Long-Term Adverse Effects of Neck Radiotherapy in Childhood on the Carotid Arteries in Survivors of Hodgkin Lymphoma

Simple Summary With novel treatments, the majority of Hodgkin lymphoma patients will become long-term survivors, which carries a risk for long-term sequelae due to treatment or the disease itself. We aimed to explore the late effects of therapeutic modalities on arterial stiffness and flow-mediated dilation in such patients, taking cardiovascular (CV) risk factors into consideration. In a group of 79 Hodgkin lymphoma survivors, we found increased arterial stiffness compared to healthy controls but not flow-mediated dilation. Neck radiotherapy increased arterial stiffness and anthracyclines decreased it. Our patient group also had more pronounced carotid atherosclerosis than controls. Our results show long-term vascular changes in Hodgkin lymphoma patients who might be therefore at increased risk of stroke. Systemic follow-up of these patients for carotid disease is warranted. Introduction: Survivors of Hodgkin lymphoma are recognized to have an increased risk of stroke and carotid artery disease owing to neck irradiation (RT). However, it remains unclear whether the vascular modifications induced by the treatment of Hodgkin lymphoma during childhood persist over the long term. Methods: Our matched study involved 79 survivors of Hodgkin lymphoma in childhood who received neck RT and 57 healthy controls. Parameters of arterial stiffness (AS), intima-media thickness (IMT), and flow-mediated dilation (FMD) of carotid arteries were assessed using ultrasound. Results: Our patient cohort demonstrated a significant increase in AS compared to controls (p < 0.05), though no such disparity was observed for FMD (p = 0.111). Neck RT intensified AS (B = 0.037, p = 0.000), while anthracyclines attenuated it (B = -0.803, p = 0.000). Multivariate analysis revealed a positive correlation between neck RT (p < 0.001) and AS. However, we found no significant association between neck RT and FMD (p = 0.277). We identified a substantial positive correlation between the dose of neck RT and AS. Conclusions: Vascular changes in survivors of childhood Hodgkin lymphoma after neck RT seem to be long-term. Therefore, these patients may have an increased risk of stroke. We suggest refinement of international guidelines according to our results.

Automated summary

This study investigated the long-term effects of therapeutic modalities on arterial stiffness and flow-mediated dilation in Hodgkin lymphoma patients. The results showed increased arterial stiffness and no change in flow-mediated dilation in these patients. Neck radiotherapy increased arterial stiffness while anthracyclines decreased it. The study suggests that Hodgkin lymphoma patients may be at increased risk of stroke and should be monitored for carotid disease.