. Allen
- Mayo Clinic - Department of Cardio-Oncology, Scottsdale, AZ, USA
| | | | - William G. Rule
- Mayo Clinic - Department of Radiation Oncology, Phoenix, AZ, USA
| | - Steven E. Schild
- Mayo Clinic - Department of Radiation Oncology, Phoenix, AZ, USA
| | - Carlos E. Vargas
- Mayo Clinic - Department of Radiation Oncology, Phoenix, AZ, USA
| | - Farouk Mookadam
- Mayo Clinic - Department of Cardio-Oncology, Scottsdale, AZ, USA
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18
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van Leeuwen FE, Ng AK. Late sequelae in Hodgkin lymphoma survivors. Hematol Oncol 2018; 35 Suppl 1:60-66. [PMID: 28591411 DOI: 10.1002/hon.2402] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Flora E van Leeuwen
- Department of Epidemiology, Division of Psychosocial Research & Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Andrea K Ng
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA.,Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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19
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Zhu Q, Kirova YM, Cao L, Arsene-Henry A, Chen J. Cardiotoxicity associated with radiotherapy in breast cancer: A question-based review with current literatures. Cancer Treat Rev 2018; 68:9-15. [DOI: 10.1016/j.ctrv.2018.03.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 03/07/2018] [Accepted: 03/08/2018] [Indexed: 12/25/2022]
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20
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M'kacher R, Cuceu C, Al Jawhari M, Morat L, Frenzel M, Shim G, Lenain A, Hempel WM, Junker S, Girinsky T, Colicchio B, Dieterlen A, Heidingsfelder L, Borie C, Oudrhiri N, Bennaceur-Griscelli A, Moralès O, Renaud S, Van de Wyngaert Z, Jeandidier E, Delhem N, Carde P. The Transition between Telomerase and ALT Mechanisms in Hodgkin Lymphoma and Its Predictive Value in Clinical Outcomes. Cancers (Basel) 2018; 10:E169. [PMID: 29848986 PMCID: PMC6025489 DOI: 10.3390/cancers10060169] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/18/2018] [Accepted: 05/25/2018] [Indexed: 11/16/2022] Open
Abstract
Background: We analyzed telomere maintenance mechanisms (TMMs) in lymph node samples from HL patients treated with standard therapy. The TMMs correlated with clinical outcomes of patients. Materials and Methods: Lymph node biopsies obtained from 38 HL patients and 24 patients with lymphadenitis were included in this study. Seven HL cell lines were used as in vitro models. Telomerase activity (TA) was assessed by TRAP assay and verified through hTERT immunofluorescence expression; alternative telomere lengthening (ALT) was also assessed, along with EBV status. Results: Both TA and ALT mechanisms were present in HL lymph nodes. Our findings were reproduced in HL cell lines. The highest levels of TA were expressed in CD30-/CD15- cells. Small cells were identified with ALT and TA. Hodgkin and Reed Sternberg cells contained high levels of PML bodies, but had very low hTERT expression. There was a significant correlation between overall survival (p < 10-3), event-free survival (p < 10-4), and freedom from progression (p < 10-3) and the presence of an ALT profile in lymph nodes of EBV+ patients. Conclusion: The presence of both types of TMMs in HL lymph nodes and in HL cell lines has not previously been reported. TMMs correlate with the treatment outcome of EBV+ HL patients.
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Affiliation(s)
- Radhia M'kacher
- Laboratoire de Radiobiologie et d'Oncologie, IRCM/DSV/CEA, 92265 Fontenay aux Roses, France.
- Cell Environment, DNA Damages R&D, Oncology Section, 75020 Paris, France.
| | - Corina Cuceu
- Laboratoire de Radiobiologie et d'Oncologie, IRCM/DSV/CEA, 92265 Fontenay aux Roses, France.
| | - Mustafa Al Jawhari
- Laboratoire de Radiobiologie et d'Oncologie, IRCM/DSV/CEA, 92265 Fontenay aux Roses, France.
| | - Luc Morat
- Laboratoire de Radiobiologie et d'Oncologie, IRCM/DSV/CEA, 92265 Fontenay aux Roses, France.
| | - Monika Frenzel
- Laboratoire de Radiobiologie et d'Oncologie, IRCM/DSV/CEA, 92265 Fontenay aux Roses, France.
| | - Grace Shim
- Laboratoire de Radiobiologie et d'Oncologie, IRCM/DSV/CEA, 92265 Fontenay aux Roses, France.
| | - Aude Lenain
- Laboratoire de Radiobiologie et d'Oncologie, IRCM/DSV/CEA, 92265 Fontenay aux Roses, France.
| | - William M Hempel
- Laboratoire de Radiobiologie et d'Oncologie, IRCM/DSV/CEA, 92265 Fontenay aux Roses, France.
| | - Steffen Junker
- Institute of Biomedicine, University of Aarhus, DK-8000 Aarhus C, Denmark.
| | - Theodore Girinsky
- Department of Radiation Therapy, Gustave Roussy Cancer Campus, 94808 Villejuif, France.
| | - Bruno Colicchio
- IRIMAS, Institut de Recherche en Informatique, Mathématiques, Automatique et Signal, Université de Haute-Alsace, 68093 Mulhouse, France.
| | - Alain Dieterlen
- IRIMAS, Institut de Recherche en Informatique, Mathématiques, Automatique et Signal, Université de Haute-Alsace, 68093 Mulhouse, France.
| | | | - Claire Borie
- Université Paris Sud, Service d'hématologie moléculaire et cytogénétique Paul brousse CHU paris Sud, Inserm UMRS935, 94800 Villejuif, France.
| | - Noufissa Oudrhiri
- Université Paris Sud, Service d'hématologie moléculaire et cytogénétique Paul brousse CHU paris Sud, Inserm UMRS935, 94800 Villejuif, France.
| | - Annelise Bennaceur-Griscelli
- Université Paris Sud, Service d'hématologie moléculaire et cytogénétique Paul brousse CHU paris Sud, Inserm UMRS935, 94800 Villejuif, France.
| | - Olivier Moralès
- CNRS, Institut Pasteur de Lille, UMR 8161-Immunoregulation of Virus-induced Cancers Team, F-59000 Lille, France.
| | - Sarah Renaud
- CNRS, Institut Pasteur de Lille, UMR 8161-Immunoregulation of Virus-induced Cancers Team, F-59000 Lille, France.
| | - Zoé Van de Wyngaert
- CHRU Lille Service des Maladies du Sang, Hopital Huriez, 59000 Lille, France.
| | - Eric Jeandidier
- Service de génétique, Groupe hospitalier de la région de Mulhouse Sud-Alsace, 68093 Mulhouse, France.
| | - Nadira Delhem
- CNRS, Institut Pasteur de Lille, UMR 8161-Immunoregulation of Virus-induced Cancers Team, F-59000 Lille, France.
| | - Patrice Carde
- Department of Medicine, Gustave Roussy Cancer Campus, 94808 Villejuif, France.
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21
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Cuomo JR, Javaheri SP, Sharma GK, Kapoor D, Berman AE, Weintraub NL. How to prevent and manage radiation-induced coronary artery disease. Heart 2018; 104:1647-1653. [PMID: 29764968 DOI: 10.1136/heartjnl-2017-312123] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 01/04/2023] Open
Abstract
Radiation-induced coronary heart disease (RICHD) is the second most common cause of morbidity and mortality in patients treated with radiotherapy for breast cancer, Hodgkin's lymphoma and other prevalent mediastinal malignancies. The risk of RICHD increases with radiation dose. Exposed patients may present decades after treatment with manifestations ranging from asymptomatic myocardial perfusion defects to ostial, triple-vessel disease and sudden cardiac death. RICHD is insidious, with a long latency and a tendency to remain silent late into the disease course. Vessel involvement is often diffuse and is preferentially proximal. The pathophysiology is similar to that of accelerated atherosclerosis, characterised by the formation of inflammatory plaque with high collagen and fibrin content. The presence of conventional risk factors potentiates RICHD, and aggressive risk factor management should ideally be initiated prior to radiation therapy. Stress echocardiography is more sensitive and specific than myocardial perfusion imaging in the detection of RICHD, and CT coronary angiography shows promise in risk stratification. Coronary artery bypass grafting is associated with higher risks of graft failure, perioperative complications and all-cause mortality in patients with RICHD. In most cases, the use of drug-eluting stents is preferable to surgical intervention, bare metal stenting or balloon-angioplasty alone.
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Affiliation(s)
- Jason R Cuomo
- Department of Medicine, Division of Cardiology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Sean P Javaheri
- Department of Medicine, Division of Cardiology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Gyanendra K Sharma
- Department of Medicine, Division of Cardiology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Deepak Kapoor
- Department of Medicine, Division of Cardiology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Adam E Berman
- Department of Medicine, Division of Cardiology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Neal L Weintraub
- Department of Medicine, Division of Cardiology, Vascular Biology Center, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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22
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Cuceu C, Hempel WM, Sabatier L, Bosq J, Carde P, M'kacher R. Chromosomal Instability in Hodgkin Lymphoma: An In-Depth Review and Perspectives. Cancers (Basel) 2018; 10:cancers10040091. [PMID: 29587466 PMCID: PMC5923346 DOI: 10.3390/cancers10040091] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/20/2018] [Accepted: 03/23/2018] [Indexed: 12/22/2022] Open
Abstract
The study of Hodgkin lymphoma (HL), with its unique microenvironment and long-term follow-up, has provided exceptional insights into several areas of tumor biology. Findings in HL have not only improved our understanding of human carcinogenesis, but have also pioneered its translation into the clinics. HL is a successful paradigm of modern treatment strategies. Nonetheless, approximately 15–20% of patients with advanced stage HL still die following relapse or progressive disease and a similar proportion of patients are over-treated, leading to treatment-related late sequelae, including solid tumors and organ dysfunction. The malignant cells in HL are characterized by a highly altered genomic landscape with a wide spectrum of genomic alterations, including somatic mutations, copy number alterations, complex chromosomal rearrangements, and aneuploidy. Here, we review the chromosomal instability mechanisms in HL, starting with the cellular origin of neoplastic cells and the mechanisms supporting HL pathogenesis, focusing particularly on the role of the microenvironment, including the influence of viruses and macrophages on the induction of chromosomal instability in HL. We discuss the emerging possibilities to exploit these aberrations as prognostic biomarkers and guides for personalized patient management.
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Affiliation(s)
- Corina Cuceu
- Laboratory of Radiobiology and Oncology and PROCyTOX, DRF, CEA, 91534 Paris-Saclay, France.
| | - William M Hempel
- Laboratory of Radiobiology and Oncology and PROCyTOX, DRF, CEA, 91534 Paris-Saclay, France.
| | - Laure Sabatier
- Laboratory of Radiobiology and Oncology and PROCyTOX, DRF, CEA, 91534 Paris-Saclay, France.
| | - Jacques Bosq
- Departement of Anapathology, Gustave Roussy Cancer Campus, 94805 Villejuif, France.
| | - Patrice Carde
- Department of Hematology Gustave Roussy Cancer Campus, 94800 Villejuif, France.
| | - Radhia M'kacher
- Laboratory of Radiobiology and Oncology and PROCyTOX, DRF, CEA, 91534 Paris-Saclay, France.
- Cell Environment, DNA damages R&D, Oncology section, 75020 Paris, France.
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23
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van Rosendael AR, Daniëls LA, Dimitriu-Leen AC, Smit JM, van Rosendael PJ, Schalij MJ, Bax JJ, Scholte AJ. Different manifestation of irradiation induced coronary artery disease detected with coronary computed tomography compared with matched non-irradiated controls. Radiother Oncol 2017; 125:55-61. [DOI: 10.1016/j.radonc.2017.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/03/2017] [Accepted: 09/06/2017] [Indexed: 01/27/2023]
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24
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Frenzel M, Ricoul M, Benadjaoud MA, Bellamy M, Lenain A, Haddy N, Diallo I, Mateus C, de Vathaire F, Sabatier L. Retrospective cohort study and biobanking of patients treated for hemangioma in childhood – telomeres as biomarker of aging and radiation exposure. Int J Radiat Biol 2017. [DOI: 10.1080/09553002.2017.1337278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Monika Frenzel
- PROCyTOX (Radiation Oncology, Cytogenetics, and Toxicology Platform), DRF Commissariat à l’Energie Atomique et aux Energies Alternatives CEA, Paris, Saclay, France
| | - Michelle Ricoul
- PROCyTOX (Radiation Oncology, Cytogenetics, and Toxicology Platform), DRF Commissariat à l’Energie Atomique et aux Energies Alternatives CEA, Paris, Saclay, France
| | | | - Marion Bellamy
- PROCyTOX (Radiation Oncology, Cytogenetics, and Toxicology Platform), DRF Commissariat à l’Energie Atomique et aux Energies Alternatives CEA, Paris, Saclay, France
- Radiation Epidemiology Group, INSERM U1018, Villejuif, Université Paris, Saclay, France
| | - Aude Lenain
- PROCyTOX (Radiation Oncology, Cytogenetics, and Toxicology Platform), DRF Commissariat à l’Energie Atomique et aux Energies Alternatives CEA, Paris, Saclay, France
| | - Nadia Haddy
- Radiation Epidemiology Group, INSERM U1018, Villejuif, Université Paris, Saclay, France
| | - Ibrahima Diallo
- Radiation Epidemiology Group, INSERM U1018, Villejuif, Université Paris, Saclay, France
| | - Christine Mateus
- Service de dermatologie, Gustave Roussy, Université Paris-Saclay, Département de Médecine Oncologique, Villejuif, France
| | - Florent de Vathaire
- Radiation Epidemiology Group, INSERM U1018, Villejuif, Université Paris, Saclay, France
| | - Laure Sabatier
- PROCyTOX (Radiation Oncology, Cytogenetics, and Toxicology Platform), DRF Commissariat à l’Energie Atomique et aux Energies Alternatives CEA, Paris, Saclay, France
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25
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Kaddour A, Colicchio B, Buron D, El Maalouf E, Laplagne E, Borie C, Ricoul M, Lenain A, Hempel WM, Morat L, Al Jawhari M, Cuceu C, Heidingsfelder L, Jeandidier E, Deschênes G, Dieterlen A, El May M, Girinsky T, Bennaceur-Griscelli A, Carde P, Sabatier L, M'kacher R. Transmission of Induced Chromosomal Aberrations through Successive Mitotic Divisions in Human Lymphocytes after In Vitro and In Vivo Radiation. Sci Rep 2017; 7:3291. [PMID: 28607452 PMCID: PMC5468351 DOI: 10.1038/s41598-017-03198-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 04/24/2017] [Indexed: 11/10/2022] Open
Abstract
The mechanisms behind the transmission of chromosomal aberrations (CA) remain unclear, despite a large body of work and major technological advances in chromosome identification. We reevaluated the transmission of CA to second- and third-division cells by telomere and centromere (TC) staining followed by M-FISH. We scored CA in lymphocytes of healthy donors after in vitro irradiation and those of cancer patients treated by radiation therapy more than 12 years before. Our data demonstrate, for the first time, that dicentric chromosomes (DCs) decreased by approximately 50% per division. DCs with two centromeres in close proximity were more efficiently transmitted, representing 70% of persistent DCs in ≥M3 cells. Only 1/3 of acentric chromosomes (ACs), ACs with four telomeres, and interstitial ACs, were paired in M2 cells and associated with specific DCs configurations. In lymphocytes of cancer patients, 82% of detected DCs were characterized by these specific configurations. Our findings demonstrate the high stability of DCs with two centromeres in close proximity during cell division. The frequency of telomere deletion increased during cell cycle progression playing an important role in chromosomal instability. These findings could be exploited in the follow-up of exposed populations.
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Affiliation(s)
- Akram Kaddour
- Laboratory of Radiobiology and Oncology and PROCyTOX, DRF, CEA, Paris-Saclay, France.,Tunis El Manar University, School of Medicine, Tunis, Tunisia
| | - Bruno Colicchio
- Laboratoire MIPS Groupe IMTI Université de Haute-Alsace, Mulhouse, France
| | - Diane Buron
- Laboratory of Radiobiology and Oncology and PROCyTOX, DRF, CEA, Paris-Saclay, France
| | - Elie El Maalouf
- Laboratoire MIPS Groupe IMTI Université de Haute-Alsace, Mulhouse, France
| | | | - Claire Borie
- APHP-Hopital Paul Brousse Université Paris Sud/ESteam Paris Inserm UMR 935, Villejuif, France
| | - Michelle Ricoul
- Laboratory of Radiobiology and Oncology and PROCyTOX, DRF, CEA, Paris-Saclay, France
| | - Aude Lenain
- Laboratory of Radiobiology and Oncology and PROCyTOX, DRF, CEA, Paris-Saclay, France
| | - William M Hempel
- Laboratory of Radiobiology and Oncology and PROCyTOX, DRF, CEA, Paris-Saclay, France
| | - Luc Morat
- Laboratory of Radiobiology and Oncology and PROCyTOX, DRF, CEA, Paris-Saclay, France
| | - Mustafa Al Jawhari
- Laboratory of Radiobiology and Oncology and PROCyTOX, DRF, CEA, Paris-Saclay, France
| | - Corina Cuceu
- Laboratory of Radiobiology and Oncology and PROCyTOX, DRF, CEA, Paris-Saclay, France
| | | | - Eric Jeandidier
- Service de Génétique Groupe Hospitalier de la Région de Mulhouse et Sud Alsace, 68070, Mulhouse, France
| | | | - Alain Dieterlen
- Laboratoire MIPS Groupe IMTI Université de Haute-Alsace, Mulhouse, France
| | - Michèle El May
- Tunis El Manar University, School of Medicine, Tunis, Tunisia
| | - Theodore Girinsky
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Patrice Carde
- Department of Hematology, Gustave Roussy cancer Campus, Villejuif, France
| | - Laure Sabatier
- Laboratory of Radiobiology and Oncology and PROCyTOX, DRF, CEA, Paris-Saclay, France
| | - Radhia M'kacher
- Laboratory of Radiobiology and Oncology and PROCyTOX, DRF, CEA, Paris-Saclay, France. .,Cell Environment, Paris, France.
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Lázár E, Oltean PB, Jáni L, Kovács I, Nyulas T, Benedek I, Benedek I. Noninvasive Assessment of Coronary Arteries in Patients with Hematologic Disorders. JOURNAL OF INTERDISCIPLINARY MEDICINE 2017. [DOI: 10.1515/jim-2017-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractHematological conditions and their treatments have an increased risk of cardiovascular events, and invasive interventions have a higher risk of periprocedural complications in this group of patients. The aim of this review was to evaluate the risk of invasive interventions in patients with hematologic disorders and to underline the role of noninvasive cardiovascular screening in patients with hematological disorders such as Hodgkin and non-Hodgkin lymphoma, anemia, hemophilia, thrombocythemia, polycythemia vera, and leukemia. Based on present knowledge in the field, our opinion is that the screening of patients with hematological diseases is very important to reduce the morbidity and mortality due to cardiovascular events. Noninvasive assessments are suitable for this purpose with a significantly lower risk compared to invasive interventions.
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Facteurs de risque et surveillance à long terme des complications cardiaques après traitement pour un cancer pendant l’enfance. Rev Med Interne 2017; 38:125-132. [DOI: 10.1016/j.revmed.2016.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 03/22/2016] [Accepted: 07/30/2016] [Indexed: 01/08/2023]
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Kwan A, Chadwick N, Hancock B. Improving Survival of Patients With Hodgkin Lymphoma Over 4 Decades: Experience of the British National Lymphoma Investigation (BNLI) With 6834 Patients. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2017; 17:108-119. [PMID: 28027894 DOI: 10.1016/j.clml.2016.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/30/2016] [Accepted: 11/10/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The management of Hodgkin lymphoma (HL) has changed markedly over the last 50 years. This is due to the expanding understanding about the biology of the disease, the development of increasingly efficacious multimodal treatment, and the recognition of how to reduce late effects. The British National Lymphoma Investigation (BNLI) was formed in the 1970s to coordinate UK research in the diagnosis and treatment of lymphoma. We describe the improvement in trial patient survival over 4 decades. PATIENTS AND METHODS This analysis is of data on 6834 patients with a de novo diagnosis of HL registered onto studies with BNLI oversight from January 1, 1970, to December 31, 2009. Patients were subdivided in 4 groups according to their decade of registration; 1970s, 1980s, 1990s, and 2000s. Because of the lengthy data collection period, there is a difference in duration of follow-up between decade groups, with median follow-up in the 1970s group of 28.2 years, 18.0 years in the 1980s group, 9.4 years in the 1990s group, and 5.4 years in the 2000s group. Comparison between data in all 4 groups is not possible beyond 13.4 years (maximum duration of follow-up in the 2000s group), and so a cutoff has been applied at 14 years. Data on overall survival, cause of death, primary treatment modality, and incidence of secondary malignancy were collected. RESULTS Clear and statistically significant improvements in survival curves between the decades were present, with 10-year overall survival increasing from 62.4% in the 1970s to 89.6% in the 2000s. There was a suggestion that second malignancy and cardiac-related deaths have been reducing over time, but longer follow-up is needed for the later decades to confirm this trend. CONCLUSION Results support existing registry data demonstrating that survival for HL has improved over the 4 decades analyzed. This data set is robust and validated, and it adds valuable understanding to the reasons behind the survival curves, which are a balance between efficacious therapies and decreased death related to cardiac conditions and second malignancies.
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Affiliation(s)
- Amy Kwan
- Academic Unit of Clinical Oncology, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Nick Chadwick
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | - Barry Hancock
- Academic Unit of Clinical Oncology, University of Sheffield, Weston Park Hospital, Sheffield, UK.
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Finot F, Kaddour A, Morat L, Mouche I, Zaguia N, Cuceu C, Souverville D, Négrault S, Cariou O, Essahli A, Prigent N, Saul J, Paillard F, Heidingsfelder L, Lafouge P, Al Jawhari M, Hempel WM, El May M, Colicchio B, Dieterlen A, Jeandidier E, Sabatier L, Clements J, M'Kacher R. Genotoxic risk of ethyl-paraben could be related to telomere shortening. J Appl Toxicol 2016; 37:758-771. [DOI: 10.1002/jat.3425] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 11/01/2016] [Accepted: 11/01/2016] [Indexed: 01/22/2023]
Affiliation(s)
- F. Finot
- Covance Laboratory; 78440 Porcheville France
- Cell Environment; Paris France
| | - A. Kaddour
- Cell Environment; Paris France
- Tunis El Manar University; School of Medicine; Tunis Tunisia
| | - L. Morat
- Radiology and Oncology Laboratory, IRCM, DSV; Commissariat à l'energie atomique (CEA); Fontenay-aux Roses France
| | - I. Mouche
- Covance Laboratory; 78440 Porcheville France
- Cell Environment; Paris France
| | - N. Zaguia
- Radiology and Oncology Laboratory, IRCM, DSV; Commissariat à l'energie atomique (CEA); Fontenay-aux Roses France
| | - C. Cuceu
- Radiology and Oncology Laboratory, IRCM, DSV; Commissariat à l'energie atomique (CEA); Fontenay-aux Roses France
| | | | - S. Négrault
- Covance Laboratory; 78440 Porcheville France
| | - O. Cariou
- Covance Laboratory; 78440 Porcheville France
| | - A. Essahli
- Covance Laboratory; 78440 Porcheville France
| | - N. Prigent
- Covance Laboratory; 78440 Porcheville France
| | - J. Saul
- Covance Laboratories; Yorkshire HG3 1PY UK
| | - F. Paillard
- Covance Laboratory; 78440 Porcheville France
| | | | - P. Lafouge
- Covance Laboratory; 78440 Porcheville France
| | | | - W. M. Hempel
- Radiology and Oncology Laboratory, IRCM, DSV; Commissariat à l'energie atomique (CEA); Fontenay-aux Roses France
| | - M. El May
- Tunis El Manar University; School of Medicine; Tunis Tunisia
| | - B. Colicchio
- Laboratoire MIPS - Groupe IMTI Université de Haute-Alsace; F-68093 Mulhouse France
| | - A. Dieterlen
- Laboratoire MIPS - Groupe IMTI Université de Haute-Alsace; F-68093 Mulhouse France
| | - E. Jeandidier
- Service de génétique Groupe Hospitalier de la Région de Mulhouse et Sud Alsace; 68070 Mulhouse France
| | - L. Sabatier
- Radiology and Oncology Laboratory, IRCM, DSV; Commissariat à l'energie atomique (CEA); Fontenay-aux Roses France
| | | | - R. M'Kacher
- Cell Environment; Paris France
- Radiology and Oncology Laboratory, IRCM, DSV; Commissariat à l'energie atomique (CEA); Fontenay-aux Roses France
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van Leeuwen FE, Ng AK. Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:323-330. [PMID: 27913498 PMCID: PMC6142518 DOI: 10.1182/asheducation-2016.1.323] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Long-term survivors of Hodgkin lymphoma (HL) experience several late adverse effects of treatment, with second malignant neoplasms (SMNs) and cardiovascular diseases (CVDs) being the leading causes of death in these patients. Other late effects have also been identified, such as pulmonary dysfunction, endocrinopathies (thyroid dysfunction, infertility), neck muscle atrophy, and persistent fatigue. HL survivors have two- to fourfold increased risks to develop SMNs and CVD compared with the general population. With respect to SMNs, radiotherapy is associated with 1.5- to 15-fold increased risk of solid malignancies. The relative risk (RR) of solid tumors increases steadily with increasing follow-up time from 5 to 15 years since radiotherapy, and remains elevated for at least 40 years. The RR of solid SMNs increases strongly with younger age at first treatment. Risks of lung, breast, and gastrointestinal (GI) cancers increase with higher radiation dose. Alkylating agent chemotherapy, especially procarbazine, does not only increase risk of leukemia but also of solid malignancies, in particular, cancers of the lung and GI tract. In contrast, gonadotoxic chemotherapy decreases the risk of radiation-associated breast cancer, through induction of premature menopause. Smoking appears to multiply the radiation- and chemotherapy-associated risks of lung cancer. Both radiotherapy and chemotherapy for HL may cause cardiovascular toxicity. Radiotherapy increases the risk of coronary heart disease, valvular heart disease, congestive heart failure (HF), and pericarditis, whereas anthracycline-containing chemotherapy increases the risks of HF and valvular heart disease. Cardiovascular toxicity following radiotherapy is usually observed from 5 to at least 35 years after therapy, whereas anthracycline-related toxicity is already observed during treatment, up to at least 25 years. The joint effects of anthracyclines, radiotherapy, and conventional cardiovascular risk factors (eg, hypertension, smoking, and physical inactivity) appear to be additive rather than multiplicative. HL survivors need lifelong risk-based screening for selected SMNs and CVDs. Furthermore, preventive strategies should include lifestyle and drug-based interventions to minimize exposure to conventional risk factors for cancer and CVD.
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Affiliation(s)
- Flora E. van Leeuwen
- Division of Psychosocial Research and Epidemiology, Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; and
| | - Andrea K. Ng
- Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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Jacob S, Ferrières J. Breast cancer radiotherapy: A case of double jeopardy. Arch Cardiovasc Dis 2016; 109:587-590. [PMID: 27836785 DOI: 10.1016/j.acvd.2016.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/05/2016] [Accepted: 09/07/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Sophie Jacob
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), PRP-HOM, SRBE, LEPID, Laboratory of Epidemiology, 92262 Fontenay-aux-Roses, France.
| | - Jean Ferrières
- Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, TSA 50032, 31059 Toulouse, France
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Leroy C, Cortet-Rudelli C, Desailloud R. [Endocrine consequences in young adult survivors of childhood cancer treatment]. ANNALES D'ENDOCRINOLOGIE 2016; 76:S29-38. [PMID: 26776287 DOI: 10.1016/s0003-4266(16)30005-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Endocrine complications (particularly gonadal, hypothalamic-pituitary and metabolic) of childhood cancer treatments are common in young adults. Gonadal damage may be the result of chemotherapy or radiotherapy. Fertility preservation must be systematically proposed before initiation of gonadotoxic treatment if only the child is eligible. Hypothalamic-pituitary deficiency is common after brain or total-body irradiation, the somatotropic axis is the most sensitive to irradiation. Pituitary deficiency screening must be repeated since this endocrine consequence can occur many years after treatment. Hormone replacement must be prudent particularly in case of treatment with growth hormone or steroids. Metabolic syndrome, diabetes and cardiovascular damage resulting from cancer treatments contribute to the increase of morbidity and mortality in this population and should be screened routinely even if the patient is asymptomatic. The multidisciplinary management of these adults must be organized and the role of the endocrinologist is now well established.
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Affiliation(s)
- C Leroy
- Service d'Endocrinologie, Diabétologie, Maladies Métaboliques, Hôpital Claude Huriez, CHRU de Lille, Rue Michel Polonovski, 59037 Lille cedex, France; Service d'Andrologie, Hôpital Calmette, CHRU de Lille, Boulevard du Professeur Jules Leclercq, 59037 Lille cedex, France; Service d'Endocrinologie et Diabétologie Pédiatrique, Hôpital Jeanne de Flandre, CHRU de Lille, avenue Eugène Avinée, 59037 Lille cedex, France; Université Lille 2, Faculté de Médecine, Lille, France.
| | - C Cortet-Rudelli
- Service d'Endocrinologie, Diabétologie, Maladies Métaboliques, Hôpital Claude Huriez, CHRU de Lille, Rue Michel Polonovski, 59037 Lille cedex, France; Université Lille 2, Faculté de Médecine, Lille, France
| | - R Desailloud
- Service d'Endocrinologie, Diabétologie et Nutrition, CHRU d'Amiens, UPJV, Hôpital Sud, Avenue René Laennec 80054 Amiens cedex 1, France; Université de Picardie Jules Verne, Faculté de Médecine, Amiens, France
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34
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Ier Congrès français Coeur & Cancer : le début d’une belle histoire attendue. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2646-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ng AK, van Leeuwen FE. Hodgkin lymphoma: Late effects of treatment and guidelines for surveillance. Semin Hematol 2016; 53:209-15. [PMID: 27496313 DOI: 10.1053/j.seminhematol.2016.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Long-term survivors of Hodgkin lymphoma (HL) are at risk for a range of late effects, with second malignant neoplasm and cardiovascular diseases being the leading causes of death in these patients. The excess risks remain significantly elevated decades after treatment, and are clearly associated with extent of treatment exposures. Other late effects have also been identified, such as pulmonary dysfunction, endocrinopathies, muscle atrophy, and persistent fatigue. Systemic documentation of late effects and recognition of treatment- and patient-related risk factors are important, as they inform optimal surveillance and risk-reduction strategies, as well as guide therapeutic modifications in newly diagnosed patients to minimize treatment-related complications. As HL therapy evolves over time, with adoption of novel agents and contemporary treatment techniques, late effect risks and follow-up recommendations need to be continuously updated.
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Affiliation(s)
- Andrea K Ng
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Flora E van Leeuwen
- Department of Epidemiology, Division of Psychosocial Research & Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Jacob S, Pathak A, Franck D, Latorzeff I, Jimenez G, Fondard O, Lapeyre M, Colombier D, Bruguiere E, Lairez O, Fontenel B, Milliat F, Tamarat R, Broggio D, Derreumaux S, Ducassou M, Ferrières J, Laurier D, Benderitter M, Bernier MO. Early detection and prediction of cardiotoxicity after radiation therapy for breast cancer: the BACCARAT prospective cohort study. Radiat Oncol 2016; 11:54. [PMID: 27056179 PMCID: PMC4823906 DOI: 10.1186/s13014-016-0627-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 03/24/2016] [Indexed: 12/29/2022] Open
Abstract
Background Radiotherapy (RT) for breast cancer presents a benefit in terms of reducing local recurrence and deaths resulting from breast cancer but it can lead to secondary effects due to the presence of neighboring cardiac normal tissues within the irradiation field. Breast RT has been shown to be associated with long-term increased risk of heart failure, coronary artery disease, myocardial infarction and finally cardiovascular death more than 10 years after RT. However, there is still a lack of knowledge for early cardiotoxicity induced by breast RT that can appear long before the onset of clinically significant cardiac events. Based on a 2-year follow-up prospective cohort of patients treated with breast RT, the BACCARAT (BreAst Cancer and CArdiotoxicity Induced by RAdioTherapy) study aims to enhance knowledge on detection and prediction of early subclinical cardiac dysfunction and lesions induced by breast RT and on biological mechanisms potentially involved, based on functional and anatomical cardiac imaging combined with simultaneous assessment of multiple circulating biomarkers and accurate heart dosimetry. Methods/Design BACCARAT study consists in a monocentric prospective cohort study that will finally include 120 women treated with adjuvant 3D CRT for breast cancer, and followed for 2 years after RT. Women aged 50 to 70 years, treated for breast cancer and for whom adjuvant 3D CRT is indicated, without chemotherapy are eligible for the study. Baseline (before RT) and follow-up data include measurements of functional myocardial dysfunction including strain and strain rate based on 2D-speckle tracking echocardiography, anatomical coronary lesions including description of plaques in segments of coronary arteries based on Coronary computed tomography angiography, and a wide panel of circulating biomarkers. The absorbed dose is evaluated for the whole heart and its substructures, in particular the coronary arteries. Analysis on occurrence and evolution of subclinical cardiac lesions and biomarkers will be performed and completed with dose-response relationship. Multivariate model of normal tissue complication probability (NTCP) will also be proposed. Discussion Tools and results developed in the BACCARAT study should allow improving prediction and prevention of potential lesions to cardiac normal tissues surrounding tumors and ultimately enhance patients’ care and quality of life. Trial registration ClinicalTrials.gov: NCT02605512
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Affiliation(s)
- Sophie Jacob
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), PRP-HOM, SRBE, LEPID, Fontenay-aux-Roses, France.
| | - Atul Pathak
- Clinique Pasteur, Unité d'Hypertension artérielle, facteurs de risque et insuffisance cardiaque, Toulouse, France
| | - Denis Franck
- Clinique Pasteur, Radiothérapie (Oncorad), Toulouse, France
| | - Igor Latorzeff
- Clinique Pasteur, Radiothérapie (Oncorad), Toulouse, France
| | - Gaelle Jimenez
- Clinique Pasteur, Radiothérapie (Oncorad), Toulouse, France
| | - Olivier Fondard
- Clinique Pasteur, Cardiologie générale et interventionnelle, Toulouse, France
| | | | | | | | - Olivier Lairez
- University Hospital Rangueil, Cardiologie B, Toulouse, France
| | | | - Fabien Milliat
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), PRP-HOM, SRBE, L3R, Fontenay-aux-Roses, France
| | - Radia Tamarat
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), PRP-HOM, SRBE, LR2I, Fontenay-aux-Roses, France
| | - David Broggio
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), PRP-HOM/SDI/LEDI, Fontenay-aux-Roses, France
| | - Sylvie Derreumaux
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), PRP-HOM, SER, UEM, Fontenay-aux-Roses, France
| | | | - Jean Ferrières
- INSERM, University Paul Sabatier, UMR1027, Epidemiology of cardiovascular diseases, Toulouse, France
| | - Dominique Laurier
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), PRP-HOM, SRBE, LEPID, Fontenay-aux-Roses, France
| | - Marc Benderitter
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), PRP-HOM, SRBE, Fontenay-aux-Roses, France
| | - Marie-Odile Bernier
- Institut de Radioprotection et de Sureté Nucléaire (IRSN), PRP-HOM, SRBE, LEPID, Fontenay-aux-Roses, France
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Moignier A, Broggio D, Derreumaux S, Beaudré A, Girinsky T, Paul JF, Drubay D, Lefkopoulos D, Franck D, Aubert B, Deutsch E, Bourhis J. Coronary stenosis risk analysis following Hodgkin lymphoma radiotherapy: A study based on patient specific artery segments dose calculation. Radiother Oncol 2015; 117:467-72. [PMID: 26277431 DOI: 10.1016/j.radonc.2015.07.043] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 06/18/2015] [Accepted: 07/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE The dose effect-effect relationship for cardiac diseases following radiotherapy suffers from uncertainties. Three dimensional coronary artery (CA) dose calculation after mediastinal Hodgkin lymphoma radiotherapy was performed, using the patient's coronary CT angiography (CCTA), and the relationship between the coronary arteries' radiation doses and the risk of stenosis was estimated. MATERIALS AND METHODS Radiotherapy simulation CT scans and CCTAs of patients treated for a mediastinal Hodgkin lymphoma were used to merge thoracic and detailed cardiovascular anatomies. Radiation treatment parameters were used to estimate CA radiation doses. Twenty-one patients without coronary stenosis (controls) were matched with twelve patients with stenosis (cases). CA segments were considered as sub-volumes of interest. Radiation doses to stenotic segments were compared with those received by normal segments (from cases and controls) using a logistic regression. RESULTS In eleven cases out of twelve, the highest of the coronary dose distribution was on a damaged segment. Logistic regression with CA segments yielded an odds ratio associated with the risk of coronary stenosis of 1.049 per additional gray with the CA segment median dose (95% confidence interval, 1.004-1.095; p-value <0.05). CONCLUSION The CA segment dose significantly increased the risk of stenosis on the segment. Such personalized CA dose calculations on larger cohorts are expected to improve the understanding of the cardiovascular radiation dose-effect relationship.
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Affiliation(s)
- Alexandra Moignier
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM/SDI/LEDI, France
| | - David Broggio
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM/SDI/LEDI, France
| | - Sylvie Derreumaux
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM/SER/UEM, France.
| | - Anne Beaudré
- Institut Gustave Roussy, Service de Radiothérapie Oncologique, France
| | - Théodore Girinsky
- Institut Gustave Roussy, Service de Radiothérapie Oncologique, France
| | | | - Damien Drubay
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM/SRBE/LEPID, France
| | | | - Didier Franck
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM/SDI/LEDI, France
| | - Bernard Aubert
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PRP-HOM/SER/UEM, France
| | - Eric Deutsch
- Institut Gustave Roussy, Service de Radiothérapie Oncologique, France
| | - Jean Bourhis
- Institut Gustave Roussy, Service de Radiothérapie Oncologique, France
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Yusuf SW, Howell RM, Gomez D, Pinnix CC, Iliescu CA, Banchs J. Radiation-related heart and vascular disease. Future Oncol 2015. [DOI: 10.2217/fon.15.129] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Improvement in cancer therapy has led to increasing number of cancer survivors, some of whom have previously been treated with mediastinal radiation. Cardiac complication may manifest years after completion of radiation therapy. Hence long-term follow-up is essential in these patients. In this paper, we have discussed the short- and long-term cardiovascular side effects of radiation therapy.
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Affiliation(s)
- Syed Wamique Yusuf
- Department of Cardiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Rebecca M Howell
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Daniel Gomez
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Chelsea C Pinnix
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Cezar A Iliescu
- Department of Cardiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Jose Banchs
- Department of Cardiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
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M'kacher R, Girinsky T, Colicchio B, Ricoul M, Dieterlen A, Jeandidier E, Heidingsfelder L, Cuceu C, Shim G, Frenzel M, Lenain A, Morat L, Bourhis J, Hempel WM, Koscielny S, Paul JF, Carde P, Sabatier L. Telomere shortening: a new prognostic factor for cardiovascular disease post-radiation exposure. RADIATION PROTECTION DOSIMETRY 2015; 164:134-137. [PMID: 25274533 DOI: 10.1093/rpd/ncu296] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Telomere length has been proposed as a marker of mitotic cell age and as a general index of human organism aging. Telomere shortening in peripheral blood lymphocytes has been linked to cardiovascular-related morbidity and mortality. The authors investigated the potential correlation of conventional risk factors, radiation dose and telomere shortening with the development of coronary artery disease (CAD) following radiation therapy in a large cohort of Hodgkin lymphoma (HL) patients. Multivariate analysis demonstrated that hypertension and telomere length were the only independent risk factors. This is the first study in a large cohort of patients that demonstrates significant telomere shortening in patients treated by radiation therapy who developed cardiovascular disease. Telomere length appears to be an independent prognostic factor that could help determine patients at high risk of developing CAD after exposure in order to implement early detection and prevention.
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Affiliation(s)
- R M'kacher
- Laboratory of Radiobiology and Oncology, CEA, DSV/iRCM, Fontenay-aux-Roses 92265, France Laboratory of Radiation Sensitivity and Radio-carcinogenesis INSERM 1030, Institut Gustave Roussy, Villejuif 94 804, France
| | - T Girinsky
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif 94 804, France
| | - B Colicchio
- Laboratoire MIPS - Groupe TIIM3D, Université de Haute-Alsace, Mulhouse Cedex F-68093, France
| | - M Ricoul
- Laboratory of Radiobiology and Oncology, CEA, DSV/iRCM, Fontenay-aux-Roses 92265, France
| | - A Dieterlen
- Laboratoire MIPS - Groupe TIIM3D, Université de Haute-Alsace, Mulhouse Cedex F-68093, France
| | - E Jeandidier
- Department of genetics, CHU, Mulhouse Cedex 68093, France
| | - L Heidingsfelder
- MetaSystems GmbH, Robert-Bosch-Str. 6, Altlussheim D-68804, Germany
| | - C Cuceu
- Laboratory of Radiobiology and Oncology, CEA, DSV/iRCM, Fontenay-aux-Roses 92265, France
| | - G Shim
- Laboratory of Radiobiology and Oncology, CEA, DSV/iRCM, Fontenay-aux-Roses 92265, France
| | - M Frenzel
- Laboratory of Radiobiology and Oncology, CEA, DSV/iRCM, Fontenay-aux-Roses 92265, France Laboratory of Radiation Sensitivity and Radio-carcinogenesis INSERM 1030, Institut Gustave Roussy, Villejuif 94 804, France Department of Radiation Oncology, Institut Gustave Roussy, Villejuif 94 804, France Laboratoire MIPS - Groupe TIIM3D, Université de Haute-Alsace, Mulhouse Cedex F-68093, France Department of genetics, CHU, Mulhouse Cedex 68093, France MetaSystems GmbH, Robert-Bosch-Str. 6, Altlussheim D-68804, Germany Biostatistics and Epidemiology Unit, Institut Gustave Roussy, Villejuif 94 804, France Department of Radiology, Marie Lannelongue, Chatenay-Malabry 92019, France Department of hematology, Institut Gustave Roussy, Villejuif 94 804, France
| | - A Lenain
- Laboratory of Radiobiology and Oncology, CEA, DSV/iRCM, Fontenay-aux-Roses 92265, France
| | - L Morat
- Laboratory of Radiobiology and Oncology, CEA, DSV/iRCM, Fontenay-aux-Roses 92265, France
| | - J Bourhis
- Laboratory of Radiation Sensitivity and Radio-carcinogenesis INSERM 1030, Institut Gustave Roussy, Villejuif 94 804, France Department of Radiation Oncology, Institut Gustave Roussy, Villejuif 94 804, France Laboratoire MIPS - Groupe TIIM3D, Université de Haute-Alsace, Mulhouse Cedex F-68093, France Department of genetics, CHU, Mulhouse Cedex 68093, France
| | - W M Hempel
- Laboratory of Radiobiology and Oncology, CEA, DSV/iRCM, Fontenay-aux-Roses 92265, France
| | - S Koscielny
- Biostatistics and Epidemiology Unit, Institut Gustave Roussy, Villejuif 94 804, France
| | - J F Paul
- Department of Radiology, Marie Lannelongue, Chatenay-Malabry 92019, France
| | - P Carde
- Department of hematology, Institut Gustave Roussy, Villejuif 94 804, France
| | - L Sabatier
- Laboratory of Radiobiology and Oncology, CEA, DSV/iRCM, Fontenay-aux-Roses 92265, France
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Kupeli S. Risks and diagnosis of coronary artery disease in Hodgkin lymphoma survivors. World J Cardiol 2014; 6:555-561. [PMID: 25068016 PMCID: PMC4110604 DOI: 10.4330/wjc.v6.i7.555] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 05/14/2014] [Indexed: 02/06/2023] Open
Abstract
Higher mortality rates are reported because of cardiovascular diseases in individuals living in industrialized areas of the World. In cancer patients, cardiotoxic chemotherapeutic agents and/or mediastinal radiotherapy are additional risk factors for the development of coronary artery disease. An improved survival rate for patients with Hodgkin lymphoma was reported in recent decades. Determining and handling the long-term effects of cancer treatment have become more important nowadays, parallel to the good results reached in survival rates. Mediastinal radiotherapy and cardiotoxic chemotherapeutic agents are routinely used to treat Hodgkin lymphoma but are commonly associated with a variety of cardiovascular complications. Drugs used in cancer treatment and radiotherapy may cause deleterious effects on contractile capacity and conduction system of the heart. Approximately ten years after the completion of all therapies, the cardiovascular disease risk peaks in patients who survived from Hodgkin lymphoma. The value of coronary computed tomography angiography as a diagnostic tool in determining coronary artery disease as early as possible is underlined in this review, in patients who are in remission and carry the risk of coronary artery disease probably because of chemo/radiotherapy used in their treatment. Survivors of Hodgkin lymphoma especially treated with combined chemoradiotherapy at younger ages are candidates for coronary computed tomography angiography.
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Gyenes GT. In Regard to Girinsky et al. Int J Radiat Oncol Biol Phys 2014; 89:931. [DOI: 10.1016/j.ijrobp.2014.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/01/2014] [Accepted: 04/01/2014] [Indexed: 11/29/2022]
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In Reply to Gyenes. Int J Radiat Oncol Biol Phys 2014; 89:931-2. [DOI: 10.1016/j.ijrobp.2014.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 04/01/2014] [Accepted: 04/01/2014] [Indexed: 11/22/2022]
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