Assessment of late effects in a cohort of female Hodgkin's lymphoma patients treated with mantle radiotherapy, identified from the DoH breast cancer screening recall showed high mortality and frequent undiagnosed abnormalities in tissues affected by radiotherapy. With increasing age, this patient group may suffer premature cardiac and respiratory morbidity. (Henry-Amar and Joly, 1996). Current treatment usually involves multiagent chemotherapy combined with limited field radiotherapy in selected patients. However, until recently, the standard radiotherapy regimen for supradiaphragmatic HL was the mantle field (Deniz et al, 2003;Horwich and Swerdlow, 2004).Young women who received mantle radiotherapy are at increased risk of breast cancer (Swerdlow et al, 2000;Deniz et al, 2003;Travis et al, 2003;Horwich and Swerdlow, 2004;Kenney et al, 2004). The risk is proportional to radiation dose, and time from treatment (Hancock et al, 1993a;Wolden et al, 1998). Younger age at the time of treatment gives the greatest risk (Hancock et al, 1993a;Bhatia et al, 1996). At 25 years of follow-up, the cumulative risk of breast cancer for women treated between 10 and 19 years of age is reported as 15 -33%, and for those treated between the ages 20 and 29 years, 15 -25% (Horwich and Swerdlow, 2004). In 2003, the UK Department of Health launched a 'Patient Notification Exercise' to inform patients of the increased breast cancer risk. The exercise mandated recall of all women with HL, who were diagnosed at or below the age of 35 from 1962 onwards. Mantle radiotherapy is associated with other long-term complications including second malignancies, and disorders of the thyroid, heart and lung (Morgan et al, 1985;Gustavsson et al, 1990;Allavena et al, 1992;Gustavsson et al, 1992; Henry-Amar and Joly, 1996). The aim of our study was to investigate the incidence of late effects in women recalled in the UK 'Patient Notification Exercise'.
MATERIALS AND METHODSPatients were identified from a network database, according to the following criteria: diagnosis of HL after 1962 and before the age of 35 years, and mantle radiotherapy. Women with a known history of breast cancer were excluded. Patients were offered a clinic appointment for counselling regarding breast cancer risk. Patients who accepted were asked if they were willing to participate in a study of late effects. The study was approved by the South Sheffield Research Ethics Committee and all patients gave written informed consent.
Late effects study protocolPatients underwent a clinical evaluation including examination of the skin and thyroid. In addition, the following investigations were performed:Blood: Serum thyroid-stimulating hormone (TSH), free T4 (fT4), parathyroid hormone and corrected calcium. Cardiac: Echocardiogram and electrocardiogram. Respiratory: Spirometry and diffusion capacity (TLCO).
Measurement and interpretation of resultsSerum measurements were considered against the laboratory normal range. Spirometry and transfer factors results were expressed as the percentage...
