The Late Appearance of Chronic Pericardial Disease in Patients Treated by Radiotherapy for Hodgkin's Disease

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Abstract
Radiation-induced chronic pericardial disease was recognized in 9 patients 53 to 124 mo. (mean, 88 mo.) after radiotherapy for Hodgkin''s disease. Depending on whether abnormal cardiac hemodynamics occurred before or after a fluid challenge, patients were considered to have either constrictive pericarditis (Group I) or occult constrictive pericarditis (Group II). There were no differences between these groups in various radiotherapy data, the use of chemotherapy or the interval after treatment when the diagnosis of chronic pericardial disease was made. There were no consistent noninvasive variables to support the diagnosis of radiation-induced chronic pericardial disease before cardiac catheterization. Four patients underwent pericardiectomy. Two of the 4 operated patients had an excellent surgical result; a 3rd patient died 4 mo. postoperatively of drug-induced granulocytopenia; the 4th patient has persistent visceral constrictive pericarditis 18 mo. after surgery. Speculation over the causes of radiation-induced chronic pericardial disease is made and recommendations for its treatment given.