​Vpliv obsevanja vratu v otroški dobi na karotidne arterije

Popit, Matjaž (avtor), Žvan, Bojana (mentor), Zadravec Zaletel, Lorna (komentor)

Uvod: S sodobnejšimi metodami zdravljenja se je preživetje otrok z rakom v zadnjih desetletjih izboljšalo, s tem pa se je v tej populaciji povečalo tudi tveganje za pojav poznih posledic zdravljenja. Radioterapija v področje vratu poveča tveganje za karotidno bolezen in možgansko kap pri odraslih z rakom, vendar pa so študije na tem področju v populaciji preživelih raka v otroštvu redke in neprepričljive. Namen: Namen naše raziskave je bil preučiti lokalne in morebitne sistemske učinke radioterapije (RT) vratu pri preživelih Hodgkinov limfom (HL) v otroštvu. S tem smo poskušali postaviti smernice za sledenje teh bolnikov. Metode: Vključili smo 79 preživelih HL v otroštvu in 57 zdravih kontrolnih preiskovancev. S pomočjo ultrazvoka smo preučili kazalce arterijske togosti in intimo-medijo na karotidnih arterijah ter od endotelija odvisno vazodilatacijo na brahialni arteriji. Rezultati: Preiskovanci so bili ob diagnozi HL stari 3 do 16 (povprečno 11.2) let in so bili v raziskavo vključeni 14 do 47 (povprečno 30.8) let kasneje v starosti 22 do 64 (povprečno 41.8) let. Predpisana doza RT na vrat je bila 10-60 (povprečno 30) Gy. Petinštestdeset preiskovancev je prejelo kemoterapijo, od teh 42 z antraciklini. Dvajset preiskovancev je imelo tudi laparotomijo s splenektomijo z namenom določanja stadija. V naši kohorti je bila arterijska togost pomembno zvišana v primerjavi s kontrolno skupino (p < 0.05). Te razlike ni bilo pri od endotelija odvisni vazodilataciji (p = 0.111). RT vratu je zvišala togost (b = 0.037, p = 0.000), zdravljenje s kemoterapijo, ki je vsebovala antracikline, pa jo je znižalo (b = ?0.803, p = 0.000). Multivariatna analiza je pokazala pomembno pozitivno korelacijo med predpisano dozo RT in togostjo (p < 0.001). Pomembne povezave med RT vratu in od endotelija odvisno vazodilatacijo nismo našli (p = 0.277). Zaključek: Karotidna togost je pri preživelih HL v otroštvu povišana. Žilne spremembe po RT vratu se zdijo dolgotrajne. Zaradi tega bi lahko ti bolniki imeli povišano tveganje za možgansko kap. Predlagamo posodobitev smernic za sledenje teh bolnikov.

• Jezik: Slovenski jezik
• Ključne besede: Hodgkinov limfom, radioterapija vratu, pozne posledice, arterijska togost, zdravljenje z antraciklini
• Vrsta gradiva: Doktorsko delo/naloga
• Organizacija: MF - Medicinska fakulteta
• Leto izida: 2025
• PID: 20.500.12556/RUL-175974
• Datum objave v RUL: 16.11.2025

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Effects of radiation therapy to the neck in childhood on the carotid arteries

Izvleček

Introduction: With new treatment options, the survival of children with cancer has improved over the past decades, and with this, the risk of developing late sequelae of treatment in this population has increased. We know that radiotherapy (RT) to the neck increases the risk of carotid disease and stroke among adult patients with cancer. Still, studies in this field with childhood cancer survivors are rare and inconclusive. Aim: The aim was to study the local effects of RT to the neck on carotid arteries in childhood Hodgkin lymphoma (HL) survivors and the systemic effects of the same treatment. With this, we tried to set up guidelines for the follow-up of these patients regarding carotid disease. Methods: Our study involved 79 childhood survivors of HL who received neck RT and 57 healthy controls. Parameters of arterial stiffness (AS) and intima-media thickness on the carotid arteries (IMT) and flow-mediated dilation (FMD) on the brachial artery were assessed using ultrasound. Results: Seventy-nine patients were investigated. They were 3 to 16 (average 11.2) years old at diagnosis of HL and were evaluated 14 to 47 (average 30.8) years later at the age of 22 to 64 (average 41.8). Prescribed RT dose to the neck ranged from 10 to 60 Gy (mean 30 Gy). Sixty-five patients received chemotherapy, 42 received anthracycline-containing chemotherapy (ACC). Twenty patients underwent staging laparotomy with splenectomy. Our group of patients showed a notable higher AS compared to the control group (p < 0.05), with no significant difference observed for FMD (p = 0.111). Neck RT heightened AS (b = 0.037, p = 0.000), while anthracyclines mitigated it (b = ⠒0.803, p = 0.000). A multivariate analysis uncovered a positive correlation between neck RT and AS (p < 0.001). However, no significant association was found between neck RT and FMD (p = 0.277). Conclusions: Carotid stiffness is enhanced in childhood HL survivors. Vascular changes after neck RT seem to be long-term. Therefore, these patients might have an increased risk of stroke. We suggest the refinement of international guidelines for follow-up according to our results.

• Ključne besede: Hodgkin lymphoma, neck radiotherapy, long-term effects, arterial stiffness, anthracycline-based chemotherapy