- 作者：Theodore Girinsky ; MD&lowast ; ; girinsky.theodore@orange.fr" class="auth_mail ; Radhia M&rsquo ; Kacher ; PhD&dagger ; ; Nathalie Lessard ; MD&lowast ; ; Serge Koscielny ; PhD&Dagger ; ; Eric Elfassy ; MD§ ; ; Franç ; ois Raoux ; MD§ ; ; Patrice Carde ; MD鈥?/sup> ; Marcos Dos Santos ; MD&lowast ; ; Jean-Pierre Margainaud ; MD¶ ; ; Laure Sabatier ; PhD&dagger ; ; Mithra Ghalibafian ; MD&lowast ; ; Jean-Franç ; ois Paul ; MD§ ;
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：1 May, 2014
- 年：2014
- 卷：89
- 期：1
- 页码：59-66
- 全文大小：289 K
Purpose
To prospectively investigate the coronary artery status using coronary CT angiography (CCTA) in patients with Hodgkin lymphoma treated with combined modalities and mediastinal irradiation.Methods and Materials
All consecutive asymptomatic patients with Hodgkin lymphoma entered the study during follow-up, from August 2007 to May 2012. Coronary CT angiography was performed, and risk factors were recorded along with leukocyte telomere length (LTL) measurements.
Results
One hundred seventy-nine patients entered the 5-year study. The median follow-up was 11.6聽years (range, 2.1-40.2聽years), and the median interval between treatment and the CCTA was 9.5聽years (range, 0.5-40聽years). Coronary artery abnormalities were demonstrated in 46 patients (26%). Coronary CT angiography abnormalities were detected in nearly 15% of the patients within the first 5聽years after treatment. A significant increase (34%) occurred 10聽years after treatment (P=.05). Stenoses were mostly nonostial. Severe stenoses were observed in 12 (6.7%) of the patients, entailing surgery with either angioplasty with stent placement or bypass grafting in 10 of them (5.5%). A multivariate analysis demonstrated that age at treatment, hypertension, and hypercholesterolemia, as well as radiation dose to the coronary artery origins, were prognostic factors. In the group of patients with LTL measurements, hypertension and LTL were the only independent risk factors.
Conclusions
The findings suggest that CCTA can identify asymptomatic individuals at risk of acute coronary artery disease who might require either preventive or curative measures. Conventional risk factors and the radiation dose to coronary artery origins were independent prognostic factors. The prognostic value of LTL needs further investigation.