Increased Risk of Second Lung Cancer in Hodgkin’s Lymphoma Survivors: A Meta-analysis

Ibrahim, Ezzeldin M.; Kazkaz, Ghieth A.; Abouelkhair, Khaled M.; Al‐Μansour, Mubarak; Alfayea, Turki; Al‐Foheidi, Meteb; Bayer, Ali; Elmasri, Osama A.

doi:10.1007/s00408-012-9418-4

Cited by 34 publications

(26 citation statements)

References 56 publications

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“…Prior NSCLC is a known risk factor for developing second primary NSCLC at estimated rates of 1-2% per year with increasing tobacco exposure conferring higher risk 6, 7 . Population-based and institutional studies have demonstrated that survivors of head and neck cancer as well as Hodgkin's lymphoma are also at increased risk of developing new primary lung cancer 8, 9 . However, it is unclear whether the antecedent cancer directly increases risk or whether confounding factors play a role.…”

Section: Introductionmentioning

confidence: 99%

Non–Small Cell Lung Cancer as a Second Primary Among Patients With Previous Malignancy: Who Is at Risk?

Nelson

Kim

et al. 2017

Clinical Lung Cancer

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Background Patients with prior malignancies may be at increased risk for non-small cell lung cancer (NSCLC). However, the extent of risk is unknown for many cancer types and it is unclear who may benefit from screening. Methods The Surveillance, Epidemiology and End Results dataset from 1992-2012 was used to identify patients with prior malignancies who were diagnosed with NSCLC ≥6 months after their initial cancer. Standardized incidence ratios (SIR) for NSCLC were calculated as a ratio of observed to expected cases adjusted by person-years at risk. Cancers with SIR >1.0 had higher risk for NSCLC than expected. Analyses were stratified by sex, radiation, and histology. Results Among cancer survivors, 32,058 developed NSCLC. Smoking-related (lung, head and neck, bladder) and hematologic malignancies regardless of prior radiation therapy had the highest SIR for NSCLC (range 1.97-4.88). Prior colorectal and renal cancer survivors also had increased SIR for NSCLC (1.16 and 1.21, respectively). Women with previous pancreatic cancer treated with radiation, breast cancer with or without radiation, and those with thyroid cancer demonstrated higher SIR for lung adenocarcinoma. Men with prior irradiated prostate cancer also had elevated SIR (1.08, CI 1.01-1.15) for lung adenocarcinoma. Patients with melanoma, prostate or uterine cancer had lower SIR for NSCLC than expected. Conclusions Smoking-related malignancies had the highest risk for NSCLC. Radiation conferred elevated risk for NSCLC for certain cancers. Melanoma, prostate, uterine cancer survivors were at low risk for NSCLC. These results may help identify high-risk screening candidates in the growing population of cancer survivors.

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Section: Introductionmentioning

confidence: 99%

Non–Small Cell Lung Cancer as a Second Primary Among Patients With Previous Malignancy: Who Is at Risk?

Nelson

Kim

et al. 2017

Clinical Lung Cancer

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“…Risks of second primary colorectal cancers are doubled [10] but might only be increased in tumours of the proximal colon [11]. A five-fold increase in risk of primary lung cancers following Hodgkin’s lymphoma has been reported [12] and risks of second primary head & neck cancers are raised [13]. …”

Section: Introductionmentioning

confidence: 99%

Second primary cancer risk - the impact of applying different definitions of multiple primaries: results from a retrospective population-based cancer registry study

2014

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BackgroundThere is evidence that cancer survivors are at increased risk of second primary cancers. Changes in the prevalence of risk factors and diagnostic techniques may have affected more recent risks.MethodsWe examined the incidence of second primary cancer among adults in the West of Scotland, UK, diagnosed with cancer between 2000 and 2004 (n = 57,393). We used National Cancer Institute Surveillance Epidemiology and End Results and International Agency for Research on Cancer definitions of multiple primary cancers and estimated indirectly standardised incidence ratios (SIR) with 95% confidence intervals (CI).ResultsThere was a high incidence of cancer during the first 60 days following diagnosis (SIR = 2.36, 95% CI = 2.12 to 2.63). When this period was excluded the risk was not raised, but it was high for some patient groups; in particular women aged <50 years with breast cancer (SIR = 2.13, 95% CI = 1.58 to 2.78), patients with bladder (SIR = 1.41, 95% CI = 1.19 to 1.67) and head & neck (SIR = 1.93, 95% CI = 1.67 to 2.21) cancer. Head & neck cancer patients had increased risks of lung cancer (SIR = 3.75, 95% CI = 3.01 to 4.62), oesophageal (SIR = 4.62, 95% CI = 2.73 to 7.29) and other head & neck tumours (SIR = 6.10, 95% CI = 4.17 to 8.61). Patients with bladder cancer had raised risks of lung (SIR = 2.18, 95% CI = 1.62 to 2.88) and prostate (SIR = 2.41, 95% CI = 1.72 to 3.30) cancer.ConclusionsRelative risks of second primary cancers may be smaller than previously reported. Premenopausal women with breast cancer and patients with malignant melanomas, bladder and head & neck cancers may benefit from increased surveillance and advice to avoid known risk factors.

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“…Retrospective data suggest that larger radiation fields are associated with an increased risk of second malignancies and a higher integral radiation dose is associated with an increased risk of death from a second malignancy [7][8][9]. The incidence of breast and lung cancers, among others, has been documented to be elevated in cHL patients after treatment, resulting in poor outcomes [10][11][12][13][14][15][16][17]. However, a recently published SEER analysis of early-stage cHL has demonstrated that the use of RT in these patients improves overall survival (OS) without increasing the rate of second malignancies [18].…”

Section: Introductionmentioning

confidence: 99%

Risk of second malignancies in patients with early‐stage classical Hodgkin's lymphoma treated in a modern era

et al. 2015

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Second malignancies remain an issue affecting morbidity and mortality in long-term survivors of early stage Hodgkin's lymphoma (HL). We undertook this study to determine if treatment in the modern era resulted in decreased second malignancies. Patients diagnosed with stage I–II cHL between 1988 and 2009 who received radiation therapy (RT) were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Freedom from second malignancy (FFSM) was estimated using the Kaplan–Meier method. Univariate analysis (UVA) was performed using the Log-Rank test, and included age, gender, year of diagnosis, and stage. Multivariable analysis (MVA) was performed using Cox Proportional Hazards modeling. The study cohort included 8807 patients. The median age at diagnosis was 32 years (range: 2–85). The majority of patients had stage II disease (n = 6044, 69%), 597 (7%) had extranodal involvement (ENI), and 1925 (22%) had B symptoms. Median follow-up for the entire cohort was 7.2 years (range: 0–22). Five hundred twenty-three (6%) patients developed a second malignancy. Median latency to second malignancy was 5.8 years (range: 0.1–21.5). Of the 523 patients that developed a second malignancy, 228 (44%) occurred in the first 5 years, 139 (27%) were diagnosed between years 5–10, and 156 (30%) beyond 10 years. The 10 year FFSM for patients treated between 1988 and 1999 was 93.0% versus 95.1% for patients treated between 2000 and 2009 (P = 0.04), On MVA, treatment between 2000 and 2009 was associated with a HR for second malignancy of 0.77 (95% Confidence Interval: 0.62–0.96, P = 0.02) compared to the treatment between 1988 and 1999. Our analysis suggests that in patients treated with RT for stage I or II cHL, treatment prior to 2000 had a slightly higher risk of second malignancy compared to treatment in 2000 and later. Further studies, with longer follow-up of patients treated in the modern era are needed to confirm these findings.

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Increased Risk of Second Lung Cancer in Hodgkin’s Lymphoma Survivors: A Meta-analysis

Abstract: The current meta-analysis provided a detailed estimate of the risk of SLC among HL survivors. The obtained results may provide guidelines concerning lung cancer screening for this population.

Cited by 34 publications

References 56 publications

Non–Small Cell Lung Cancer as a Second Primary Among Patients With Previous Malignancy: Who Is at Risk?

Non–Small Cell Lung Cancer as a Second Primary Among Patients With Previous Malignancy: Who Is at Risk?

Second primary cancer risk - the impact of applying different definitions of multiple primaries: results from a retrospective population-based cancer registry study

Risk of second malignancies in patients with early‐stage classical Hodgkin's lymphoma treated in a modern era

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