Second malignancy risk associated with treatment of Hodgkin's lymphoma: meta-analysis of the randomised trials

Franklin, Jeremy; Pluetschow, Annette; Paus, Marcus D; Specht, Lena; Anselmo, Anna Paola; Avilés, Agustín; Biti, Giampaolo; Богатырева, Т. И.; Bonadonna, Gianni; Brillant, Corinne; Cavalieri, Elena; Diehl, Volker; Eghbali, Houchingue; Fermé, Christophe; Henry-Amar, Michel; Hoppe, Richard T.; Howard, Steven K.; Meyer, Ralph M.; Niedzwiecki, Donna; Pavlovsky, Santiago; Radford, John; Raemaekers, John; Ryder, David; Schiller, Petra; Шахтарина, С. В.; Valagussa, Pinuccia; Wilimas, Judith A.; Yahalom, Joachim

doi:10.1093/annonc/mdl302

Cited by 177 publications

(90 citation statements)

References 71 publications

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“…In a recent report, a switch from a 35-Gy mantle field to involved field radiotherapy (IFRT) at the same total dose reduced the estimated 20-year excess RR of BC by 63% (Hodgson et al, 2007). This model is consistent with meta-analysis data of clinical trials demonstrating an odds ratio of 3.25 (P ¼ 0.04) for the development of BC for women treated with extended field vs IFRT (Franklin et al, 2006). It may be possible to avoid radiotherapy altogether in a proportion of patients with both early and advanced stage HL, thus reducing the detrimental long-term sequelae of treatment for these individuals.…”

Section: Discussionsupporting

confidence: 70%

The UK national breast cancer screening programme for survivors of Hodgkin lymphoma detects breast cancer at an early stage

et al. 2009

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BACKGROUND: Supradiaphragmatic radiotherapy (SRT) to treat Hodgkin's lymphoma (HL) at a young age increases the risk of breast cancer (BC). A national notification risk assessment and screening programme (NRASP) for women who were treated with SRT before the age of 36 years was instituted in the United Kingdom in 2003. In this study, we report the implementation and screening results from the largest English Cancer Network. METHODS: A total of 417 eligible women were identified through cancer registry/hospital databases and from follow-up (FU) clinics. Screening results were collated retrospectively, and registry searches were used to capture BC cases. RESULTS: Of the 417 women invited for clinical review, 243 (58%) attended. Of these 417 women, 23 (5.5%) have been diagnosed with BC, a standardised incidence ratio of 2.9 compared with the age-matched general population. Of five invasive BCs diagnosed within the NRASP, none involved axillary lymph nodes compared with 7 of 13 (54%) diagnosed outside the programme (Po0.10). The mean latency for BC cases was 19.5±8.35 years and the mean FU duration for those unaffected by BC was 14.6±9.11 years (Po0.01), suggesting that those unaffected by BC remain at high risk. Recall and negative biopsy rates were acceptable (10.5 and 0.8%, respectively). CONCLUSIONS: The NRASP appears to detect BC at an early stage with acceptable biopsy rates, although numbers are small. Determination of NRASP results on a national basis is required for the accurate evaluation of screening efficacy in women previously treated with SRT.

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Section: Discussionsupporting

confidence: 70%

The UK national breast cancer screening programme for survivors of Hodgkin lymphoma detects breast cancer at an early stage

et al. 2009

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“…13 For patients treated at age 25 years with a chest radiation dose of at least 40 Gy without alkylating agents, the estimated cumulative absolute risks of breast cancer by age 35, 45, and 55 years were 1.4%, 11.1%, and 29.0%, respectively. Several studies have demonstrated a direct correlation between breast cancer risk and radiation field size [14][15][16][17] and also showed that smaller fields and treatment volume are associated with a significantly lower risk of breast cancer. In a population-based study comparing outcome of de novo breast cancer versus breast cancer after HL, women with localized breast cancer after HL had a significantly increased 2-fold risk of death from breast cancer compared with patients with de novo breast cancer.…”

Section: Second Malignancymentioning

confidence: 99%

Current survivorship recommendations for patients with Hodgkin lymphoma: focus on late effects

2014

Blood

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Long-term survivors of Hodgkin lymphoma (HL) are at an increased risk for a range of late complications, with subsequent malignant neoplasm and cardiovascular disease representing the 2 leading causes of death in these patients. Raising awareness, close follow-up, and adoption of selected earlydetection and risk-reduction strategies may help to reduce the adverse impact of these late effects on patients. This chapter reviews known long-term complications of HL therapy, risk factors, and the timing of their occurrence. Where available, data on the efficacy of screening for selected late effects of HL are presented. Current evidence-based and consensus-based recommendations on follow-up of longterm HL survivors are also reviewed. As HL therapy evolves over time, late effects and implications on follow-up of patients treated in the contemporary era should be considered and opportunities for future research should be explored. (Blood. 2014; 124(23):3373-3379)

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“…The risk of developing secondary cancers is highest when RT is used as a component of first-line treatment. A meta-analysis by Franklin et al 89 showed that the risk of developing secondary cancers was lower with combined modality treatment than with RT alone as the initial treatment. The risk was marginally higher with combined modality treatment compared with chemotherapy alone as initial treatment.…”

Section: Monitoring For Late Effectsmentioning

confidence: 99%

Hodgkin Lymphoma Version 1.2017, NCCN Clinical Practice Guidelines in Oncology

Hoppe¹,

Advani²,

Ai³

et al. 2017

J Natl Compr Canc Netw

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OverviewHodgkin lymphoma (HL) is an uncommon malignancy involving lymph nodes and the lymphatic system. Most patients are diagnosed between 15 and 30 years of age, followed by another peak in adults aged ≥55 years. In 2017, an estimated 8,260 people will be diagnosed with HL in the United States and 1,070 will die of the disease. AbstractThis portion of the NCCN Guidelines for Hodgkin lymphoma (HL) focuses on the management of classical HL. Current management of classical HL involves initial treatment with chemotherapy or combined modality therapy followed by restaging with PET/CT to assess treatment response using the Deauville criteria (5-point scale). The introduction of less toxic and more effective regimens has significantly advanced HL cure rates. However, long-term follow-up after completion of treatment is essential to determine potential long-term effects. Please NoteThe NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines These guidelines are also available on the Internet. For the latest update, visit NCCN.org.

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Second malignancy risk associated with treatment of Hodgkin's lymphoma: meta-analysis of the randomised trials

Cited by 177 publications

References 71 publications

The UK national breast cancer screening programme for survivors of Hodgkin lymphoma detects breast cancer at an early stage

The UK national breast cancer screening programme for survivors of Hodgkin lymphoma detects breast cancer at an early stage

Current survivorship recommendations for patients with Hodgkin lymphoma: focus on late effects

Hodgkin Lymphoma Version 1.2017, NCCN Clinical Practice Guidelines in Oncology

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