Solid cancer risk after treatment of Hodgkin's disease

Boivin, Jean‐François; O’Brien, K.

doi:10.1002/1097-0142(19880615)61:12<2541::aid-cncr2820611225>3.0.co;2-g

Cited by 82 publications

(19 citation statements)

References 26 publications

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“…It is known from several studies (Boivin and O'Brien, 1988;Tucker et al, 1988;Swerdlow et al, 1992;van Leeuwen et al, 1994), and unsurprising in the light of the findings in other radiation-exposed cohorts such as atomic bomb survivors (National Research Council, 1990), that solid cancer risks can be increased by radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…The risks after chemotherapy alone are much less clear, however. There have been relatively small numbers of person-years of long-term follow-up after chemotherapy without radiotherapy in most cohorts yet published, and until recently the power of such cohorts has been low and increased risk of solid cancers has not been seen (Boivin and O'Brien, 1988;Young et al, 1990). Four recent studies have shown increased solid cancer risk after chemotherapy (Kaldor et al, 1992;Swerdlow et al, 1992;Biti et al, 1994;Boivin et al, 1995) while others did not (Abrahamsen et al, 1993;van Leeuwen et al, 1994b).…”

Section: Discussionmentioning

confidence: 99%

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Second malignancy in patients with Hodgkin's disease treated at the Royal Marsden Hospital

Swerdlow

Barber²,

Horwich³

et al. 1997

Br J Cancer

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Summary Risk of second primary malignancy was assessed in follow-up to June 1991 of 1039 patients first treated for Hodgkin's disease at the Royal Marsden Hospital during 1963-91. A total of 77 second malignancies occurred. There were significantly raised risks of stomach [standardized incidence ratio (SIR)=4.0], lung (SIR=3.8), bone (SIR=26.5), soft tissue (SIR=1 6.9) and non-melanoma skin (SIR=3.9) cancers, non-Hodgkin's lymphoma (SIR=4.6), and acute and non-lymphocytic leukaemia (SIR=31.3), with a relative risk of 3.3 for all second cancers other than non-melanoma skin cancer. Solid cancer risk was raised to a similar extent in patients treated only with radiotherapy (SIR=2.6, P<0.001), only with chemotherapy (SIR=2.1, P=0.08) and with both (SIR=3.1, P<0.001). Leukaemia risk was raised only in those receiving chemotherapy, whether alone or with radiotherapy. The relative risk for solid cancers was much greater in patients who were younger at first treatment (trend P<0.001), whereas leukaemia risk was greatest for those first treated at ages 25-44. For solid cancers (P<0.001) but not leukaemia (P=0.05) there was a strong gradient of greater relative risks at younger attained ages. The relative risk of second cancers overall was 27.5 at ages under 25 and 2.0 at ages 55 and above. Leukaemia and solid cancer risks in patients treated with chlorambucil, vinblastine, procarbazine and prednisone (ChIVPP) were not significantly greater than those in patients treated with mustine, vincristine, procarbazine and prednisone (MOPP). Number of cycles of chemotherapy was significantly related to risk of leukaemia (P<0.001), and there was a trend in the same direction for solid cancers (P=0.07). The study adds to evidence that alkylating chemotherapy may increase the risk of solid cancers, and that ChIVPP does not provide a less carcinogenic alternative to MOPP chemotherapy. The very large relative risks found for solid cancers at young attained ages and in patients treated when young may have important implications as, in the long term, the majority of second malignancies after Hodgkin's disease are solid cancers. The risks of solid malignancies need clarification by larger collaborative epidemiological studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Second malignancy in patients with Hodgkin's disease treated at the Royal Marsden Hospital

Swerdlow

Barber²,

Horwich³

et al. 1997

Br J Cancer

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“…After radiotherapy there are raised risks of several solid tumours (Boivin & O'Brien, 1988), and probably also of leukaemia (Boivin et al, 1984; Tucker et al, 1988;Van Leeuwen et al, 1989). After chemotherapy, a very high risk of acute or non-lymphocytic leukaemia has been shown (Pedersen-Bjergaard et al, 1987; Tucker et al, 1988), and in a recent study we found solid cancer risk also to be increased (Swerdlow et al, 1992).…”

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confidence: 90%

Risk of second primary cancer after Hodgkin's disease in patients in the British National Lymphoma Investigation: relationships to host factors, histology and stage of Hodgkin's disease, and splenectomy

Swerdlow

Douglas²,

Hudson³

et al. 1993

Br J Cancer

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Summary The risks of second primary cancer were analysed in 2846 patients with Hodgkin's disease treated within the British National Lymphoma Investigation during 1970-87. The relative risk (RR) of leukaemia was significantly greater in women (RR = 30.1; 95% confidence limits (CL) 13.0-59.5) than in men (RR = 10.9; 95% CL 4.7-21.5), and showed a significant trend of greater risk with younger age at first treatment (P<0.001). The relative risk of solid cancers was similar between the sexes, but again significantly greater at young than at older ages of first treatment (P<0.01). Non-Hodgkin's lyrrphoma relative risks, although not related to sex or age, were significantly related to histology of the o;:iginal Hodgkin's disease, and were greatest after lymphocyte predominant Hodgkin's disease (RR = 55.6; 95% CL 18.0 -129.7). The relative risk of second cancers did not vary significantly according to whether or not splenectomy had been performed. Leukaemia risk was non-significantly greater after splenectomy than with no splenectomy, which accorded with previous evidence of a modest increased risk associated with this operation.If the greater relative risk of solid second cancers after treatment at young than at older ages persists with longer follow-up, the incidence rates of these second primaries in patients treated young for Hodgkin's disease will become very substantial as they age. This emphasises the need to maintain long-term follow-up surveillance of young Hodgkin's disease patients apparently cured of their disease, and to continue to develop new less carcinogenic treatment regimes.An increased risk of second cancers after modern intensive treatment for Hodgkin's disease is well established (Kaldor et al., 1987). After radiotherapy there are raised risks of several solid tumours (Boivin & O'Brien, 1988), and probably also of leukaemia (Boivin et al., 1984; Tucker et al., 1988;Van Leeuwen et al., 1989). After chemotherapy, a very high risk of acute or non-lymphocytic leukaemia has been shown (Pedersen-Bjergaard et al., 1987; Tucker et al., 1988), and in a recent study we found solid cancer risk also to be increased (Swerdlow et al., 1992). The risks of these second primary malignancies in relation to host factors, and subtype and stage of Hodgkin's disease, are unclear. Investigation of this needs data sets with large numbers of patients, and the results which have been published have been inconsistent (Tucker et al., 1988; Van der Velden et al., 1988;Kaldor et al., 1990;Henry-Amar et al., 1990). We present here analyses of these factors in data from the British National Lymphoma Investigation (BNLI), a long-established, large clinical collaborative investigation whose files have detailed treatment data and virtually complete follow-up information. Materials and methodsThe BNLI is a collaborative group of over 60 participating centres in the UK, which has collected detailed data on the diagnosis, therapy and follow-up of lymphoma patients treated at the centres since 1970. Most of the patients were in rand...

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“…In addition, the estimated average follow-up period was only 3.6 years for the CT only patients, far shorter than for the RT and CT groups. 49 We therefore do not believe that the literature indicates a higher second malignancy risk exists after CMT than after single modality therapy.…”

Section: Risk Of Solid Tumorsmentioning

confidence: 99%

Impact on second malignancy risk of the combined use of radiation and chemotherapy for lymphomas

Lavey

Eby

Prosnitz

1990

Cancer

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The risk of a second malignancy was determined for 999 patients given primary treatment using chemotherapy only, radiation therapy only, or both for Hodgkin's Disease or a non-Hodgkin's lymphoma at Duke University Medical Center between 1970 and 1981. The incidence, 10-year actuarial risk, and relative risk of developing an acute leukemia, solid tumor, or second lymphoma were determined by treatment modality and initial lymphoma type. Among the 313 Hodgkin's disease patients, the acute leukemia actuarial risk was 2.0% after chemotherapy, 1.4% after radiation therapy, and 0.9% after combined treatment with chemotherapy and radiation therapy. Their relative risk for acute leukemia was 51.3 overall (95% confidence interval [CI] 13.8 to 131.8) and was elevated in each treatment group. Among the 686 non-Hodgkin's lymphoma patients, the acute leukemia actuarial risk was zero after radiation therapy, 4.6% after chemotherapy, and 4.5% after the combined treatment, again not significantly different between treatment groups. The leukemia relative risk was 10.6 (95% CI 3.4 to 24.8) in the chemotherapy and 11.9 (95% CI 3.2 to 30.6) in the combined treatment group. Among both the Hodgkin's disease and non-Hodgkin's lymphoma populations, the combined treatment group had a lower actuarial risk for solid tumors than either the chemotherapy or radiation therapy group (P less than 0.02). Solid tumor actuarial risk did not differ significantly between the chemotherapy and radiation therapy groups. Hodgkin's disease patients had a solid tumor relative risk that was elevated significantly after radiation therapy (6.5; 95% CI 2.4 to 14.0) and to a lesser extent after chemotherapy (2.6; 95% CI 0.8 to 6.1) or combined treatment (1.7; 95% CI 0.2 to 6.0). Solid tumor relative risk among non-Hodgkin's lymphoma patients was 0.3 for the combined treatment, 0.8 for the chemotherapy, and 1.0 for the radiation therapy group. None of the Hodgkin's disease patients developed a non-Hodgkin's lymphoma. This study found no significant difference in leukemia risk among lymphoma patients treated with chemotherapy and the combined treatment. It also found that the overall risk of a second malignancy is no higher after treatment with the combined therapy than with chemotherapy or radiation therapy alone.

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Solid cancer risk after treatment of Hodgkin's disease

Cited by 82 publications

References 26 publications

Second malignancy in patients with Hodgkin's disease treated at the Royal Marsden Hospital

Second malignancy in patients with Hodgkin's disease treated at the Royal Marsden Hospital

Risk of second primary cancer after Hodgkin's disease in patients in the British National Lymphoma Investigation: relationships to host factors, histology and stage of Hodgkin's disease, and splenectomy

Impact on second malignancy risk of the combined use of radiation and chemotherapy for lymphomas

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