Expanded neuromuscular morbidity in Hodgkin lymphoma after radiotherapy

Tatsuya Oishi; Cory J Kogelschatz; Nathan P Young; Ernest M Hoffmann; Nathan P Staff; Sue L Visscher; Bijan J Borah; William E Krauss; Kogulavadanan Arumaithurai; Shahar Shelly; Stephen M Ansell; Christopher J Klein

doi:10.1093/braincomms/fcaa050

Expanded neuromuscular morbidity in Hodgkin lymphoma after radiotherapy

Brain Commun. 2020 Apr 25;2(1):fcaa050. doi: 10.1093/braincomms/fcaa050. eCollection 2020.

Authors

Affiliations

¹ Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
² Intermountain Neurosciences Institute, Murray, UT 84107, USA.
³ Center of the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA.
⁴ Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
⁵ Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
⁶ Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.

Abstract

Our study aims to quantitate neuromuscular morbidity from radiotherapy in Hodgkin lymphoma including: (i) frequency and (ii) time of onsets for neurological localizations; (iii) degree of disabilities and (iv) number of clinical visits compared to cardiopulmonary Hodgkin lymphoma-radiation complications. Medical records from Mayo Health systems were retrieved; identifying neuromuscular radiation treated Hodgkin lymphoma-complications from 1 January 1994 to 31 December 2016. Of an estimated 4100 post-radiotherapy Hodgkin lymphoma patients, 4.6% (189) were identified with complications. Mean latency to physician visit for symptoms was 23.7 years (range: 1-50). Most commonly identified complications included: head drop 10% (19) with or without myopathy, myopathy 39% (73), plexopathy 29% (54), myelopathy 27% (51) and polyradiculopathy 13% (24). Other findings included benign and malignant nerve sheath tumours 5% (9), phrenic and long thoracic mononeuropathies 7% (14) and compressive spinal meningioma 2% (4). Patients frequently had multiple coexisting complications (single = 76% [144], double = 17% [33], triple = 4% [8], quadruple = 2% [4]). Cardiac 28% (53) and pulmonary 15% (29) complications were also seen in these patients. History of Hodgkin lymphoma was initially overlooked by neurologists (14.3%, 48/336 clinical notes). Hospital and outpatient visits for complications were frequent: neuromuscular 19% (77/411) versus cardiopulmonary 30% (125/411). Testing was largely exclusionary, except when imaging identified secondary malignancy. Modified Rankin score at diagnosis varied: 0-1 (55.8%), 2-3 (5.8%) and 4-5 (38.3%). Neuromuscular complications among post-radiation Hodgkin lymphoma are diverse, occurring in ∼1 of 20 having markedly delayed onsets often eluding diagnosis. Frequent care visits and major morbidity are common. Survivorship recommendations should recognize the diverse neurological complications.

Keywords: Hodgkin lymphoma; neuromuscular; radiation complications.