In reply [4]

The patients with non-Hodgkin’s lymphoma were treated with doxorubicin and radiation therapy according to the international protocol, at doses carrying no associated cardiotoxicity. Doxorubicin and radiation therapy may have a synergistic toxic effect on the myocardium, however1. We also conducted an intragroup statistical assessment as regards intima-media thickness, and there was no evidence of a significant difference. Some authors, moreover, have recently examined carotid wall thickening in patients treated with radiotherapy for head or neck tumors, and they found significant wall thickening by comparison with the nonirradiated vessel2. These considerations lead us to conclude that radiation therapy is a risk factor in addition to the classic risk factors for atherosclerosis. Radiotherapy cannot be postponed, of course, but we might also consider ways to protect these patients using antioxidant therapy, for instance.