Treatment of Hodgkin's Lymphoma (HL) has now improved to a stage where more than 80% of patients experience 5-year survival [1]. This conservative estimate is even more impressive in early-stage disease where the early survival rate can be as high as 95% in those managed with combined modality treatment [2]. Patients are increasingly more likely to experience mortality as a consequence of their treatment, rather than from the primary disease itself. Thus, given that many of these patients are diagnosed at a relatively young age, much of the current treatment focus has shifted to preventing secondary organ injury and long-term treatment-related morbidity.

Current treatment for HL generally involves a multi-modal approach, including mediastinal radiotherapy and an anthracycline-based chemotherapy regime. Both of these modalities are known to be cardiotoxic, especially in the long term. Radiation in particular results in a discrete entity known as radiation-associated heart disease (RAHD) which presents and behaves differently to most conventional cardiovascular disease.

Given the early age of radiotherapy in HL patients, RAHD has the time necessary to develop over decades into advanced disease that necessitates invasive intervention [3]. Management of these patients is complex and there are currently no clinical guidelines to guide best practice. Moreover, all current evidence in this cohort is derived from observational studies. While baseline medical therapy is mandatory in all cases, cardiac surgery emerges as an intervention that can either deliver the most favourable outcomes, or offer the only definitive treatment option.

This review explores the development of RAHD in the long-term HL survivor, with specific emphasis on introducing the role of cardiac surgery to practitioners who follow up HL patients long-term. We also indicate how decisions made during treatment planning influence the long-term outcomes and subsequent surgical interventions required for these patients.