Hodgkin lenfoma sonrası kalpte ve akciğerde görülen geç yan etkiler

Günümüzde çocukluk çağı kanserlerinin tedavisi, klinik, biyolojik, genetik faktörler ve tedaviye yanıtı dikkate alınarak risk odaklı bir yaklaşım olarak gelişmiştir. Uzun dönem çocukluk çağı kanseri hastalarında kalp hastalıkları kanser dışı ölümlerin en sık nedenidir. Kemoterapi ve radyoterapinin toksik etkileri ile kardiyomiyopati, konjestif kalp yetmezliği, perikardiyal efüzyon, konstriktif perikardit, koroner arter hastalığı, miyokard enfarktüsü ve aritmi gelişebilir. Önceki yıllarda yüksek doz radyoterapiye bağlı olarak görülen radyasyon pnömonisi, pulmoner fibrozis ve spontan pnömotoraks gibi akciğer komplikasyonları günümüzde nadiren görülmektedir. Hodgkin lenfoma hastaları gibi mediastinal radyoterapi ve/veya kardiyotoksik ajanlarla tedavi edilen hastaların uzun süreli takibi hayati öneme sahiptir. Sol ventrikül ve kalp kapak fonksiyonları ekokardiyografi ile, QTc ve ritim anormallikleri elektrokardiyografi ile izlenmeli, kardiyovasküler sağlığı etkileyebilecek diğer faktörler ve solunum fonksiyon testleri periyodik olarak değerlendirilmelidir. Bilgisayarlı tomografi anjiyografi, aldıkları tedaviler ve özellikle mediastinal radyoterapi nedeniyle risk altında olan Hodgkin lenfoma yaşayanlarında olası koroner anormalliklerin erken teşhis edilmesinde önemli bir role sahiptir.

Cardiac and pulmonary late side effects after Hodgkin lymphoma

Current treatment of childhood cancers has developed as a risk-oriented approach considering clinical, biological, genetic factors and treatment response. Cardiac diseases are the most common cause of non-cancer death in long-term childhood cancer patients. Cardiomyopathy, congestive heart failure, pericardial effusion, constrictive pericarditis, coronary artery disease, myocardial infarction, and arrhythmias may develop with the toxic effects of chemotherapy and radiotherapy. Pulmonary complications such as radiation pneumonitis, pulmonary fibrosis and spontaneous pneumothorax, which are seen in previous years due to high dose radiotherapy are currently rarely seen. Long-term follow-up of patients who are treated with mediastinal radiotherapy and/or cardiotoxic agents, such as patients with Hodgkin lymphoma, is of vital importance. Left ventricular and heart valve functions should be monitored by echocardiography, QTc and rhythm abnormalities should be monitored by electrocardiography and other factors that may affect cardiovascular health and pulmonary function tests should be evaluated periodically. Computerized tomography angiography has a role of in the early identification of possible coronary abnormalities in Hodgkin lymphoma patients at risk for coronary artery disease due to the treatments they received, especially mediastinal radiotherapy.

Keywords:

Cardiac late effects, pulmonary late effects, Hodgkin lymphoma children,

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