Postradiation cardiac sarcoma and other secondary cancers more than 25 years after chemotherapy and mantle-field radiation for Hodgkin's lymphoma

40E n APPLIED RADIATION ONCOLOGY www.appliedradiationoncology.com March 2015 CASE SUMMARY In July 2013, a 48-year-old Caucasian female presented to the emergency department with rapid-onset fatigue, shortness of breath and palpitations. Her medical history was remarkable for early stage Hodgkin’s lymphoma (HL) diagnosed at age 19 (1984) for which she underwent doxorubicin, bleomycin, vinblastine and dacarbazine chemotherapy, then mantle-field radiation to 40 Gy (port films unavailable) with a complete response. During the late-1990s, she was diagnosed with hypothyroidism and a prolactinoma, both managed medically. She had regular surveillance of the breasts and thyroid. In early 2012, she was diagnosed with a Stage IA T1aN0M0 invasive tubular carcinoma in the upper outer quadrant of the right breast. After consideration of risks from re-irradiation as part of breast conservation therapy, she opted for bilateral mastectomy with flap reconstruction. In July, 2012, surveillance ultrasound of the thyroid revealed the growth of a nodule. Fine-needle aspirate was suspicious and she underwent total thyroidectomy, revealing a T1a follicular papillary microcarcinoma.