BACKGROUND: Our aim was to define predictors of late radiation-induced lung 
injury (RILI) in Hodgkin's lymphoma (HL) survivors treated with 
bleomycin-containing chemotherapy and radiotherapy.
MATERIAL AND METHODS: Eighty consecutive patients treated with chemotherapy and 
subsequent supradiaphragmatic radiation therapy for HL were retrospectively 
reviewed for symptoms and/or radiological signs of RILI. Median patient age was 
26 years (range 14-55). Left, right, and total lung dosimetric parameters along 
with clinical, disease, and treatment-related characteristics were analyzed. 
Multivariate logistic regression analyses were performed. A receiver operator 
characteristic (ROC) curve analysis was performed to find possible cutoff values 
dividing patients into high- and low-risk groups.
RESULTS: Seven of 80 (9%) patients had lung disease at baseline. Four of 80 (5%) 
had toxicity after chemotherapy and before the beginning of radiotherapy. These 
patients were excluded from further evaluation. At a median time of 10 months 
(range 9-18), 9/69 patients (13%) developed lung radiological changes on 
computed tomography (CT) after treatment. Four of nine patients were diagnosed 
RTOG grade ≥ 2. On multivariate analyses, left-lung V30 (p = 0.004, OR = 1.108 
95% CI 1.033-1.189) and total-lung V30 (p = 0.009, OR = 1.146 95% CI 
1.035-1.270) resulted to be predictors of lung CT changes with a cutoff value of 
16% and 15%, respectively. When only symptomatic RILI was considered a left-lung 
V30 cutoff value of 32% was estimated.
CONCLUSION: Bleomycin and RT may cause lung injury in a small, but significant 
fraction of HL patients. Left-lung V30 predicts the risk of developing 
asymptomatic or symptomatic RILI after sequential chemo-radiotherapy.