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Second solid malignancies after combined modality therapy for Hodgkin's disease

R Doria1, T Holford, L R Farber

  • 1Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA.

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
|August 1, 1995
PubMed
Summary

Patients with recurrent Hodgkin's disease treated with combined modality therapy (CMT) faced a significantly higher risk of developing second solid malignancies. Those with previously untreated disease had only a modest, non-significant increase in risk.

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Area of Science:

  • Oncology
  • Cancer Epidemiology
  • Radiation Oncology

Background:

  • Hodgkin's disease treatment has evolved, with combined modality therapy (CMT) involving chemotherapy and radiation becoming standard.
  • Understanding the long-term risks of second solid malignancies (SSM) after CMT is crucial for patient management.
  • Previous studies have indicated a potential link between cancer treatments and secondary cancers.

Purpose of the Study:

  • To determine the actuarial incidence (AI) and relative risk (RR) of second solid malignancies (SSM) in Hodgkin's disease patients treated with CMT.
  • To compare the risk of SSM between patients with previously untreated advanced disease and those with recurrent disease after radiation.

Main Methods:

  • A cohort of 183 Hodgkin's disease patients treated with CMT between 1969 and 1983 was analyzed.

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  • Patients were divided into two groups: Group A (previously untreated advanced disease) and Group B (recurrent disease after radiation).
  • Actuarial incidence and relative risk of solid tumors (ST) and non-Hodgkin's lymphoma (NHL) were calculated during long-term follow-up.

    • Main Results:

    • At 20 years, the AI for SSM was 12% in Group A versus 41% in Group B.
    • The RR for developing ST was 1.88 (not significant) in Group A and 8.84 (significant) in Group B.
    • The RR for developing NHL was significantly increased in both groups, with no significant difference between them.

    Conclusions:

    • Patients treated with CMT for recurrent Hodgkin's disease (Group B) had a highly significant increase in the RR of ST.
    • Previously untreated patients (Group A) showed a modest, non-significant increase in ST risk.
    • Potential factors for increased ST risk in Group B include cumulative radiation, chemotherapy effects, or longer follow-up.