Late effects on pulmonary function of mantle‐field irradiation, chemotherapy or combined modality therapy for Hodgkin's disease

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Abstract
The aim of the present study was to assess late pulmonary sequelae after treatment for Hodgkin''s disease with various treatment modalities. Pulmonary function was studied in 142 patients per median 8 years after treatment for Hodgkin''s disease with mantle-field irradiation (54 patients), chemotherapy (26 patients) or mantle-field irradiation followed by chemotherapy (62 patients). Mantle-field irradiation was associated with a primary obstructive and minor restrictive lung function impairment, whereas chemotherapy and combined modality therapy were associated with a restrictive lung function impairment. The number of patients with impaired lung function and the number of patients with complaints of dyspnea, however, were almost the same in the three treatment groups. 5% of the 142 patients had a pathologically low total lung capacity, i.e. values less than 2 standard deviations below predicted values. Pathologically low values of forced vital capacity and forced expiratory volume in 1 second were seen in 33% and 27% of the patients. 33% of the smokers (n = 80) had a pathologically low diffusion capacity in contrast to 8% of the non-smokers (n = 62). Dyspnea on exertion was present in 24% of the 142 patients and was more frequent among patients with pulmonary functional abnormalities. In conclusion, late pulmonary sequelae after treatment for Hodgkin''s disease do not provide a basis for choice between otherwise equally effective treatment regimes.