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Annals of Oncology Advance Access published online on May 7, 2008
Annals of Oncology, doi:10.1093/annonc/mdn284
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

A prospective study of pulmonary function in Hodgkin’s lymphoma patients

A. K. Ng1,*, S. Li2, D. Neuberg2, R. Chi1, D. C. Fisher3, B. Silver1 and P. M. Mauch1

1 Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
2 Department of Biostatistics and Computational Biology
3 Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

* Correspondence to: Dr A. K. Ng, Department of Radiation Oncology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02114, USA. Tel: +1-617-732-6310; Fax: +1-617-732-7347; E-mail: ang{at}lroc.harvard.edu

Background: To prospectively study changes in lung function in Hodgkin's lymphoma (HL) patients and to explore predictors for these changes over time.

Methods: In all, 52 patients with HL receiving bleomycin-based chemotherapy with (n = 23) or without (n = 29) mediastinal radiotherapy were enrolled. Pretreatment pulmonary function tests were carried out. These were repeated at 1 month, 6 months, and 1 year after therapy.

Results: With chemotherapy alone, the median %DLCO declined significantly at 1 month but returned to baseline by 6 months. The median %DLCO did not further decrease with radiotherapy, but remained persistently reduced at 1 year. In patients who received radiotherapy, having >33% of lung volume receive 20 Gy (V20) and a mean lung dose (MLD) of >13 Gy significantly predicted for persistently reduced %DLCO at 6 months (P = 0.035). Smoking significantly predicted for a persistently reduced %DLCO at 1 year (P = 0.036). On multivariable analysis, significant predictors for decline in %DLCO at 1 year were higher baseline %DLCO (P = 0.01), higher MLD (P = 0.02), and a smoking history (P = 0.02).

Conclusions: Several factors contribute to decline in %DLCO in HL patients who received bleomycin-based computed tomography. The identification of threshold radiation dosimetric parameters for reduced lung function may provide guidance in the radiation planning of these patients.

bleomycin, hodgkin lymphoma, lung toxicity, radiation parameters

Received for publication April 3, 2008. Accepted for publication April 8, 2008.


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