KARDIALE SPATFOLGEN NACH MANTELFELDBESTRAHLUNG

Purpose: We have retrospectively evaluated the cardiac function in patients after mantle-irradiation for Hodgkin's disease. Patients and Methods: Forty-three patients, mean age 39.8 ± 13 years, who had been treated with mantle-irradiation from 1979 through 1984 at the University of Erlangen-Nurnberg, were examined. All of them were in first remission at 5 to 11 years (mean 8.1 years) after radiotherapy (n = 24) or combined modality treatment (n = 19). Mantle-irradiation had been administered through equally weighted anteriorposterior-posterioranterior portals with 5 fractions of 2 Gy per week up to a total mediastinal dose of 41.8 ± 7 Gy (including boost). The examination programm included anamnesis, physical examination, Doppler-echocardiography and ergometry. Hundred and twenty-two non-irradiated volunteers and cardiological patients were used as control group. Results: None of the patients suffered from clinical symptoms. Pericardial thickening was present in 26%. The left ventricular endsystolic diameter (31.3 ± 5.5 mm, normal value 26 to 42 mm) and the thickness of the left ventricular posterior wall (8.1 ± 1.8 mm, normal value 6 to 11 mm) were within the normal range. The left ventricular ejection fraction was also normal (67.1 ± 8% in patients versus 67.0 ± 8% in control subjects). Evaluation of diastolic parameters, however, revealed significant changes. The isovolumic relaxation time was significantly decreased as compared to the control group (38.8 ± 17 ms versus 50.8 ± 21 ms, p < 0.05). The same we found for the shortening fraction (33.6 ± 6% versus 38.1 ± 6%, p < 0.05). The most significant changes were found after combined modality therapy, especially after radiotherapy and anthracyclin-based chemotherapy. 30% of the patients were tachycardic (pulse > 100/min) at rest. At ergometry, the frequency of signs of ischemia (5%), conduction disturbances (2%), and rhythm disturbances (7%) was not elevated. Conclusions: In this retrospective investigation, patients after mantle irradiation with modern techniques showed only minimal cardiologic abnormalties within the first 10 years after treatment. The most sensitive parameters were the isovolumic relaxation times. The clinical relevance of such findings remains to be defined. Pathophysiologically, our findings (decreased relaxation time plus tachycardia) support the theory that myocardial damage after radiotherapy may result in subsequent increased β-receptor density as proposed by Schultz-Hector et al. on the basis of experimental data.