Four patients with recurrences of Hodgkin's disease after 15 years or more

LONG-TERM SURVIVORS of Hodgkin’s disease have an increased risk of dying in comparison to the standard population [ 1, 21. Second malignancies, intercurrent diseases and cardiac failure are the main causes of death. This means that patients require follow-up for a very long period after the treatment. Some patients may develop recurrent Hodgkin’s disease many years after they have reached complete remission. This report discusses tumour regrowth in 4 patients after a tumour-free interval of at least 15 years. Patient 1, a female, was referred to our hospital in January 1961. A mediastinai mass was found in November 1959. The erythrocyte sedimentation rate (ESR) was elevated. At thoracotomy a tumour was found above the right hilus. Histology of the biopsy showed nodular sclerosing Hodgkin’s disease. Approximately 1 year later the mediastinum became more enlarged. The patient was irradiated to a dose of 30 Gy by two opposing fields in 18 fractions with orthovoltage therapy (250 kV). In 1964 there was a recurrence of nodular sclerosing Hodgkin’s disease in the left neck. This area was treated with orthovoltage therapy; she received 25 Gy in seven fractions. Follow-up was performed mainly in the local hospital. The patient then presented with tumour recurrence in the lower part of the sternum with a fistula into the left upper abdomen in 1981, that is 17 years after the last treatment. Histology again showed Hodgkin’s disease, nodular sclerosis. She was treated with six cycles of mechloretramine, vincristine, procarbazine, prednisone (MOW), which led to regression of the tumour mass. The patient was then irradiated on the side of the original tumour recurrence to a dose of 30 Gy by megavoltage therapy. In July 1986 histologically proven recurrences-Hodgkin’s disease, nodular sclerosing type-developed in the nasopharynx, the left side of the neck and thereafter in the groin and lung. She died in December 1989. Patient 2, a male, born in 1920 was diagnosed with Hodgkin’s disease, nodular sclerosing subtype, stage iA, in 1955. He was irradiated on both axillae to a dose of 7 Gy and on both sides of