Lung function impairment in long-term survivors of Hodgkin's disease

Background: Treatment of Hodgkin's disease (HD) involves radiationand chemotherapy, modalities known to cause lung injury. Patients and methods: In Norway, between 1980 and 1988, 129patients aged less than 50 years at the time of diagnosis, hadcurative treatment with thoracic radiation alone or combined-modalitytherapy for supradiaphragmatic HD. We have examined 116 (90%)of these patients by interview, chest X-ray and lung functiontests, 5–13 years after treatment. Results: Nearly 30% of the patients had dyspnoea on exertionand associated reductions in total lung capacity (TLC), forcedvital capacity (FVC), forced expiratory volume in 1 second (FEV1)and gas transfer (TLCO) (p<<0.05). Radiographic evidenceof no, slight or moderate fibrosis occurred in 32%, 54% and14% of the patients, respectively. Moderate fibrosis was associatedwith reductions in FVC, FEV1 and TLCO (p<<0.05). Radiationplus chemotherapy containing bleomycin-anthracyclines (mediancumulative bleomycin dose 120 mg) was associated with decreasesin FVC and TLCO (p<<0.05). In the multivariate analysis,chemotherapy with bleomycin-anthracyclines was the only significantpredictor for lung function impairment. Conclusion: More than five years after therapy, respiratorysymptoms and reduction in lung function were diagnosed in nearlyone-third of otherwise healthy HD survivors. Hodgkin's disease, radiotherapy, paclitaxel, combined modality, late adverse effects, lung function tests