Predicted Risks of Cardiovascular Disease Following Chemotherapy and Radiotherapy in the UK NCRI RAPID Trial of Positron Emission Tomography–Directed Therapy for Early-Stage Hodgkin Lymphoma

FIG 1.. Distribution of mean doses in Gy to cardiovascular structures for PET-negative patients receiving radiotherapy and for whom dosimetry was completed (n = 144). (A) Whole heart, showing those with mediastinal involvement (dark blue) and those without (light blue). (B) Common carotid arteries. PET, positron emission tomography.

FIG 2.. Predicted cardiovascular mortality for PET-negative patients receiving radiotherapy for whom radiation dosimetry was completed (n = 144). (A) Predicted cumulative risks of mortality from heart disease or stroke for the general population, for patients receiving ABVD chemotherapy alone, and for patients receiving ABVD plus IFRT. Cumulative risks allow for the competing risk of noncardiovascular causes of death. (B) Predicted absolute excess risk of mortality from heart disease or stroke for patients receiving ABVD plus IFRT compared with patients receiving ABVD alone, by disease category. (C) Predicted absolute excess risk of mortality from heart disease for patients receiving ABVD plus IFRT compared with patients receiving ABVD alone, by categories of mean whole heart dose in Gy. To achieve comparability across categories, predictions for each category assume all 144 patients received the average radiation dose in that category. (D) Predicted absolute excess risk of mortality from stroke for patients receiving ABVD plus IFRT compared with patients receiving ABVD alone, by categories of mean bilateral common carotid artery dose in Gy. To achieve comparability across categories,…

FIG 3.. Predicted 30-year absolute excess risk of radiation-related heart disease or stroke for PET-negative patients who received radiotherapy and for whom dosimetry was completed (n = 144). Mortality is indicated by orange lines and incidence by black lines. (A) Individual absolute excess risks. Dotted line corresponds to the median excess risk (ie, average of patients ranked 72 and 73 of 144), which was 0.26% for mortality and 3.61% for incidence. (B) Population average absolute excess risks. Dotted line corresponds to population average for irradiated patients if 50% of PET-negative patients with the lowest predicted risks were irradiated. This group of irradiated patients has 0.11% average excess risk for mortality and 1.79% for incidence. PET, positron emission tomography.

FIG 4.. Predicted cardiovascular disease incidence for PET-negative patients receiving radiotherapy and for whom radiation dosimetry was completed (n = 144). (A) Predicted cumulative risks of incident heart disease or stroke for the general population, for patients receiving ABVD chemotherapy alone, and for patients receiving ABVD plus IFRT. Cumulative risks allow for the competing risk of noncardiovascular causes of death. (B) Predicted absolute excess risk of incident heart disease or stroke for patients receiving ABVD plus IFRT compared with patients receiving ABVD alone, by disease category. (C) Predicted absolute excess risk of incident heart disease for patients receiving ABVD plus IFRT compared with patients receiving ABVD alone, by categories of mean whole heart dose in Gy. To achieve comparability across categories, predictions for each category assume all 144 patients received the average radiation dose in that category. (D) Predicted absolute excess risk of incident stroke for patients receiving ABVD plus IFRT compared with patients receiving ABVD alone, by categories of mean bilateral common carotid artery dose in Gy. To achieve comparability across categories, predictions…