LATE CARDIAC EFFECTS AFTER TREATMENT FOR CHILDHOOD HODGKINS-DISEASE WITH CHEMOTHERAPY AND LOW-DOSE RADIOTHERAPY

Twenty-four patients under 18 years when treated for Hodgkin's disease (20 male, four female) were examined no less than five years after th e completion of the treatment. The mean age was 17 years (range 9.5-25 .0 years) at the time of study. All patients received six courses of c yclophosphamide - oncovin - procarbazine prednisolone chemotherapy; in addition, nine patients received low-dose radiotherapy excluding the mediastinum and eight of 24 patients received mediastinal radiotherapy ; the dose was between 20-30 Gy. All patients had normal cardiovascula r findings on clinical examination. ECG and chest radiography were wit hin normal limits in all patients. Resting left ventricular ejection f raction and fractional shortening were decreased in only one patient ( 4%), but there was no significant difference between the patient group and a control group for left ventricular systolic function (p>0.05). In the patient group, early diastolic peak velocity, peak velocity at atrial contraction, left ventricular isovolumic relaxation time, and t he rate of decrease of flow velocity in early diastole were significan tly different from that of the control group (p<0.05). In conclusion, the late effects of our treatment proto col for Hodgkin's disease appe ar to be minimal. These observations support combined modality, low-do se irradiation regimens in children and adolescents and suggest the ne ed for careful cardiac screening of treated patients.