Late sequelae of treatment of Hodgkin's disease

Twenty-three years after it was observed that successful treatment of Hodgkin's disease was associated with risk of a second malignancy related to treatment, the literature is maturing. Early reports of leukemia risk rising and falling between 5 and 10 years after treatment continue to be supported. The real problem is the steady emergence of solid tumors in radiation treatment fields, particularly breast cancer and in females treated between the ages of 10 and 25. Several reports this year again emphasize this point. One avenue to pursue to avoid this complication is to use combination chemotherapy alone, especially in young women. The other relates to one observation made this year that low doses of radiation may not be as carcinogenic as full doses. These data suggest that chemotherapy and low-dose radiotherapy in early stage Hodgkin's disease need our attention in rigorously designed clinical trials.