Pulmonary outcomes in patients with Hodgkin lymphoma treated with involved field radiation.
BACKGROUND
Abnormalities in pulmonary function tests (PFT) and clinical symptoms have been reported in up to one third of patients with Hodgkin lymphoma (HL) treated with irradiation. The purpose of this study is to describe the prevalence of pulmonary complications in HL patients treated using contemporary protocols.


METHODS
Eligible patients at Children's Hospital Los Angeles from 1999 to 2009 were identified from the radiation oncology database. Clinical features, radiographic findings, PFT, and radiation details were retrospectively ascertained.


RESULTS
The median age at diagnosis of 65 patients with HL was 13.6 years and the median follow-up was 3.7 years. The median prescribed radiation dose was 21 Gy. The prevalence of clinical symptoms was low: chronic cough (3%), dyspnea (9.2%), and supplemental oxygen requirement (1.5%). Radiological interstitial lung changes were observed in 31% of the patients. PFT results following irradiation were available in 38 patients. Forced expiratory volume in 1 second (FEV1) and forced expiratory flow 25-75% (FEF25-75%) were decreased in 13% and 11% of patients respectively. Residual volume (RV) was elevated in 21%. Total Lung capacity (TLC) was decreased in 8%. Age at irradiation (P = 0.004), maximum lung dose (P = 0.03), and volume of lung receiving >25 Gy were associated with development of adverse pulmonary outcomes on univariate analysis. On multivariate analysis, older age was associated with worse outcomes.


CONCLUSIONS
In survivors of pediatric HL, involved field irradiation was accompanied by a low prevalence of pulmonary symptoms but substantial subclinical dysfunction. Older age at irradiation was associated with worse pulmonary outcomes.
Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.
Rajkumar
R
Venkatramani
Sunil
S
Kamath
Kenneth
K
Wong
Arthur J
AJ
Olch
Jemily
J
Malvar
Richard
R
Sposto
Fariba
F
Goodarzian
David R
DR
Freyer
Thomas G
TG
Keens
Leo
L
Mascarenhas
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003371:Cough / Q000209:etiology / Q000503:physiopathology; D016208:Databases, Factual; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006689:Hodgkin Disease / Q000503:physiopathology / Q000532:radiotherapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008168:Lung / Q000503:physiopathology*; D008171:Lung Diseases / Q000209:etiology / Q000503:physiopathology; D008297:Male; D015995:Prevalence; D011879:Radiotherapy Dosage; D012189:Retrospective Studies
Hodgkin lymphoma; childhood; pulmonary fibrosis; pulmonary function; radiation