Nonmalignant complications of therapy for Hodgkin's disease

Patients successfully treated for Hodgkin's disease provide the oncologist with an opportunity and a responsibility to evaluate long-term adverse effects of staging procedures and treatment regimens. This is necessary both to better understand the often unique clinical problems that develop long after completion of treatment for Hodgkin's disease and to more critically evaluate new treatment programs by comparison with existing effective but toxic regimens. Long-term survivors of Hodgkin's disease have various, often subclinical, cardiac abnormalities that result from both radiation and chemotherapy. Pneumonitis and subsequent fibrosis often follow irradiation. A variety of immunologic disturbances exists before and after treatment and predisposes to significant viral and bacterial infections. Finally, hypothyroidism and premature gonadal failure may follow therapy and require long-term hormone replacement. Further therapeutic advances for Hodgkin's disease will continue to alter this spectrum of complications, which, if unrecognized, may produce significant ongoing morbidity for long-term survivors.