Cardiopulmonary toxicity of different chemoradiotherapy combined regimens for Hodgkin's disease

Alessandra Busia, Alberto Laffranchi, Simonetta Viviani, Valeria Bonfante, Fabrizio Villani

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

The majority of patients with Hodgkin 's disease can be cured by combination of polychemotherapy and radiotherapy (RT) that can produce late toxic pulmonary and cardiac effects which often remain at a subclinical level. The aim of the present investigation was to compare the late pulmonary and cardiac toxicity of three chemotherapeutic regimens combined with RT and particularly doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD), vincristine, epirubicin, cyclophosphamide, etoposide and prednisone (VEBEP) and ABVD with mechloretamine, vincristine, procarbazine and prednisone (MOPP). Patients and Methods: We investigated 147 patients suffering from Hodgkin's disease after a follow-up of at least 5 years from the completion of CT-RT. Seventy-eight patients were submitted to ABVD-RT, 36 to VEBEP-RT and 33 to MOPP-ABVD-RT. Patients underwent spirometry, 2D-doppler echocardiography at rest, cardiopulmonary exercise test on cycloergometer and determination of cardiac output by a non invasive method. Results: Patients of the three different treatment groups showed tolerance to exercise, and oxygen consumption significantly lower than the predicted values but there were no statistically significant difference between the three groups. Nevertheless, patients treated with VEBEP and with MOPP-ABVD showed an ejection fraction at rest lower than those observed in the ABVD group and patients treated with VEBEP showed a cardiac output for oxygen uptake lower than those observed in the ABVD and MOPP-ABVD treatment groups. Conclusion: These data confirm that the combination of mediastinal RT with the more commonly used polychemotherapy regimens produce late toxic effects. The lower exercise capacity seems to be due to a combination of decreased cardiac performance and impairment of ventilation. The VEBEP regimens could be potentially more toxic for the heart, probably because of the higher cumulative dose of anthracyclines.

Original languageEnglish
Pages (from-to)4381-4387
Number of pages7
JournalAnticancer Research
Volume30
Issue number10
Publication statusPublished - Oct 2010

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Chemoradiotherapy
Vincristine
Prednisone
Hodgkin Disease
Epirubicin
Radiotherapy
Procarbazine
Etoposide
Cyclophosphamide
Poisons
Combination Drug Therapy
Cardiac Output
Lung
Dacarbazine
Exercise Tolerance
Vinblastine
Doppler Echocardiography
Anthracyclines
Spirometry
Bleomycin

Keywords

  • Cardiopulmonary toxicity
  • Hodgkin's disease

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Cardiopulmonary toxicity of different chemoradiotherapy combined regimens for Hodgkin's disease. / Busia, Alessandra; Laffranchi, Alberto; Viviani, Simonetta; Bonfante, Valeria; Villani, Fabrizio.

In: Anticancer Research, Vol. 30, No. 10, 10.2010, p. 4381-4387.

Research output: Contribution to journalArticle

Busia, Alessandra ; Laffranchi, Alberto ; Viviani, Simonetta ; Bonfante, Valeria ; Villani, Fabrizio. / Cardiopulmonary toxicity of different chemoradiotherapy combined regimens for Hodgkin's disease. In: Anticancer Research. 2010 ; Vol. 30, No. 10. pp. 4381-4387.
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abstract = "The majority of patients with Hodgkin 's disease can be cured by combination of polychemotherapy and radiotherapy (RT) that can produce late toxic pulmonary and cardiac effects which often remain at a subclinical level. The aim of the present investigation was to compare the late pulmonary and cardiac toxicity of three chemotherapeutic regimens combined with RT and particularly doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD), vincristine, epirubicin, cyclophosphamide, etoposide and prednisone (VEBEP) and ABVD with mechloretamine, vincristine, procarbazine and prednisone (MOPP). Patients and Methods: We investigated 147 patients suffering from Hodgkin's disease after a follow-up of at least 5 years from the completion of CT-RT. Seventy-eight patients were submitted to ABVD-RT, 36 to VEBEP-RT and 33 to MOPP-ABVD-RT. Patients underwent spirometry, 2D-doppler echocardiography at rest, cardiopulmonary exercise test on cycloergometer and determination of cardiac output by a non invasive method. Results: Patients of the three different treatment groups showed tolerance to exercise, and oxygen consumption significantly lower than the predicted values but there were no statistically significant difference between the three groups. Nevertheless, patients treated with VEBEP and with MOPP-ABVD showed an ejection fraction at rest lower than those observed in the ABVD group and patients treated with VEBEP showed a cardiac output for oxygen uptake lower than those observed in the ABVD and MOPP-ABVD treatment groups. Conclusion: These data confirm that the combination of mediastinal RT with the more commonly used polychemotherapy regimens produce late toxic effects. The lower exercise capacity seems to be due to a combination of decreased cardiac performance and impairment of ventilation. The VEBEP regimens could be potentially more toxic for the heart, probably because of the higher cumulative dose of anthracyclines.",
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