LATE PULMONARY TOXICITY AFTER TREATMENT FOR HODGKINS-DISEASE

The combination of mediastinal radiotherapy (RT) with chemotherapy (CT ) including bleomycin is associated with an increased risk of pulmonar y toxicity. The aim of the present investigation was to evaluate late pulmonary effects of RT plus CT consisting of the ABVD regimen in pati ents suffering from early stage Hodgkin's disease. For this purpose pu lmonary function was serially evaluated before, at the end and at leas t 1 year after therapy in 32 patients (median age 28 years) with Hodgk in's disease stages IA,B - IIA. Treatment consisted of four cycles of ABVD chemotherapy followed by mediastinal irradiation at the median do se of 36 Gy (range 30.6 - 43.2). At the end of treatment, resting mean pulmonary function tests showed a significant decline of forced expir atory volume in 1 second (FEV1), forced expiratory flow at 25-75 %, (F EF25-75%), total lung capacity (TLC), vital capacity (VC) and carbon m onoxide diffusing capacity (DLCO). The decline of TLC, VC and DLCO, in dicative of a pulmonary defect of restrictive type, persisted 1 year f rom the end of therapy Only seven patients developed symptoms of cough and mild shortness of breath with effort These data confirm that RT c ombined with shell term ABVD result in pulmonary dysfunction that does not seem to have clinical significance.