LATE EFFECTS OF CHEMORADIOTHERAPY IN PEDIATRIC HODGKINS-DISEASE

We treated 137 Turkish children with biopsy-proven Hodgkin's disease, followed up between the years 1964 and 1989. Most patients were treate d and were in advanced stage with histological subtype of mixed cellul arity (67.5%). Radiotherapy (Mantle form) and/or MOPP, ABVD and OPPA c ombination chemotherapy regimens were used in 75.84% of patients. The followup period in these patients ranged from 5 to 24 years. The late effects in 28 patients who were evaluated for the late sequelae of che moradiotherapy are presented. Seven out of 28 patients showed retarded sexual maturation. Testicular and ovarian functions were assessed in 11 patients, all of whom showed elevated serum FSH levels and 2 azoosp ermia. Analysis of thyroid functions was carried out in patients recei ving radiotherapy to the neck. The thyroid gland was palpable in 6 pat ients. Further analysis showed diffuse hyperplasia in 5 and nodular in 1 patient. The nodule was excised and reported as ''nodular colloidal goiter''. Two patients had elevated TSH levels. ''Swan-like neck'' wa s observed in 3 patients who had received 40 to 42 Gy radiotherapy to the neck. Cirrhosis due to chronic hepatitis B infection was diagnosed in 2 patients as an unusual late complication. The secondary malignan cy occurred in only 1 case in the form of ''fibrosarcoma''. The second neoplasm was probably radiation-induced as it occurred in the field o f prior radiotherapy.