Original contributionCauses of death after therapy for early stage Hodgkin's disease entered on EORTC protocols

The risk of dying from different causes after Hodgkin's disease (HD) therapy has been quantified from a series of 1,449 patients with early stages included in four successive clinical trials conducted by the European Organization for Research and Treatment of Cancer (EORTC) Lymphoma Cooperative Group since 1963. Overall, 240 patients died and the 15-year survival rate was 69% whereas the expected rate was 95%. The standardized mortality ratio (SMR) technique was used to quantify excess deaths as a function of time since first therapy. At each interval, SMR was significantly increased, giving: 0–3 year, 8.86 (p < 0.001); 4–6 year, 9.25 (p < 0.001); 7–9 year, 7.08 (p < 0.001); 10–12 year, 9.53 (p < 0.001); 13–15 year, 4.37 (p < 0.01); and 16+ years, 3.80 (p < 0.05). While the proportion of deaths as a consequence of HD progression, treatment side-effect, and intercurrent disease decreased with time, that of second cancer and cardiac failure peaked during the 10–12 year post-treatment interval. After 15 years of follow-up, the risk of dying from causes other than HD continued to increase. These findings indicate that although probably cured from HD, patients are at higher risk for death than expected, a risk that might be a consequence of therapy.