Adapted from the NCI Cancer Bulletin.
Patients who receive radiation therapy for Hodgkin lymphoma may be at increased risk of a stroke or transient ischemic attack (TIA), also called a "mini stroke," later in life, according to a report in the July 1, 2009, Journal of the National Cancer Institute (see the journal abstract). The risk is primarily associated with radiation to the neck and chest area, and it remains elevated for years after treatment.
The researchers, led by Dr. Flora E. van Leeuwen of the Netherlands Cancer Institute, tracked 2,201 survivors of Hodgkin lymphoma who were treated before the age of 51 between 1965 and 1995. At a median follow-up of almost 18 years, 96 survivors developed a stroke or TIA. The incidence of stroke among the survivors was 2.2 times that of the general population, while the incidence of TIA was 3.1 times that of the general population.
Overall, these events occurred at a relatively young age (the median age was 52 years, with a range from 24 to 80 years). For young survivors of Hodgkin lymphoma who are at especially increased risk of stroke and TIA, physicians should consider strategies to reduce the risk, such as treatment of hypertension and certain lifestyle changes, the researchers said.
The findings add to the overwhelming evidence that using radiation therapy in Hodgkin lymphoma is "shortsighted," according to an accompanying editorial by Dr. Dan Longo of the National Institute on Aging. Even though treatments for this disease have included reduced doses of radiation since 1995, there is no evidence yet that this translates into fewer late effects for survivors, he cautioned.
"Unfortunately, given the lifelong increased risks of late effects that have been documented from the use of radiation therapy, we simply cannot keep exposing patients to risk without clear benefit while we wait for safety data to be produced," Dr. Longo added.