Tolerance to Chemotherapy After Prior Irradiation for Hodgkin's Disease

Abstract

Although intensive radiotherapy is generally well tolerated by patients with Hodgkin's disease, such treatment significantly reduces the bone marrow reserve. The hematologic tolerance to chemotherapy was evaluated in patients who had received prior irradiation. The important factors in determining the postirradiation tolerance to chemotherapy were extent of bone marrow irradiated and the time interval from completion of radiotherapy to onset of chemotherapy. Inability to deliver adequate chemotherapy after extensive radiotherapy was associated with both failure to achieve drug-induced remissions and limited survival times. This experience serves to emphasize the necessity for a rigorous diagnostic evaluation for each patient before institution of radical radiotherapy. Failure to carefully investigate the extent of disease, especially with respect to extranodal involvement, can only result in a radiation-induced reduction of bone marrow reserve which may prevent the subsequent administration of effective (though palliative) chemotherapy.