PURPOSE: To evaluate the risk factors associated with lung cancer (LC) and other 
second neoplasms (SN) in Hodgkin lymphoma (HL) survivors.
METHODS: We retrospectively analyzed the clinical characteristics and outcomes 
of 604 patients treated in our institution between 1968 and 2012.
RESULTS: 90 out of 604 patients developed SN: 27 LC and 63 other SN. The median 
time elapsed until LC and other SN was 16.5 and 11.8 years, respectively (p = 
0.003). In the LC group, 85.5 % of patients were male and 84.6 % smokers (HR 7, 
95 % CI 2.4-20.7, p < 0.001). Radiotherapy (RT) doses applied were higher in the 
SN group with an increased risk of LC (HR: 4.0 95 % CI 1.1-11.6, p = 0.010) and 
other SN (HR: 3.3 95 % CI 1.6-6.7 p = 0.001) with doses higher than 42 Gy. No 
association was found between alkylating agents and development of SN. In LC, 
the most frequent histology was adenocarcinoma with an elapsed time after HL of 
13.2 years in early stages and 21.3 in advanced (p = 0.02). Median OS after a 
diagnosis of LC was 12.6 months ranging from 5.9 (in cases presenting due to 
symptoms) to 49.1 (incidentally diagnosed cases) (p = 0.005).
CONCLUSIONS: RT treatment, especially with doses higher than 42 Gy, and smoking 
increase the risk of SN after HL. In this series, LC patients with early stages 
had a shorter elapsed time from HL diagnosis and longer OS, therefore the role 
of LC screening in HL survivors should be prospectively evaluated and smoking 
cessation counseling ought to be a key aspect during follow-up.