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Late Pulmonary Effects in Favorable Stage I and IIA Hodgkin's Disease Treated With Radiotherapy Alone.

Villani, Fabrizio M.D.; Viviani, Simonetta M.D.; Bonfante, Valeria M.D.; De Maria, Patrizia M.D.; Soncini, Fulvia M.D.; Laffranchi, A. M.D.

American Journal of Clinical Oncology: February 2000 - Volume 23 - Issue 1 - pp 18-21
Original Article

Radiotherapy (RT) in patients with favorable-stage Hodgkin's disease can induce clinical and subclinical evidence of pulmonary damage lasting over the years. In this study, we monitored 36 patients with stage IA-IIA Hodgkin's disease treated with subtotal nodal RT. The planned dose of RT was 40 Gy to 44 Gy to the involved areas and 36 Gy to the adjacent uninvolved areas. Pulmonary 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 parameters improved during the follow-up period, whereas the decline of DLCO (-6.4%) was persistent. No correlation was found between mantle RT dose and DLCO changes. Four patients showed a decline of DLCO of >20% from pretreatment values but only one was symptomatic. Our study confirms that RT induces a pulmonary-restrictive disease at a subclinical level that seems to be reversible in the majority of patients.

From the Division of Cardiology and Respiratory Physiopathology (F.V., P.D.M.), Division of Medical Oncology A (S.V., V.B.), Division of Radiotherapy B (F.S.), and Division of Radiology A (A.L.), Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.

Address correspondence and reprint requests to Dr. Fabrizio Villani, Division of Cardiology and Respiratory Physiopathology, Istituto Nazionale Tumori, Via Venezian, 1, 20133 Milan, Italy.

© 2000 Lippincott Williams & Wilkins, Inc.