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Acute and Long-Term Complications of Radiotherapy for Hodgkin Lymphoma

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Book cover Radiotherapy for Hodgkin Lymphoma

Abstract

Radiation therapy for Hodgkin lymphoma (HL) has undergone major transformations over the last few decades and remains an important modality in the treatment of the disease. Some of the complications of radiation treatment described in the literature may not be entirely applicable to patients treated in the modern era. However, even as HL therapy evolves, it is imperative to continue the long-term follow-up of survivors with careful documentation of the types of late effects that may be associated with new treatments (both radiation therapy and chemotherapy). The contribution of other modifying factors, including genetic factors, environmental factors, and lifestyle choices may also have important implications for patient counseling and follow-up recommendations. An improved recognition and understanding of therapy-related complications can inform modifications in regimens to minimize exposures to cytotoxic agents. However, reduction of current treatments that have established efficacy should not be undertaken outside the context of clinical trials. Optimal treatments for HL will require careful balancing to continue to maximize efficacy while minimizing toxicity.

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References

  • Adams MJ, Lipsitz SR, Colan SD et al (2004) Cardiovascular status in long-term survivors of Hodgkin’s disease treated with chest radiotherapy. J Clin Oncol 22:3139–3148

    Article  PubMed  Google Scholar 

  • Advani R, Hoppe R, Rosenberg SA et al (2006) Incidence of secondary leukemia/myelodysplasia (AML/MDS) in Hodgkin’s disease (HD) with three generations of therapy at Stanford University. J Clin Oncol 24:426

    Google Scholar 

  • Aleman BM, van den Belt-Dusebout AW, Klokman WJ et al (2003) Long-term cause-specific mortality of patients treated for Hodgkin’s disease. J Clin Oncol 21:3431–3439

    Article  PubMed  Google Scholar 

  • Aleman BM, van den Belt-Dusebout AW, De Bruin ML et al (2007) Late cardiotoxicity after treatment for Hodgkin lymphoma. Blood 109:1878–1886

    Article  PubMed  CAS  Google Scholar 

  • Anselmo AP, Cartoni C, Bellantuono P et al (1990) Risk of infertility in patients with Hodgkin’s disease treated with ABVD vs MOPP vs ABVD/MOPP. Haematologica 75:155–158

    PubMed  CAS  Google Scholar 

  • Arseneau JC, Sponzo RW, Levin DL et al (1972) Nonlymphomatous malignant tumors complicating Hodgkin’s disease. Possible association with intensive therapy. N Engl J Med 287:1119–1122

    Article  PubMed  CAS  Google Scholar 

  • Aviles A, Neri N, Nambo JM et al (2005) Late cardiac toxicity secondary to treatment in Hodgkin’s disease. A study comparing doxorubicin, epirubicin and mitoxantrone in combined therapy. Leuk Lymphoma 46:1023–1028

    Article  PubMed  CAS  Google Scholar 

  • Behringer K, Josting A, Schiller P et al (2004) Solid tumors in patients treated for Hodgkin’s disease: a report from the German Hodgkin Lymphoma Study Group. Ann Oncol 15:1079–1085

    Article  PubMed  CAS  Google Scholar 

  • Behringer K, Breuer K, Reineke T et al (2005) Secondary amenorrhea after Hodgkin’s lymphoma is influenced by age at treatment, stage of disease, chemotherapy regimen, and the use of oral contraceptives during therapy: a report from the German Hodgkin’s Lymphoma Study Group. J Clin Oncol 23:7555–7564

    Article  PubMed  Google Scholar 

  • Bhatia S, Ramsay NK, Bantle JP et al (1996) Thyroid abnormalities after therapy for Hodgkin’s disease in childhood. Oncologist 1:62–67

    PubMed  Google Scholar 

  • Boivin JF, Hutchison GB, Lubin JH et al (1992) Coronary artery disease mortality in patients treated for Hodgkin’s disease. Cancer 69:1241–1247

    Article  PubMed  CAS  Google Scholar 

  • Bonadonna G, Bonfante V, Viviani S et al (2004) ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin’s disease: long-term results. J Clin Oncol 22:2835–2841

    Article  PubMed  Google Scholar 

  • Bowers DC, McNeil DE, Liu Y et al (2005) Stroke as a late treatment effect of Hodgkin’s Disease: a report from the Childhood Cancer Survivor Study. J Clin Oncol 23:6508–6515

    Article  PubMed  Google Scholar 

  • Bucher JA, Fleming TJ, Fuller LM et al (1988) Preliminary observations on the effect of mantle field radiotherapy on salivary flow rates in patients with Hodgkin’s disease. J Dent Res 67:518–521

    Article  PubMed  CAS  Google Scholar 

  • Carmel RJ, Kaplan HS (1976) Mantle irradiation in Hodgkin’s disease. An analysis of technique, tumor eradication, and complications. Cancer 37:2813–2825

    Article  PubMed  CAS  Google Scholar 

  • Children’s Oncology Group (2008) Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers Version 3.0. www.survivorshipguidelines.org

  • Clifton DK, Bremner WJ (1983) The effect of testicular x-irradiation on spermatogenesis in man. A comparison with the mouse. J Androl 4:387–392

    PubMed  CAS  Google Scholar 

  • Constine LS, Donaldson SS, McDougall IR et al (1984) Thyroid dysfunction after radiotherapy in children with Hodgkin’s disease. Cancer 53:878–883

    Article  PubMed  CAS  Google Scholar 

  • Cosset JM, Henry-Amar M, Pellae-Cosset B et al (1991) Pericarditis and myocardial infarctions after Hodgkin’s disease therapy. Int J Radiat Oncol Biol Phys 21:447–449

    Article  PubMed  CAS  Google Scholar 

  • Das P, Ng AK, Earle CC et al (2006) Computed tomography screening for lung cancer in Hodgkin’s lymphoma survivors: decision analysis and cost-effectiveness analysis. Ann Oncol 17:785–793

    Article  PubMed  CAS  Google Scholar 

  • De Bruin ML, Huisbrink J, Hauptmann M et al (2008) Treatment-related risk factors for premature menopause following Hodgkin lymphoma. Blood 111:101–108

    Article  PubMed  Google Scholar 

  • Diehl V, Franklin J, Pfreundschuh M et al (2003) Standard and increased-dose BEACOPP chemotherapy compared with COPP-ABVD for advanced Hodgkin’s disease. N Engl J Med 348:2386–2395

    Article  PubMed  CAS  Google Scholar 

  • Dores GM, Metayer C, Curtis RE et al (2002) Second malignant neoplasms among long-term survivors of Hodgkin’s disease: A population-based evaluation over 25 years. J Clin Oncol 20:3484–3494

    Article  PubMed  Google Scholar 

  • Engert A, Schiller P, Josting A et al (2003) Involved-field radiotherapy is equally effective and less toxic compared with extended-field radiotherapy after four cycles of chemotherapy in patients with early-stage unfavorable Hodgkin’s lymphoma: results of the HD8 trial of the German Hodgkin’s Lymphoma Study Group. J Clin Oncol 21:3601–3608

    Article  PubMed  Google Scholar 

  • Engert A, Diehl V, Franklin J et al (2009) Escalated-dose BEACOPP in the treatment of patients with advanced-stage Hodgkin’s lymphoma: 10 years of follow-up of the GHSG HD9 study. J Clin Oncol 27:4548–4554

    Article  PubMed  Google Scholar 

  • Eriksson F, Gagliardi G, Liedberg A et al (2000) Long-term cardiac mortality following radiation therapy for Hodgkin’s disease: analysis with the relative seriality model. Radiother Oncol 55:153–162

    Article  PubMed  CAS  Google Scholar 

  • Esik O, Csere T, Stefanits K et al (2003a) A review on radiogenic Lhermitte’s sign. Pathol Oncol Res 9:115–120

    Article  PubMed  Google Scholar 

  • Esik O, Csere T, Stefanits K et al (2003b) Increased metabolic activity in the spinal cord of patients with long-standing Lhermitte’s sign. Strahlenther Onkol 179:690–693

    Article  PubMed  Google Scholar 

  • Ferme C, Eghbali H, Meerwaldt JH et al (2007) Chemotherapy plus involved-field radiation in early-stage Hodgkin’s disease. N Engl J Med 357:1916–1927

    Article  PubMed  CAS  Google Scholar 

  • Franklin J, Pluetschow A, Paus M et al (2006) Second malignancy risk associated with treatment of Hodgkin’s lymphoma: meta-analysis of the randomised trials. Ann Oncol 17:1749–1760

    Article  PubMed  CAS  Google Scholar 

  • Friedman DL, Constine LS (2006) Late effects of treatment for Hodgkin lymphoma. J Natl Compr Canc Netw 4:249–257

    PubMed  Google Scholar 

  • Ghalibafian M, Beaudre A, Girinsky T (2008) Heart and coronary artery protection in patients with mediastinal Hodgkin lymphoma treated with intensity-modulated radiotherapy: dose constraints to virtual volumes or to organs at risk? Radiother Oncol 87:82–88

    Article  PubMed  Google Scholar 

  • Girinsky T, Ghalibafian M (2005) Radiation treatment in non Hodgkin’s lymphomas: present and future directions. Cancer Radiother 9:422–426

    Article  PubMed  CAS  Google Scholar 

  • Girinsky T, Pichenot C, Beaudre A et al (2006a) Is intensity-modulated radiotherapy better than conventional radiation treatment and three-dimensional conformal radiotherapy for mediastinal masses in patients with Hodgkin’s disease, and is there a role for beam orientation optimization and dose constraints assigned to virtual volumes? Int J Radiat Oncol Biol Phys 64:218–226

    Article  PubMed  Google Scholar 

  • Girinsky T, van der Maazen R, Specht L et al (2006b) Involved-node radiotherapy (INRT) in patients with early Hodgkin lymphoma: concepts and guidelines. Radiother Oncol 79:270–277

    Article  PubMed  Google Scholar 

  • Glanzmann C, Kaufmann P, Jenni R et al (1998) Cardiac risk after mediastinal irradiation for Hodgkin’s disease. Radiother Oncol 46:51–62

    Article  PubMed  CAS  Google Scholar 

  • Hancock SL, Cox RS, McDougall IR (1991) Thyroid diseases after treatment of Hodgkin’s disease. N Engl J Med 325:599–605

    Article  PubMed  CAS  Google Scholar 

  • Hancock SL, Donaldson SS, Hoppe RT (1993a) Cardiac disease following treatment of Hodgkin’s disease in children and adolescents. J Clin Oncol 11:1208–1215

    PubMed  CAS  Google Scholar 

  • Hancock SL, Tucker MA, Hoppe RT (1993b) Factors affecting late mortality from heart disease after treatment of Hodgkin’s disease. JAMA 270:1949–1955

    Article  PubMed  CAS  Google Scholar 

  • Heidenreich PA, Hancock SL, Lee BK et al (2003) Asymptomatic cardiac disease following mediastinal irradiation. J Am Coll Cardiol 42:743–749

    Article  PubMed  Google Scholar 

  • Heidenreich PA, Hancock SL, Vagelos RH et al (2005) Diastolic dysfunction after mediastinal irradiation. Am Heart J 150:977–982

    Article  PubMed  Google Scholar 

  • Heidenreich PA, Schnittger I, Strauss HW et al (2007) Screening for coronary artery disease after mediastinal irradiation for Hodgkin’s disease. J Clin Oncol 25:43–49

    Article  PubMed  Google Scholar 

  • Henry-Amar M, Hayat M, Meerwaldt JH et al (1990) Causes of death after therapy for early stage Hodgkin’s disease entered on EORTC protocols. EORTC Lymphoma Cooperative Group. Int J Radiat Oncol Biol Phys 19:1155–1157

    Article  PubMed  CAS  Google Scholar 

  • Hill DA, Gilbert E, Dores GM et al (2005) Breast cancer risk following radiotherapy for Hodgkin lymphoma: modification by other risk factors. Blood 106:3358–3365

    Article  PubMed  CAS  Google Scholar 

  • Hirsch A, Vander EN, Straus DJ et al (1996) Effect of ABVD chemotherapy with and without mantle or mediastinal irradiation on pulmonary function and symptoms in early-stage Hodgkin’s disease. J Clin Oncol 14:1297–1305

    PubMed  CAS  Google Scholar 

  • Hodgson DC, Gilbert ES, Dores GM et al (2007a) Long-term solid cancer risk among 5-year survivors of Hodgkin’s lymphoma. J Clin Oncol 25:1489–1497

    Article  PubMed  Google Scholar 

  • Hodgson DC, Pintilie M, Gitterman L et al (2007b) Fertility among female hodgkin lymphoma survivors attempting pregnancy following ABVD chemotherapy. Hematol Oncol 25:11–15

    Article  PubMed  Google Scholar 

  • Hoppe RT (1997) Hodgkin’s disease: complications of therapy and excess mortality. Ann Oncol 8(Suppl 1):115–118

    Article  PubMed  Google Scholar 

  • Horning SJ, Adhikari A, Rizk N et al (1994) Effect of treatment for Hodgkin’s disease on pulmonary function: results of a prospective study. J Clin Oncol 12:297–305

    PubMed  CAS  Google Scholar 

  • Hull MC, Morris CG, Pepine CJ et al (2003) Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of hodgkin lymphoma treated with radiation therapy. JAMA 290:2831–2837

    Article  PubMed  CAS  Google Scholar 

  • Kaldor JM, Day NE, Clarke EA et al (1990) Leukemia following Hodgkin’s disease. N Engl J Med 322:7–13

    Article  PubMed  CAS  Google Scholar 

  • Keene HJ, Fleming TJ, Toth BB (1994) Cariogenic microflora in patients with Hodgkin’s disease before and after mantle field radiotherapy. Oral Surg Oral Med Oral Pathol 78:577–582

    Article  PubMed  CAS  Google Scholar 

  • Koh ES, Sun A, Tran TH et al (2006) Clinical dose-volume histogram analysis in predicting radiation pneumonitis in Hodgkin’s lymphoma. Int J Radiat Oncol Biol Phys 66:223–228

    Article  PubMed  Google Scholar 

  • Koh ES, Tran TH, Heydarian M et al (2007) A comparison of mantle versus involved-field radiotherapy for Hodgkin’s lymphoma: reduction in normal tissue dose and second cancer risk. Radiat Oncol 2:13

    Article  PubMed  Google Scholar 

  • Lewanski CR, Sinclair JA, Stewart JS (2000) Lhermitte’s sign following head and neck radiotherapy. Clin Oncol (R Coll Radiol) 12:98–103

    CAS  Google Scholar 

  • Lushbaugh CC, Casarett GW (1976) The effects of gonadal irradiation in clinical radiation therapy: a review. Cancer 37:1111–1125

    Article  PubMed  CAS  Google Scholar 

  • Mauch P, Ng A, Aleman B et al (2005) Report from the Rockefellar Foundation Sponsored International Workshop on reducing mortality and improving quality of life in long-term survivors of Hodgkin’s disease: July 9–16, 2003, Bellagio, Italy. Eur J Haematol Suppl 75:68–76

    Article  Google Scholar 

  • Meistrich ML (1993) Effects of chemotherapy and radiotherapy on spermatogenesis. Eur Urol 23:136–141

    PubMed  CAS  Google Scholar 

  • National Comprehensive Cancer Network (2009) Clinical Practice Guidelines in Oncology. www.nccn.org

  • Ng AK, Bernardo MP, Weller E et al (2002a) Long-term survival and competing causes of death in patients with early-stage Hodgkin’s disease treated at age 50 or younger. J Clin Oncol 20:2101–2108

    Article  PubMed  Google Scholar 

  • Ng AK, Bernardo MVP, Weller E et al (2002b) Second malignancy after Hodgkin disease treated with radiation therapy with or without chemotherapy: long-term risks and risk factors. Blood 100:1989–1996

    Article  PubMed  CAS  Google Scholar 

  • Ogilvy-Stuart AL, Shalet SM (1993) Effect of radiation on the human reproductive system. Environ Health Perspect 101(Suppl 2):109–116

    Article  PubMed  Google Scholar 

  • Rueffer U, Josting A, Franklin J et al (2001) Non-Hodgkin’s lymphoma after primary Hodgkin’s disease in the German Hodgkin’s Lymphoma Study Group: incidence, treatment, and prognosis. J Clin Oncol 19:2026–2032

    PubMed  CAS  Google Scholar 

  • Saslow D, Boetes C, Burke W et al (2007) American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 57:75–89

    Article  PubMed  Google Scholar 

  • Schonfeld SJ, Gilbert ES, Dores GM et al (2006) Acute myeloid leukemia following Hodgkin lymphoma: a population-based study of 35, 511 patients. J Natl Cancer Inst 98:215–218

    Article  PubMed  Google Scholar 

  • Sieniawski M, Reineke T, Nogova L et al (2008) Fertility in male patients with advanced Hodgkin lymphoma treated with BEACOPP: a report of the German Hodgkin Study Group (GHSG). Blood 111:71–76

    Article  PubMed  CAS  Google Scholar 

  • Sklar C, Whitton J, Mertens A et al (2000) Abnormalities of the thyroid in survivors of Hodgkin’s disease: data from the Childhood Cancer Survivor Study. J Clin Endocrinol Metab 85:3227–3232

    Article  PubMed  CAS  Google Scholar 

  • Sklar CA, Mertens AC, Mitby P et al (2006) Premature menopause in survivors of childhood cancer: a report from the childhood cancer survivor study. J Natl Cancer Inst 98:890–896

    Article  PubMed  Google Scholar 

  • Swerdlow AJ, Barber JA, Hudson GV et al (2000) Risk of second malignancy after Hodgkin’s disease in a collaborative British cohort: the relation to age at treatment. J Clin Oncol 18:498–509

    PubMed  CAS  Google Scholar 

  • Swerdlow AJ, Schoemaker MJ, Allerton R et al (2001) Lung cancer after Hodgkin’s disease: a nested case-control study of the relation to treatment. J Clin Oncol 19:1610–1618

    PubMed  CAS  Google Scholar 

  • Swerdlow AJ, Higgins CD, Smith P et al (2007) Myocardial infarction mortality risk after treatment for Hodgkin disease: a collaborative British cohort study. J Natl Cancer Inst 99:206–214

    Article  PubMed  Google Scholar 

  • Tarbell NJ, Thompson L, Mauch P (1990) Thoracic irradiation in Hodgkin’s disease: disease control and long-term complications. Int J Radiat Oncol Biol Phys 18:275–281

    Article  PubMed  CAS  Google Scholar 

  • Travis LB (2002) Therapy-associated solid tumors. Acta Oncol 41:323–333

    Article  PubMed  Google Scholar 

  • Travis LB, Gospodarowicz M, Curtis RE et al (2002) Lung cancer following chemotherapy and radiotherapy for Hodgkin’s disease. J Natl Cancer Inst 94:182–192

    Article  PubMed  Google Scholar 

  • Travis LB, Hill DA, Dores GM et al (2003) Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease. JAMA – J Am Med Assoc 290:465–475

    Article  Google Scholar 

  • Tura S, Fiacchini M, Zinzani PL et al (1993) Splenectomy and the increasing risk of secondary acute leukemia in Hodgkin’s disease. J Clin Oncol 11:925–930

    PubMed  CAS  Google Scholar 

  • van der Kaaij MA, Heutte N, Le SN et al (2007) Gonadal function in males after chemotherapy for early-stage Hodgkin’s lymphoma treated in four subsequent trials by the European Organisation for Research and Treatment of Cancer: EORTC Lymphoma Group and the Groupe d’Etude des Lymphomes de l’Adulte. J Clin Oncol 25:2825–2832

    Article  PubMed  Google Scholar 

  • van Leeuwen FE, Somers R, Hart AA (1987) Splenectomy in Hodgkin’s disease and second leukaemias. Lancet 2:210–211

    Article  PubMed  Google Scholar 

  • van Leeuwen FE, Chorus AM, Belt-Dusebout AW et al (1994) Leukemia risk following Hodgkin’s disease: relation to cumulative dose of alkylating agents, treatment with teniposide combinations, number of episodes of chemotherapy, and bone marrow damage. J Clin Oncol 12:1063–1073

    PubMed  Google Scholar 

  • van Leeuwen FE, Klokman WJ, Veer MB et al (2000) Long-term risk of second malignancy in survivors of Hodgkin’s disease treated during adolescence or young adulthood. J Clin Oncol 18:487–497

    PubMed  Google Scholar 

  • van Leeuwen FE, Klokman WJ, Stovall M et al (2003) Roles of radiation dose, chemotherapy, and hormonal factors in breast cancer following Hodgkin’s disease. J Natl Cancer Inst 95:971–980

    Article  PubMed  Google Scholar 

  • van Rijswijk RE, Verbeek J, Haanen C et al (1987) Major complications and causes of death in patients treated for Hodgkin’s disease. J Clin Oncol 5:1624–1633

    PubMed  Google Scholar 

  • Viviani S, Santoro A, Ragni G et al (1985) Gonadal toxicity after combination chemotherapy for Hodgkin’s disease. Comparative results of MOPP vs ABVD. Eur J Cancer Clin Oncol 21:601–605

    Article  PubMed  CAS  Google Scholar 

  • Wallace WH, Shalet SM, Hendry JH et al (1989) Ovarian failure following abdominal irradiation in childhood: the radiosensitivity of the human oocyte. Br J Radiol 62:995–998

    Article  PubMed  CAS  Google Scholar 

  • Wallace WH, Thomson AB, Saran F et al (2005) Predicting age of ovarian failure after radiation to a field that includes the ovaries. Int J Radiat Oncol Biol Phys 62:738–744

    Article  PubMed  Google Scholar 

  • Williams RS, Mendenhall N (1992) Laparoscopic oophoropexy for preservation of ovarian function before pelvic node irradiation. Obstet Gynecol 80:541–543

    PubMed  CAS  Google Scholar 

  • Williams RS, Littell RD, Mendenhall’ NP (1999) Laparoscopic oophoropexy and ovarian function in the treatment of Hodgkin disease. Cancer 86:2138–2142

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, Brigham & Women’s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis St, ASB1-L2, Boston, MA, 02115, USA

    Andrea K. Ng

  2. Philip Rubin Center of Excellence in Cancer Prevention and Survivorship, Wilmot Cancer Center, University of Rochester Medical Center, 601 Elmwood Avenue, 647, Rochester, NY, 14642, USA

    Lois B. Travis

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  1. Andrea K. Ng
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Correspondence to Andrea K. Ng .

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Editors and Affiliations

  1. Rigshospitalet, Dept. Oncology 3994, Koebenhavns Universitet, Blegdamsvej 9, Koebenhavn, 2100, Denmark

    Lena Specht

  2. Dept. Radiation Oncology, Memorial Sloan-Kettering Cancer Center, York Ave. 1275, New York, 10021, New York, USA

    Joachim Yahalom

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Ng, A.K., Travis, L.B. (2011). Acute and Long-Term Complications of Radiotherapy for Hodgkin Lymphoma. In: Specht, L., Yahalom, J. (eds) Radiotherapy for Hodgkin Lymphoma. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-78944-4_14

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