Late pulmonary effects in favorable stage I and IIA Hodgkin's disease treated with radiotherapy alone

Radiotherapy (RT) in patients with favorable-stage Hodgkin's disease can in duce clinical and subclinical evidence of pulmonary damage lasting over the years. In this study, we monitored 36 patients with stage TA-IIA Hodgkin's disease treated with subtotal nodal RT. The planned dose of RT was 40 Gy t o 44 Gy to the involved areas and 36 Gy to the adjacent uninvolved areas. P ulmonary function was evaluated by chest radiograph, spirometric parameters , arterial blood gas analysis, and single-breath CO transfer factor (DLCO). The tests were performed before and at the end of irradiation, and during the follow-up 1 and 3 to 5 years after the treatment. At the end of RT, we found a significant decrease of total lung capacity, vital capacity, forced expiratory volume in 1 second, residual volume, and DLCO, Spirometric para meters improved during the follow-up period, whereas the decline of DLCO (- 6.4%) was persistent. No correlation was found between mantle RT dose and D LCO changes. Four patients showed a decline of DLCO of >20% from pretreatme nt values but only one was symptomatic. Our study confirms that RT induces a pulmonary-restrictive disease at a subclinical level that seems to be rev ersible in the majority of patients.