Evaluation of Late Cardiotoxicity by Pulsed Doppler Echocardiography in Patients Treated for Hodgkin’s Disease

Abstract

In the treatment of all stages of Hodgkin’s disease, intensified chemotherapy, irradiation and bone marrow transplantation have led to the expectation of long-term survival in more than 70% of patients. The 5-year survival rate is approximately 90% in stages I and II and about 60% in stages III and IV (Santoro et al. 1987; Henkelman et al. 1988; Loeffler étal. 1988; Longo 1990). This therapeutic success has focused attention on chronic or irreversible side effects such as secondary cancer (Qaldor et al. 1990; Santoro et al. 1987), gonadal toxicity (Santoro et al. 1987), (da Cunha et al. 1984; Kreuser et al. 1988, 1992), thyroid diseases (Hancock et al. 1991), and psychosocial sequelae (Fobair et al. 1986). Although considerable data have been published on late cardiotoxicity associated with treatment for Hodgkin’s disease, including mediastinal irradiation and various chemotherapeutic regimens (Table 1; Ruckdeschel et al. 1975; Martin et al. 1975; Brosius et al. 1981; Applefeld et al. 1981,1982; Gottdiener et al. 1983; Kramer et al. 1984; La Monte et al. 1986; Watchie et al. 1987; Green et al. 1987; Pohjola-Sintonen et al. 1987; Gustavson et al. 1990), there is currently only limited information available about the impact of myocardial, valvular, and pericardial abnormalities on cardiac hemodynamic parameters. However, the influence of therapy-induced cardiac abnormalities on altered hemodynamics would probably reflect their clinical significance.