carcinoma was elevated for the RT group (RR 1.5; 95% confidence interval [CI], Medical Center, Haifa, Israel.1.1-2.0) but not for the non-RT group (RR 1.0; 95% CI, 0.7-1.2). R adiation therapy (RT) is known to cause a variety of malignancies, including leukemia, sarcomas, thyroid carcinoma, and lung carcinoma.1-3 Scattered reports have suggested links to other malignancies, such as gastric carcinoma, as well.2 As would be expected, the organs at risk for a given type of RT are the sites that lie within the radiation port.Studies regarding pelvic RT have found an association with a subsequent increased risk of bladder carcinoma. This has been reported after RT for cervical carcinoma 4,5 and ovarian carcinoma. These studies have also suggested a synergistic effect with exposure demonstrate superiority for one treatment over the other.

The number of cancer patients who live longer and are cured of their disease is increasing. Many of them have received radiotherapy as part of their treatment. Postirradiation sarcoma (PIS), while still uncommon, is a complication which is appearing more frequently as the number of long-term survivors increases. Studies of the clinical characteristics of PIS, such as stage of disease, grade, survival, and prognosis, are therefore of increasing importance, and may lead to different strategies for early detection and prevention. In a literature review of PIS, we identified 344 cases with sufficient data for analysis of these clinical characteristics. In these selected cases, we found that: (a) PIS was most often diagnosed at an advanced stage and high grade; (b) most of the tumors were located in areas where radical surgery could not be performed; (c) the response rate to chemotherapy was almost always poor; and (d) most patients with PIS died from locally advanced and/or metastatic disease within a few months after diagnosis. PIS is a serious, usually fatal, late complication of radiotherapy and it should be weighed in the decision to use this modality of therapy. In the follow-up of cancer patients, a low threshold of suspicion for PIS is recommended in order to detect it early for possible resection. Because of the poor prognosis, more aggressive and investigative chemotherapeutic regimens are warranted.

Background. Most current lymphoma protocols limit vincristine dose to 2 mg per single dose. Because a lower dose of vincristine may be associated with poorer outcome, there is some rationale to increase the dose of vincristine. Methods. The feasibility of full dose vincristine (i.e., 1.4 mg/m2 without 2‐mg dose limit) was prospectively evaluated in lymphoma patients treated with various combinations. After an initial dose of 1.4 mg/m2, patients were carefully monitored, and dose was modified according to toxicity. Results. One hundred and four consecutive patients (31 with Hodgkin's disease and 73 with non‐Hodgkin's lymphoma), aged 18–78 years were evaluated. The first dose was greater than 2 mg in 90% of the patients. The mean actual dose (percent of projected dose) was 100% in the first course and gradually decreased to 64% in the eighth course. The mean actual dose intensity of vincristine (percent of projected dose intensity) during the initial six cycles of prednisone, methotrexate, calcium leucovorin, doxorubicin, cyclophosphamide, etoposide, and mechlorethamine, vincristine, procarbazine, prednisone (ProMACE/MOPP), cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), and MOPP/doxorubicin, bleomycin, and vinblastine (MOPP/ABV) was 82% and MOPP/doxorubicin, bleomycin, and vinblastine was 82%, 83%, and 87%, respectively. Symptoms of neuropathy developed in 92% of the patients and were usually of mild or moderate severity. Toxicity included World Health Organization (WHO) Grades 3 and 4 constipation in 10 (10%), and WHO Grade 3 peripheral neurotoxicity in 16 (15%) patients. Rapid improvement was usually noticed within a few weeks after withdrawal of vincristine. The median duration of symptoms from discontinuation of vincristine was 3 months for paresthesiae and motor weakness and 5 months for muscle cramps. Conclusions. Full dose vincristine in lymphoma protocols is feasible but is associated with increased toxicity. The therapeutic advantage of full dose vincristine has yet to be proven.

Background. Ionizing radiation is a lung carcinogen in a variety of settings, including after breast cancer radiation therapy. The authors explored whether cigarette smoking and breast cancer radiation therapy have a multiplicative effect on the risk of subsequent lung cancer. Methods. This case‐control study investigated women registered with primary breast cancer in the Connecticut Tumor Registry who developed a second malignancy between 1986 and 1989. Those diagnosed with a subsequent primary lung cancer were compared with those diagnosed with a subsequent nonsmoking, nonradiation‐related second malignancy, and age‐adjusted odds ratios were calculated with logistic regression. Results. No radiation effects were observed within 10 years of initial primary breast cancer. Among both smokers and nonsmokers diagnosed with second primary cancers more than 10 years after an initial primary breast cancer, radiation therapy was associated with a 3‐fold increased risk of lung cancer. A multiplicative effect was observed, with women exposed to both cigarette smoking and breast cancer radiation therapy having a relative risk of 32.7 (95% confidence interval [CI], 6.9–154). The radiation carcinogenic effect was observed only for the ipsilateral lung and not for the contralateral lung both in smokers and nonsmokers. Conclusions. Breast cancer radiation therapy, as delivered before 1980, increased the risk of lung cancer after ten years in nonsmokers, and a multiplicative effect was observed in smokers. For both smokers and non‐smokers, this effect was observed only for the ipsilateral lung and not the contralateral lung. Modern techniques, however, significantly decrease the radiation dose to the lungs, which may decrease the risk of lung cancer. Nonetheless, due to the available choices in early‐stage breast cancer treatment, current practices may need to be revised for young breast cancer patients who smoke. Cancer 1994: 73:1615–20.

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