A case of delayed appearance of effusive-constrictive pericarditis after radiation therapy for Hodgkin's disease

Ahn, Heok Soo; Kwak, Jae Yong; Yim, Chang Yeol

Abstract

The heart was considered to be relatively resistant to ionizing irradiation in the range of doses used in radiation therapy before follow up and review of a large number of patients who had undergone mediastinal irradiation and survived for several years. Cardiac complications after mediastinal irradiation include coronary artery disease, valvular heart disease, and acute and chronic pericardial disease. Pericarditis and pericardial effusion have been regarded as the most common side effects of cardiac irradiation. However, modern techniques of irradiation, dose fractionation, and reduction of the heart volume irradiated in most malignancies have substantially reduced the frequency of cardiac complications including pericarditis. Therefore, effusive- constrictive or constrictive pericarditis is less often noted after the completion of radiation therapy. Delayed appearance of effusive-constrictive pericarditis after mediastinal irradiation has not been commonly recognized by physicians. We recently experienced a case of delayed pericarditis with effusion occurring 36 months after radiation therapy for young patient with Hodgkin's disease. Mediastinal irradiation for Hodgkin's disease increases the risk of subsequent death from heart disease. Risk increased with high mediastinal doses, minimal protective cardiac blocking, young age at irradiation, and increasing duration of follow-up. Consequently, the current practice of using a subcarinal block and multiple portals, with irradiation through both anterior and posterior fields, may be expected to lead to a decline in the incidence and severity of cardiac abnormality after irradiation.