EFFECT OF ABVD CHEMOTHERAPY WITH AND WITHOUT MANTLE OR MEDIASTINAL IRRADIATION ON PULMONARY-FUNCTION AND SYMPTOMS IN EARLY-STAGE HODGKINS-DISEASE

Purpose: To evaluate the effect of doxorubicin, bleomyncin, vinblastin e, and dacarbazine (ABVD) chemotherapy alone and of ABVD with mantle o r mediastinal irradiation (RT) on the pulmonary function of patients w ith early-stage Hodgkin's disease (HD). Patients and Methods: Between 1989 and 1993, 60 patients with clinical stage I to IIIA HD enrolled o nto randomized trials at Memorial Sloan-Kettering Cancer Center (MSKCC ) underwent prospective evaluation of pulmonary function. All patients received six cycles of ABVD, and 30 patients received mantle or media stinal RT. Pulmonary function tests (pFTs) and symptom evaluation were conducted before, during, and after completion of chemotherapy and RT , and at various intervals thereafter. The median follow-up time was 3 0 months. Results: During chemotherapy, symptoms of cough and dyspnea on exertion developed in 32 of 60 patients (53%) and declines in pulmo nary function occurred in 22 of 60 patients (37%). Discontinuation of bleomycin was necessary in 14 of 60 patients (23%). Following chemothe rapy, there was a significant decline in median forced vital capacity (FVC) and diffusing capacity of carbon monoxide (DLCO). In patients wh o received mantle or mediastinal RT, there was a further decline in FV C following radiation therapy. At the most recent follow-up evaluation , five of 29 patients (18%) who received ABVD alone and nine of 30 (30 %) who received ABVD and RT reported persistent mild pulmonary symptom s (P = .36), which did not significantly affect normal daily activity. Conclusion: ABVD chemotherapy induced acute pulmonary toxicity that r equired bleomycin dose modification in a substantial number of patient s. The addition of RT resulted in a further decrease in FVC; however, this did nor significantly affect the functional status of patients. ( C) 1996 by American Society of Clinical Oncology.