title: [Complications in children cured from Hodgkin's disease].
abstract: THE AIM of the study was to evaluate the incidence of pulmonary complications in children cured from Hodgkin's disease (HD).
  
  
  METHODS
  42 children with HD were treated in the Department of Paediatrics, Haematology, Oncology and Endocrinology, Medical University of Gdansk, between 1994 and 2004. Stages of HD: II--26 children, III--10, IV--6; general symptoms (group B) were present in 50% of patients. Mediastinal involvement was found in 33 children, lung parenchyma infiltration in seven and bronchi involvement in one. In 1/3 of these patients the localization of HD within the chest was massive and symptomatic with signs of the superior caval vein symptoms, cough, dyspnea and cardiac tamponade. The treatment was conducted according to the schemes of the Polish Paediatric Leukaemia /Lymphoma Study Group. Eleven patients required therapy modification including six, in whom the intense line II chemotherapy Salvage 95 was introduced. 29 patients received chest irradiation with doses between J 75 and 36.5 Gy. Pulmonary function was evaluated from the results of clinical examination, 1 chest radiography (CXR), computed tomography, spirometry and lung scintigraphy.
  
  
  RESULTS
  Pulmonary complications occurring as fatigue and diminished physical effort tolerance was observed in only two children. Some of the remaining 40 patients demonstrated asymptomatic abnormalities in the analysed tests. Abnormalities in CXR (upper mediastinal fibrosis, postoperational changes within the diaphragm and pneumonitis) were found in six children, minor ventilation problems in spirometry--in 12 and decreased lung perfusion in five. The scintigraphic signs of lung embolisation were not observed in our material. Most of the pulmonary complications occurred in children with enlarged lymph notes located within the chest, especially these with bulky disease presenting with cardio-pulmonary symptoms. In this group of patients the chest irradiation was performed in all except four children, three patients were also administered aggressive salvage chemotherapy.
  
  
  CONCLUSIONS
  The pulmonary complications in children after completed therapy of HD are not common and mainly asymptomatic and occur predominantly in patients with massive mediastinal and/or lung involvement at diagnosis. The issue needs further evaluation of a more numerous group of HD survivors and a longer follow-up.
authors.affiliation: Klinika Pediatrii, Hematologii, Onkologii i Endokrynologii, Akademia Medyczna, ul. Debinki 7, 80-211 Gdańsk, Poland. tsten@amg.gda.pl
authors.forename: Teresa
authors.initials: T
authors.lastname: Stachowicz-Stencel
authors.forename: Ewa
authors.initials: E
authors.lastname: Bien
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Adamkiewicz-Drozynska
authors.forename: Anna
authors.initials: A
authors.lastname: Szolkiewicz
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kuziemski
authors.forename: Piotr
authors.initials: P
authors.lastname: Lass
authors.forename: Joanna
authors.initials: J
authors.lastname: Stefanowicz
authors.forename: Danuta
authors.initials: D
authors.lastname: Sierota
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Polczynska
authors.forename: Dorota
authors.initials: D
authors.lastname: Birkholz
authors.forename: Marcin
authors.initials: M
authors.lastname: Hennig
authors.forename: Anna
authors.initials: A
authors.lastname: Balcerska
mesh_terms: D000293:Adolescent; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000150:complications* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D011044:Poland / Q000453:epidemiology; D018714:Radiotherapy, Adjuvant; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome