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Elevated stroke risk seen in Hodgkin’s lymphoma survivors

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Survivors of Hodgkin’s lymphoma are to 2- to 3-times more likely to experience a stroke or TIA compared with people in the general population, with much of the risk related to radiotherapy of the neck and mediastinum, according to a report in the Journal of the National Cancer Institute for July 1st.

Radiation exposure to the neck might be expected to cause stenosis of the carotid arteries, which, in turn, would increase the risk of stroke and TIA. However, data on the long-term risks of stroke and TIA after treatment for Hodgkin’s disease are limited, Dr. Flora E. van Leeuwen, from the Netherlands Cancer Institute, Amsterdam, and colleagues note.

The current investigation featured 2201 five-year survivors of Hodgkin’s lymphoma who underwent treatment before they were 51 years old, from 1965 to 1995.

During a median follow-up period of 17.5 years, 55 patients sustained a stroke, 31 had a TIA, and 10 had both. Thirty-six percent of ischemic events were from large-artery atherosclerosis and 24% were from cardioembolisms.

Relative to the general population, Hodgkin’s lymphoma survivors were 2.2- and 3.1-times more likely to experience a stroke or TIA, respectively. Moreover, little change in these risks was noted after prolonged follow-up. Thirty years following treatment for Hodgkin’s lymphoma, the cumulative incidence of stroke or TIA was 7%.

Radiotherapy to the head and neck was independently linked with ischemic cerebrovascular disease with a hazard ratio of 2.5. Chemotherapy, by contrast, was not significantly linked with an increased risk of stroke or TIA.

Other correlates of cerebrovascular disease included hypertension, diabetes, and hypercholesterolemia. Smoking and being overweight, however, were not risk factors.

“For young survivors of Hodgkin’s lymphoma, who are at especially increased risk of stroke and TIA,” Dr. van Leeuwen’s group suggests “physicians should consider appropriate risk-reducing strategies, such as treatment of hypertension and lifestyle changes to reduce the risk of stroke and TIA.”

J Natl Cancer Inst 2009;101:928-937.