PURPOSE: Hodgkin lymphoma (HL) survivors have an increased risk of 
cardiovascular disease (CD), lung cancer, and breast cancer. We investigated the 
risk for the development of CD and secondary lung, breast, and thyroid cancer 
after radiation therapy (RT) delivered with deep inspiration breath-hold (DIBH) 
compared with free-breathing (FB) using 3-dimensional conformal RT (3DCRT) and 
intensity modulated RT (IMRT). The aim of this study was to determine which 
treatment modality best reduced the combined risk of life-threatening late 
effects in patients with mediastinal HL.
METHODS AND MATERIALS: Twenty-two patients with early-stage mediastinal HL were 
eligible for the study. Treatment plans were calculated with both 3DCRT and 
IMRT on both DIBH and FB planning computed tomographic scans. We reported the 
estimated dose to the heart, lung, female breasts, and thyroid and calculated 
the estimated life years lost attributable to CD and to lung, breast, and 
thyroid cancer.
RESULTS: DIBH lowered the estimated dose to heart and lung regardless of 
delivery technique (P<.001). There was no significant difference between IMRT-FB 
and 3DCRT-DIBH in mean heart dose, heart V20Gy, and lung V20Gy. The mean breast 
dose was increased with IMRT regardless of breathing technique. Life years lost 
was lowest with DIBH and highest with FB.
CONCLUSIONS: In this cohort, 3DCRT-DIBH resulted in lower estimated doses and 
lower lifetime excess risks than did IMRT-FB. Combining IMRT and DIBH could be 
beneficial for a subgroup of patients.