Screening for coronary artery disease after mediastinal irradiation in Hodgkin lymphoma survivors: phase II study of indication and acceptance†

L A Daniëls; A D G Krol; M A de Graaf; A J H A Scholte; M B Van't Veer; H Putter; A de Roos; M J Schalij; C L Creutzberg

doi:10.1093/annonc/mdu130

Screening for coronary artery disease after mediastinal irradiation in Hodgkin lymphoma survivors: phase II study of indication and acceptance†

L A Daniëls
, A D G Krol
, M A de Graaf
, A J H A Scholte
, M B Van't Veer
, H Putter
, A de Roos
, M J Schalij
, C L Creutzberg

pre-AMC

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Cardiovascular diseases are the most common nonmalignant cause of death in Hodgkin lymphoma (HL) survivors, especially after mediastinal irradiation. We investigated the role of computed tomographic coronary angiography (CTA) as a screening tool for coronary artery disease (CAD) in asymptomatic HL survivors, and related CTA findings to exercise testing and subsequent interventions.

PATIENTS AND METHODS: Patients were eligible for this phase II study if at least 10 years disease-free and treated with mediastinal radiotherapy. Screening consisted of electrocardiogram, exercise testing and CTA. Primary end point was significant CAD (stenosis >50%) on CTA. CTA screening was considered to be indicated for testing in a larger population if ≥6 of 50 CTA scanned patients (12%) would need revascularization. Screening was evaluated with a questionnaire before and after screening.

RESULTS: Fifty-two patients were included, and 48 patients underwent CTA. Median age was 47 years, time since HL diagnosis 21 years. There were 45 evaluable scans. Significant CAD on CTA was found in 20% (N = 9), significantly increased compared with the 7% expected abnormalities (P = 0.01, 95% confidence interval 8.3% to 31.7%). In 11% (N = 5), significant stenosis was confirmed at coronary angiography, and revascularization was carried out. Additionally, two patients were treated with optimal medical therapy. Ninety percent of patients were content with screening, regardless whether the CTA showed abnormalities.

CONCLUSIONS: Prevalence of significant CAD among HL survivors is high, while asymptomatic even in the presence of life-threatening CAD. This might justify screening by CTA in asymptomatic HL survivors who had mediastinal radiotherapy, but needs to be evaluated in a larger cohort. The trial protocol was approved by the Ethics Committee of the LUMC and registered with ClinicalTrials.gov, NCT01271127.

Original language	English
Pages (from-to)	1198-203
Number of pages	6
Journal	Annals of oncology
Volume	25
Issue number	6
DOIs	https://doi.org/10.1093/annonc/mdu130
Publication status	Published - Jun 2014
Externally published	Yes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Adult
Coronary Angiography
Coronary Artery Disease/diagnosis
Electrocardiography
Exercise Test
Female
Hodgkin Disease/radiotherapy
Humans
Male
Mediastinum/radiation effects
Middle Aged
Prevalence
Radiotherapy/adverse effects
Survivors

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10.1093/annonc/mdu130

https://academic.oup.com/annonc/article-pdf/25/6/1198/16703009/mdu130.pdf

Cite this

Daniëls, L. A., Krol, A. D. G., de Graaf, M. A., Scholte, A. J. H. A., Van't Veer, M. B., Putter, H., de Roos, A., Schalij, M. J., & Creutzberg, C. L. (2014). Screening for coronary artery disease after mediastinal irradiation in Hodgkin lymphoma survivors: phase II study of indication and acceptance†. Annals of oncology, 25(6), 1198-203. https://doi.org/10.1093/annonc/mdu130

@article{9c5e90c112bc4ccdbf6bc3bcdd9663ae,

title = "Screening for coronary artery disease after mediastinal irradiation in Hodgkin lymphoma survivors: phase II study of indication and acceptance†",

abstract = "BACKGROUND: Cardiovascular diseases are the most common nonmalignant cause of death in Hodgkin lymphoma (HL) survivors, especially after mediastinal irradiation. We investigated the role of computed tomographic coronary angiography (CTA) as a screening tool for coronary artery disease (CAD) in asymptomatic HL survivors, and related CTA findings to exercise testing and subsequent interventions.PATIENTS AND METHODS: Patients were eligible for this phase II study if at least 10 years disease-free and treated with mediastinal radiotherapy. Screening consisted of electrocardiogram, exercise testing and CTA. Primary end point was significant CAD (stenosis >50\%) on CTA. CTA screening was considered to be indicated for testing in a larger population if ≥6 of 50 CTA scanned patients (12\%) would need revascularization. Screening was evaluated with a questionnaire before and after screening.RESULTS: Fifty-two patients were included, and 48 patients underwent CTA. Median age was 47 years, time since HL diagnosis 21 years. There were 45 evaluable scans. Significant CAD on CTA was found in 20\% (N = 9), significantly increased compared with the 7\% expected abnormalities (P = 0.01, 95\% confidence interval 8.3\% to 31.7\%). In 11\% (N = 5), significant stenosis was confirmed at coronary angiography, and revascularization was carried out. Additionally, two patients were treated with optimal medical therapy. Ninety percent of patients were content with screening, regardless whether the CTA showed abnormalities.CONCLUSIONS: Prevalence of significant CAD among HL survivors is high, while asymptomatic even in the presence of life-threatening CAD. This might justify screening by CTA in asymptomatic HL survivors who had mediastinal radiotherapy, but needs to be evaluated in a larger cohort. The trial protocol was approved by the Ethics Committee of the LUMC and registered with ClinicalTrials.gov, NCT01271127.",

keywords = "Adult, Coronary Angiography, Coronary Artery Disease/diagnosis, Electrocardiography, Exercise Test, Female, Hodgkin Disease/radiotherapy, Humans, Male, Mediastinum/radiation effects, Middle Aged, Prevalence, Radiotherapy/adverse effects, Survivors",

author = "Dani{\"e}ls, \{L A\} and Krol, \{A D G\} and \{de Graaf\}, \{M A\} and Scholte, \{A J H A\} and \{Van't Veer\}, \{M B\} and H Putter and \{de Roos\}, A and Schalij, \{M J\} and Creutzberg, \{C L\}",

note = "{\textcopyright} The Author 2014. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: [email protected].",

year = "2014",

month = jun,

doi = "10.1093/annonc/mdu130",

language = "English",

volume = "25",

pages = "1198--203",

journal = "Annals of oncology",

issn = "0923-7534",

publisher = "Oxford University Press",

number = "6",

}

TY - JOUR

T1 - Screening for coronary artery disease after mediastinal irradiation in Hodgkin lymphoma survivors

T2 - phase II study of indication and acceptance†

AU - Daniëls, L A

AU - Krol, A D G

AU - de Graaf, M A

AU - Scholte, A J H A

AU - Van't Veer, M B

AU - Putter, H

AU - de Roos, A

AU - Schalij, M J

AU - Creutzberg, C L

PY - 2014/6

Y1 - 2014/6

N2 - BACKGROUND: Cardiovascular diseases are the most common nonmalignant cause of death in Hodgkin lymphoma (HL) survivors, especially after mediastinal irradiation. We investigated the role of computed tomographic coronary angiography (CTA) as a screening tool for coronary artery disease (CAD) in asymptomatic HL survivors, and related CTA findings to exercise testing and subsequent interventions.PATIENTS AND METHODS: Patients were eligible for this phase II study if at least 10 years disease-free and treated with mediastinal radiotherapy. Screening consisted of electrocardiogram, exercise testing and CTA. Primary end point was significant CAD (stenosis >50%) on CTA. CTA screening was considered to be indicated for testing in a larger population if ≥6 of 50 CTA scanned patients (12%) would need revascularization. Screening was evaluated with a questionnaire before and after screening.RESULTS: Fifty-two patients were included, and 48 patients underwent CTA. Median age was 47 years, time since HL diagnosis 21 years. There were 45 evaluable scans. Significant CAD on CTA was found in 20% (N = 9), significantly increased compared with the 7% expected abnormalities (P = 0.01, 95% confidence interval 8.3% to 31.7%). In 11% (N = 5), significant stenosis was confirmed at coronary angiography, and revascularization was carried out. Additionally, two patients were treated with optimal medical therapy. Ninety percent of patients were content with screening, regardless whether the CTA showed abnormalities.CONCLUSIONS: Prevalence of significant CAD among HL survivors is high, while asymptomatic even in the presence of life-threatening CAD. This might justify screening by CTA in asymptomatic HL survivors who had mediastinal radiotherapy, but needs to be evaluated in a larger cohort. The trial protocol was approved by the Ethics Committee of the LUMC and registered with ClinicalTrials.gov, NCT01271127.

AB - BACKGROUND: Cardiovascular diseases are the most common nonmalignant cause of death in Hodgkin lymphoma (HL) survivors, especially after mediastinal irradiation. We investigated the role of computed tomographic coronary angiography (CTA) as a screening tool for coronary artery disease (CAD) in asymptomatic HL survivors, and related CTA findings to exercise testing and subsequent interventions.PATIENTS AND METHODS: Patients were eligible for this phase II study if at least 10 years disease-free and treated with mediastinal radiotherapy. Screening consisted of electrocardiogram, exercise testing and CTA. Primary end point was significant CAD (stenosis >50%) on CTA. CTA screening was considered to be indicated for testing in a larger population if ≥6 of 50 CTA scanned patients (12%) would need revascularization. Screening was evaluated with a questionnaire before and after screening.RESULTS: Fifty-two patients were included, and 48 patients underwent CTA. Median age was 47 years, time since HL diagnosis 21 years. There were 45 evaluable scans. Significant CAD on CTA was found in 20% (N = 9), significantly increased compared with the 7% expected abnormalities (P = 0.01, 95% confidence interval 8.3% to 31.7%). In 11% (N = 5), significant stenosis was confirmed at coronary angiography, and revascularization was carried out. Additionally, two patients were treated with optimal medical therapy. Ninety percent of patients were content with screening, regardless whether the CTA showed abnormalities.CONCLUSIONS: Prevalence of significant CAD among HL survivors is high, while asymptomatic even in the presence of life-threatening CAD. This might justify screening by CTA in asymptomatic HL survivors who had mediastinal radiotherapy, but needs to be evaluated in a larger cohort. The trial protocol was approved by the Ethics Committee of the LUMC and registered with ClinicalTrials.gov, NCT01271127.

KW - Adult

KW - Coronary Angiography

KW - Coronary Artery Disease/diagnosis

KW - Electrocardiography

KW - Exercise Test

KW - Female

KW - Hodgkin Disease/radiotherapy

KW - Humans

KW - Male

KW - Mediastinum/radiation effects

KW - Middle Aged

KW - Prevalence

KW - Radiotherapy/adverse effects

KW - Survivors

U2 - 10.1093/annonc/mdu130

DO - 10.1093/annonc/mdu130

M3 - Article

SN - 0923-7534

VL - 25

SP - 1198

EP - 1203

JO - Annals of oncology

JF - Annals of oncology

IS - 6

ER -

Screening for coronary artery disease after mediastinal irradiation in Hodgkin lymphoma survivors: phase II study of indication and acceptance†

Abstract

UN SDGs

Keywords

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