ISSN:
1569-8041
Keywords:
childhood
;
Hodgkin's disease
;
late effects
;
lung function
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Background: Pulmonary sequelae have been reported in patients treatedfor Hodgkin's disease (HD). Few data are available about patients treated forchildhood HD followed over several years. Patients and methods: In a cross-sectional study carried out for 76months (median time) after treatment completion, we evaluated the lungfunction abnormalities and respiratory symptoms in 27 patients (16 males and11 females) with HD diagnosed betweeen 1983 and 1994 (median age at diagnosis11 years, range 2–16 years). They had been treated with chemotherapy andradiotherapy according to current protocol AIEOP-MH 83 (n = 14) orAIEOP-MH 89 (n = 13). At the time of the study, 26 patients were infirst complete remission and one in second remission. Of the 27 patients, 19had had mediastinal irradiation at a dose of 20 Gy (n = 5) or20.8–44 Gy (n = 14). Forced vital capacity (FVC), functionalresidual capacity (FRC), forced expiratory volume in one second(FEV1), FEV1/FVC ratio, and maximal expiratoryflow at 25% of FVC were registered; diffusion capacity for carbonmonoxide (DLCO) was determined. Data were expressed asstandard deviation (SD) score. Four patterns of respiratory functionabnormalities were defined: restrictive, obstructive, isolated bronchiolarimpairment, isolated diffusing impairment. Results: Twelve patients (44%) were asymptomatic and showedcompletely normal pulmonary function tests. Three patients reported dyspneaon exertion, and one of them also cough and phlegm: out of these symptomaticsubjects, only 1 had functional abnormality (isolated DLCOimpairment). A restrictive pattern was found in 5 patients (18%),including 2 who also had a pathological DLCO SD score. Eightadditional patients (30%) had isolated diffusing impairment. Oxygensaturation was normal in all patients. Forty-seven percent of patients withnormal DLCO had had lower dose irradiation (20 Gy) comparedto 10% of patients with impaired DLCO (P =0.054). Similarly, patients with normal DLCO had hadsignificantly less chemotherapy as compared to patients with abnormalDLCO (P = 0.003). Occurrence of lung abnormalities wasnot significantly associated with sex, age at treatment, mediastinalirradiation, and time elapsed from treatment completion. Conclusion: Adolescents and young adults treated for childhood HD areat risk for lung function abnormalities, significantly more frequent inpatients who received more intense treatment, as mediastinal irradiation ata higher dose (〉20 Gy) and more chemotherapy blocks. Long-term follow-upshould be offered to these patients because of their possible limitedpotential for pulmonary function and possible lesser resistance toadverse agents such as smoke, pollution, infections, and aging.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1023/A:1008281213703
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