Assessment of cardiac and pulmonary function in adult patients with Hodgkin's disease treated with ABVD or MOPP/ABVD plus adjuvant low-dose mediastinal irradiation

We evaluated the long-term effects of combined modality therapy (CMT) with adriamycin, bleomycin, vinblastine, dacarbazine (ABVD) or mechlorethamine, vincristine, prednisone, procarbazine (MOPP)/ABVD plus adjuvant low-dose (< 30 Gy) involved-field radiation therapy (LDRT) on cardiac and pulmonary fun ctions in adult patients with Hodgkin's disease (HD). Adjuvant LDRT (mean d ose, 2340 cGy) to the mediastinum was administered to 24 patients after che motherapy with MOPP/ABVD (n = 10) and ABVD (n = 14). The mean doses of doxo rubicin and bleomycin were 233 mg/m(2) and 92 IU/m(2), respectively. Cardia c and pulmonary function tests were performed in all patients and, when ava ilable, were compared with pretreatment studies. After a median follow-up o f 6.3 years, none of the patients had cardiac or pulmonary symptoms. A 4.7% overall decrease in left ventricular ejection fraction (LVEF) was observed (p = 0.03), but only one patient had a mildly decreased LVEF (47%). Diasto lic function, LVEF, and left ventricular volume remained within the normal range in the other 23 patients. Mild pulmonary function study abnormalities occurred in 8 of 24 patients, 6 of whom were cigarette smokers. There were no significant changes in total lung capacity and forced vital-capacity (F VC) values, but there was a 3% overall decrease in FEV1/FVC ratio (p = 0.05 ). In adult patients with HD, adjuvant LDRT after chemotherapy with ABVD or MOPP/ABVD did not result in a significant incidence of permanent pulmonary or cardiac toxicity after more than 6.3 years of median follow-lip. Furthe r studies are warranted to fully evaluate the impact of such therapy on car diopulmonary function.