Late treatment sequelae of Hodgkin disease in a cohort of long-term survivors treated at the Department of Pediatric Oncology, Motol, between 1980 and 1999
Abstract
Background: There has not been a statistically significant increase in either the overall survival or the event-free survival in our Hodgkin Disease patients during the past two decades. The aim of the present study was to evaluate a wide spectrum of functional impairments in patients in remission for more than five years.
Design and Subjects: We conducted a cross-sectional study to evaluate functional non-oncologic sequelae in patients treated between 1980 and 1999 using one of four different treatment protocols. Three hundred forty seven patients with Hodgkin Disease who were diagnosed prior to the age of 19 were treated at our hospital during the above time period.
In 2003, 270 out of these 347 patients were in remission for at least five years. The mean age at the time of enrollment in the study was 23.9 (SD +/4.9) years, and the mean time in remission was 10.6 (SD +/3.9) years.
Methods and Results: All patients received a thorough physical examination, and particular attention was focused on the effects of treatment on the musculoskeletal system. In addition, immunologic, endocrine, pulmonary function and exercise testing were performed as well.
We found that 32% of patients had sub-clinical hypothyroidism. Immunologic evaluation revealed increased IgE in 29.9 %, lower total T lymphocyte counts in 18.8%, lower proportion of T-helper cells in 13.6% and a decreased CD4/ CD8 ratio in 26.2% of the patients studied.
Total cholesterol, triglycerides, HDL and LDL were checked, and 47.4% had at least one elevated level. Mammogram and/or breast ultrasonography was performed in 68 women.
At least one pathological finding was found in 58.8% of women. We did not detect any cases of carcinoma of the breast.
Abnormal pulmonary function at least in one parameter was found in 49.7% out of 153 patients examined. Exercise stress testing did not reveal any signs of myocardial ischemia on ECG, maximal aerobic capacity was decreased more than two standard deviations of reference values in 18.9% out of 224 patients examined.
Echocardiographic examination revealed hemodynamically significant heart valvular pathology in 1% of the cohort. No impairment in LVEF and no cases of cardiomyopathy were found.
Questionnaires completed by study subjects revealed that: 1) 21.7% of respondents felt that the mental recovery period from treatment exceeded one year, 2) 7.8% felt that "they were never going to recover", 3) Physical fitness recovery was longer than one year in 46% of patients longer than five years in15.5% of the cohort. Conclusions: We found a wide variety of late sequelae and yet a small incidence of serious sequelae in patients with Hodgkin Disease treated during childhood or adolescence.
The potential for significant longevity in these patients emphasizes the importance of identifying and minimizing late sequelae of the treatment regimens.