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August 5, 1988

Late Complications of Curative Treatment in Hodgkin's Disease

JAMA. 1988;260(5):680-683. doi:10.1001/jama.1988.03410050100038

SELECTED CASE  CANCER therapy has transformed Hodgkin's disease (HD) from a uniformly fatal to a largely curable disorder. Although most long-term survivors enjoy a normal quality and length of life, complications related to curative treatment can be quite diverse (Figure), as illustrated in the following case report.A 29-year-old woman who presented with mediastinal stage II-B nodular sclerosing HD in 1978 received urgent chest irradiation due to symptoms of superior vena caval obstruction. Findings from subsequent staging laparotomy were normal, and she was treated with total nodal irradiation (49 Gy) using an expanded mediastinal port. She obtained a clinical complete remission complicated by chronic pulmonary fibrosis, soft-tissue fibrosis, and elevated levels of thyroid-stimulating hormone (TSH). In 1979 she developed pleuritic chest pain, a perihilar mass, and pleural effusion consistent with recurrent HD. Following six cycles of mechlorethamine hydrochloride (Mustargen), vincristine sulfate (Oncovin), procarbazine, and prednisone (MOPP), complicated by febrile neutropenia,