MODEST DECLINE IN LATE MORTALITY FOLLOWING HODGKINS-DISEASE IN THE SOUTHEASTERN NETHERLANDS SINCE 1972

Since prolonged remission can be induced in the majority of patients w ith Hodgkin's disease (HD), treatment-related mortality and morbidity have emerged, We investigated whether awareness of toxicity diminished treatment-related mortality for unselected patients treated between 1 972 and 1993 in general hospitals in the southeastern Netherlands. We also estimated the prevalence of treatment-related morbidity among pat ients treated in the 1980s. Data were collected on all 345 HD patients registered in the Eindhoven Cancer Registry between 1972 and 1993, Me dical records and histology were reviewed; follow-up ended in 1994, Ad ministration of MOPP chemotherapy decreased, and there was a shift fro m total nodal irradiation to less extended low-dose radiotherapy. For cured patients the 10-year relative survival improved from 84% in the 1970s to 90% in the 1980s, which is reflected by a decline in excess m ortality from 16% to 10%. The 10-year relative mortality risk due to s econdary malignancies decreased from 4.3 (95% CI, 1.2-7.4) to 3.0 (CI 0.2-5.8), which is also reflected by a decline in the 10-year cumulati ve incidence for all cancers from 10% to 5%, However, the relative ris k of late cardiovascular death, which is closely related to previous i rradiation, barely changed, as shown by a decrease from 2.4 (CI0.4-4.5 ) to 2.2 (CI.0-4.7). HD survivors profited less from the sharp decline in cardiovascular mortality observed for the general population. Amon g patients, the prevalence of serious treatment-related morbidity 5 ye ars or more after initial diagnosis was 34%, In conclusion, modest dec line in excess mortality among cured HD patients was observed in the 1 980s, as reflected by a decrease in mortality due to second malignanci es. However, late mortality, especially due to radiation-related cardi ovascular disease, is still substantial. About one third of HD survivo rs suffer radiation-induced sequelae, Clinical trials to find ways to minimize iatrogenic complications are important.