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Abstract
BACKGROUND Women treated with mantle irradiation for Hodgkin lymphoma (HL) are at an increased risk of developing breast cancer (BC). Current guidelines recommend screening breast magnetic resonance imaging (MRI) as an adjunct to mammography (M) in these patients. There are limited data, however, as to the impact of breast MRI on cancer detection rates. The aim of the current study is to evaluate the use of breast MRI in survivors of HL treated and followed at a single institution. MATERIALS AND METHODS We retrospectively reviewed 980 female patients treated with mantle irradiation for HL between 1961 and 2008. Records were reviewed to determine age at radiotherapy treatment, radiotherapy dose, breast imaging (including M and breast MRI), biopsy results if applicable, and incidence of BC. RESULTS A total of 118 patients had breast imaging performed at our institution. Median age at HL diagnosis was 28 years (range, 10 to 69 y). Median radiotherapy dose was 36 Gy (range, 20 to 45 Gy). Seventy-nine patients (67%) underwent M screening only, 1 (1%) breast MRI only, and 38 (32%) both M and breast MRI. Of these 38, 19 (50%) underwent 54 screening MRI studies (range per patient=1 to 8), 13 (34%) underwent preoperative MRI for workup of BC, and 6 (16%) initiated screening MRI of the contralateral breast only after diagnosed with BC. Fifty-nine biopsies were performed: 47 were prompted by suspicious M findings only, 10 by palpable findings on physical examination (PE), and 2 by suspicious breast MRI findings. Of the 47 biopsies prompted by M, 24 revealed malignant disease, whereas 23 proved to be benign. All 10 biopsies performed by palpation were malignant. Both biopsies prompted by MRI findings were benign. With M, there were 34 true-positive findings in 32 patients, 23 false-positive findings, and 1 false-negative finding. With screening MRI, there were 2 false-positive findings, 1 false-negative finding, and no true-positive findings. CONCLUSIONS The role of screening breast MRI in women previously irradiated for HL is evolving. Further education of patients and physicians is important to increase awareness of more sensitive BC screening modalities in this high-risk population. Future studies are necessary to determine the appropriate integration of screening breast MRI into the ongoing follow-up of these women.
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Haque W, Dabaja B, Tann A, Khan M, Szeja S, Butler EB, Teh BS. Changes in treatment patterns and impact of radiotherapy for early stage diffuse large B cell lymphoma after Rituximab: A population-based analysis. Radiother Oncol 2016; 120:150-5. [PMID: 27373911 DOI: 10.1016/j.radonc.2016.05.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/27/2016] [Accepted: 05/30/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Use of Rituximab for diffuse large B cell lymphoma (DLBCL) has improved outcomes and led to further questions regarding the benefit of consolidative radiation therapy (RT). This study sought to determine changes in RT utilization following the incorporation of Rituximab for treatment of early stage DLBCL and to examine survival outcomes. MATERIALS/METHODS We included patients in the Surveillance, Epidemiology, and End Results database, diagnosed with Stage I-II DLBCL between 1992 and 2011. Linear regression was performed to determine rate of RT utilization over time during the pre- and post-Rituximab eras (1992-2001 vs. 2002-2011). Kaplan-Meier and Cox Regression were performed to compare overall survival (OS) for patients treated with or without RT. Propensity-score matching was used to compare survival outcomes to account for indication bias. RESULTS 34,680 patients met the specified criteria. RT utilization was 35.2% in the pre-Rituximab era and 29.9% in the post-Rituximab era (P<0.001). Linear regression revealed that in the pre-Rituximab era the slope of the best fit line for RT utilization by year was positive (m=0.01, P=0.0046), while the slope was negative in the post-Rituximab era (m=-0.008, P=0.0102). RT use was associated with improved OS in both the pre-Rituximab era (hazard ratio [HR]=0.797; 95% confidence interval [CI] 0.756-0.841) and the post-Rituximab era (HR=0.745; 95% CI 0.702-0.789). Propensity-score matched analysis confirmed that RT use improved OS in the pre-Rituximab era (HR=0.844; 95% CI 0.793-0.897) and post-Rituximab era (0.754; 95% CI 0.703-0.809). CONCLUSION RT utilization has decreased following incorporation of Rituximab for first line treatment of DLBCL. RT use is associated with improved OS in both pre- and post-Rituximab eras, suggesting that RT should continue to be used for management of early stage DLBCL, even in the era of Rituximab.
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Affiliation(s)
- Waqar Haque
- Department of Radiation Oncology, Greater Houston Physicians in Medicine Association, United States
| | - Bouthaina Dabaja
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, United States
| | - Anne Tann
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, United States
| | - Mohammad Khan
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, United States
| | - Sean Szeja
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, United States
| | - E Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, United States
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, United States
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Appel BE, Chen L, Buxton AB, Hutchison RE, Hodgson DC, Ehrlich PF, Constine LS, Schwartz CL. Minimal Treatment of Low-Risk, Pediatric Lymphocyte-Predominant Hodgkin Lymphoma: A Report From the Children's Oncology Group. J Clin Oncol 2016; 34:2372-9. [PMID: 27185849 DOI: 10.1200/jco.2015.65.3469] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Children's Oncology Group study AHOD03P1 was designed to determine whether excellent outcomes can be maintained for patients with low-risk, pediatric lymphocyte-predominant Hodgkin lymphoma (LPHL) with a strategy of resection alone or minimal chemotherapy. PATIENTS AND METHODS Patients with stage IA LPHL in a single node that was completely resected were observed without further therapy; recurrences were treated with three cycles of doxorubicin/vincristine/prednisone/cyclophosphamide (AV-PC). Patients with unresected stage IA or stage IIA LPHL were treated with three cycles of AV-PC. Patients with less than a complete response (CR) to AV-PC received 21-Gy involved-field radiation therapy (IFRT). RESULTS A total of 183 eligible patients were enrolled; 178 were evaluable. Of these, 52 patients underwent complete resection of a single node. There were 13 relapses at a median of 11.5 months; 5-year event-free survival (EFS) was 77% (range, 62% to 87%). A total of 135 patients received AV-PC; 126 were treated at diagnosis and nine at relapse after surgery alone. Eleven patients receiving AV-PC had less than CR and received IFRT. Fourteen first events occurred among 135 patients (12 relapses and two second malignancies). Two relapses occurred in patients who had received IFRT. Five-year EFS was 88.8% (95% CI, 81.8% to 93.2%). Five-year EFS for the entire cohort was 85.5% (95% CI, 79.2% to 90.1%); overall survival was 100%. CONCLUSION Some 75% of highly selected pediatric patients with LPHL may be spared chemotherapy after surgical resection alone. Pediatric LPHL has excellent EFS with chemotherapy that is less intensive than standard regimens; > 90% of patients can avoid radiation therapy. The salvage rate for the few relapses is high, with 100% survival overall.
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Affiliation(s)
- Burton E Appel
- Burton E. Appel, Hackensack University Medical Center, Hackensack, NJ; Lu Chen and Allen B. Buxton, Children's Oncology Group, Monrovia, CA; Robert E. Hutchison, State University of New York Upstate Medical University, Syracuse; Louis S. Constine, University of Rochester, Rochester, NY; David C. Hodgson, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Lu Chen
- Burton E. Appel, Hackensack University Medical Center, Hackensack, NJ; Lu Chen and Allen B. Buxton, Children's Oncology Group, Monrovia, CA; Robert E. Hutchison, State University of New York Upstate Medical University, Syracuse; Louis S. Constine, University of Rochester, Rochester, NY; David C. Hodgson, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Allen B Buxton
- Burton E. Appel, Hackensack University Medical Center, Hackensack, NJ; Lu Chen and Allen B. Buxton, Children's Oncology Group, Monrovia, CA; Robert E. Hutchison, State University of New York Upstate Medical University, Syracuse; Louis S. Constine, University of Rochester, Rochester, NY; David C. Hodgson, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert E Hutchison
- Burton E. Appel, Hackensack University Medical Center, Hackensack, NJ; Lu Chen and Allen B. Buxton, Children's Oncology Group, Monrovia, CA; Robert E. Hutchison, State University of New York Upstate Medical University, Syracuse; Louis S. Constine, University of Rochester, Rochester, NY; David C. Hodgson, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX
| | - David C Hodgson
- Burton E. Appel, Hackensack University Medical Center, Hackensack, NJ; Lu Chen and Allen B. Buxton, Children's Oncology Group, Monrovia, CA; Robert E. Hutchison, State University of New York Upstate Medical University, Syracuse; Louis S. Constine, University of Rochester, Rochester, NY; David C. Hodgson, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peter F Ehrlich
- Burton E. Appel, Hackensack University Medical Center, Hackensack, NJ; Lu Chen and Allen B. Buxton, Children's Oncology Group, Monrovia, CA; Robert E. Hutchison, State University of New York Upstate Medical University, Syracuse; Louis S. Constine, University of Rochester, Rochester, NY; David C. Hodgson, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Louis S Constine
- Burton E. Appel, Hackensack University Medical Center, Hackensack, NJ; Lu Chen and Allen B. Buxton, Children's Oncology Group, Monrovia, CA; Robert E. Hutchison, State University of New York Upstate Medical University, Syracuse; Louis S. Constine, University of Rochester, Rochester, NY; David C. Hodgson, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cindy L Schwartz
- Burton E. Appel, Hackensack University Medical Center, Hackensack, NJ; Lu Chen and Allen B. Buxton, Children's Oncology Group, Monrovia, CA; Robert E. Hutchison, State University of New York Upstate Medical University, Syracuse; Louis S. Constine, University of Rochester, Rochester, NY; David C. Hodgson, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Cindy L. Schwartz, University of Texas MD Anderson Cancer Center, Houston, TX
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Ng AK, van Leeuwen FE. Hodgkin lymphoma: Late effects of treatment and guidelines for surveillance. Semin Hematol 2016; 53:209-15. [PMID: 27496313 DOI: 10.1053/j.seminhematol.2016.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Long-term survivors of Hodgkin lymphoma (HL) are at risk for a range of late effects, with second malignant neoplasm and cardiovascular diseases being the leading causes of death in these patients. The excess risks remain significantly elevated decades after treatment, and are clearly associated with extent of treatment exposures. Other late effects have also been identified, such as pulmonary dysfunction, endocrinopathies, muscle atrophy, and persistent fatigue. Systemic documentation of late effects and recognition of treatment- and patient-related risk factors are important, as they inform optimal surveillance and risk-reduction strategies, as well as guide therapeutic modifications in newly diagnosed patients to minimize treatment-related complications. As HL therapy evolves over time, with adoption of novel agents and contemporary treatment techniques, late effect risks and follow-up recommendations need to be continuously updated.
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Affiliation(s)
- Andrea K Ng
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Flora E van Leeuwen
- Department of Epidemiology, Division of Psychosocial Research & Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Farvid MS, Chen WY, Michels KB, Cho E, Willett WC, Eliassen AH. Fruit and vegetable consumption in adolescence and early adulthood and risk of breast cancer: population based cohort study. BMJ 2016; 353:i2343. [PMID: 27170029 PMCID: PMC5068921 DOI: 10.1136/bmj.i2343] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the association between fruit and vegetable intake during adolescence and early adulthood and risk of breast cancer. DESIGN Prospective cohort study. SETTING Health professionals in the United States. PARTICIPANTS 90 476 premenopausal women aged 27-44 from the Nurses' Health Study II who completed a questionnaire on diet in 1991 as well as 44 223 of those women who completed a questionnaire about their diet during adolescence in 1998. MAIN OUTCOME MEASURE Incident cases of invasive breast cancer, identified through self report and confirmed by pathology report. RESULTS There were 3235 cases of invasive breast cancer during follow-up to 2013. Of these, 1347 cases were among women who completed a questionnaire about their diet during adolescence (ages 13-18). Total fruit consumption during adolescence was associated with a lower risk of breast cancer. The hazard ratio was 0.75 (95% confidence interval 0.62 to 0.90; P=0.01 for trend) for the highest (median intake 2.9 servings/day) versus the lowest (median intake 0.5 serving/day) fifth of intake. The association for fruit intake during adolescence was independent of adult fruit intake. There was no association between risk and total fruit intake in early adulthood and total vegetable intake in either adolescence or early adulthood. Higher early adulthood intake of fruits and vegetables rich in α carotene was associated with lower risk of premenopausal breast cancer. The hazard ratio was 0.82 (0.70 to 0.96) for the highest fifth (median intake 0.5 serving/day) versus the lowest fifth (median intake 0.03 serving/day) intake. The association with adolescent fruit intake was stronger for both estrogen and progesterone receptor negative cancers than estrogen and progesterone receptor positive cancers (P=0.02 for heterogeneity). For individual fruits and vegetables, greater consumption of apple, banana, and grapes during adolescence and oranges and kale during early adulthood was significantly associated with a reduced risk of breast cancer. Fruit juice intake in adolescence or early adulthood was not associated with risk. CONCLUSION There is an association between higher fruit intake and lower risk of breast cancer. Food choices during adolescence might be particularly important.
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Affiliation(s)
- Maryam S Farvid
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA Harvard/Massachusetts General Hospital Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA
| | - Wendy Y Chen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Karin B Michels
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Eunyoung Cho
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Gözdaşoğlu S, Pamir A, Ünal E, Gökçora İH, Uluoğlu Ö, Ceyhan K, Deda H, Işıkman E, Yavuz G, Taçyıldız N, Çavdar A. Secondary Neoplasms in Children with Hodgkin's Lymphoma Receiving C-MOPP and Radiotherapy: Presentation of Four Cases. Turk J Haematol 2016; 33:66-70. [PMID: 26377258 PMCID: PMC4805347 DOI: 10.4274/tjh.2015.0027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Patients who survive Hodgkin lymphoma (HL) are at increased risk of secondary neoplasms (SNs). A wide variety of SNs have been reported, including leukemias, non-Hodgkin's lymphomas, and solid tumors, specifically breast and thyroid cancers. Herein we report subsequent neoplasms in four patients with HL receiving chemoradiotherapy. It is interesting that three SNs, fibrosarcoma, thyroid carcinoma, and retrobulbar meningioma, were observed in the radiation area in one of our patients. A hypopharyngeal epithelioid malignant peripheral nerve sheath tumor as an unusual secondary malignant neoplasm developed in another patient, while a benign thyroid nodule and invasive ductal breast carcinoma were observed at different times in the female patient. Follicular adenoma of the thyroid gland developed in one of our patients.
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Farvid MS, Eliassen AH, Cho E, Liao X, Chen WY, Willett WC. Dietary Fiber Intake in Young Adults and Breast Cancer Risk. Pediatrics 2016; 137:e20151226. [PMID: 26908709 PMCID: PMC4771124 DOI: 10.1542/peds.2015-1226] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We evaluated fiber intake during adolescence and early adulthood in relation to breast cancer (BC) risk in the Nurses' Health Study II. METHODS Among 90,534 premenopausal women who completed a dietary questionnaire in 1991, we documented 2833 invasive BC cases during 20 years of follow-up. In 1998, 44,263 of these women also completed a questionnaire about their diet during high school; among these women, we documented 1118 cases of BC by end of follow-up. Multivariable-adjusted Cox proportional hazards regression was used to model relative risks (RRs) and 95% confidence intervals (CIs) for BC across categories of dietary fiber. RESULTS Among all women, early adulthood total dietary fiber intake was associated with significantly lower BC risk (RR for highest versus lowest quintile 0.81; 95% CI 0.72-0.91; Ptrend = .002). Higher intakes of soluble fiber (RR for highest versus lowest quintile 0.86; 95% CI 0.77-0.97; Ptrend = .02) and insoluble fiber (RR for highest versus lowest quintile 0.80; 95% CI 0.71-0.90; Ptrend < .001) were each associated with lower BC risk. Total dietary fiber intake in adolescence was also associated with lower BC risk (RR for highest versus lowest quintile 0.84; 95% CI 0.70-1.01; Ptrend = .04). For the average of fiber intake during adolescence and early adult life, the RR comparing highest with lowest quintiles was 0.75 (95% CI 0.62-0.91, Ptrend = .004). CONCLUSIONS Our findings support the hypothesis that higher fiber intakes reduce BC risk and suggest that intake during adolescence and early adulthood may be particularly important.
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Affiliation(s)
| | - A. Heather Eliassen
- Epidemiology, and,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eunyoung Cho
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts;,Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Xiaomei Liao
- Epidemiology, and,Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Wendy Y. Chen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts;,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Walter C. Willett
- Departments of Nutrition,,Epidemiology, and,Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Adolescent Diet and Breast Cancer Risk. Curr Nutr Rep 2016. [DOI: 10.1007/s13668-016-0155-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bhuller KS, Zhang Y, Li D, Sehn LH, Goddard K, McBride ML, Rogers PC. Late mortality, secondary malignancy and hospitalisation in teenage and young adult survivors of Hodgkin lymphoma: report of the Childhood/Adolescent/Young Adult Cancer Survivors Research Program and the BC Cancer Agency Centre for Lymphoid Cancer. Br J Haematol 2016; 172:757-68. [PMID: 26727959 DOI: 10.1111/bjh.13903] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 10/30/2015] [Indexed: 02/02/2023]
Abstract
Late complications affecting Hodgkin lymphoma (HL) survivors are well described in paediatric and adult-based publications. This study determined the late morbidity and mortality risk for 442 teenage and young adult (TYAs) 5-year HL survivors, diagnosed at 15-24 years of age between 1970 and 1999, identified from the British Columbia Cancer Registry. Treatment details were abstracted from charts. Survivors and a matched comparison cohort were linked to provincial administrative health datasets until December 2006 and regression analysis was performed, providing risk ratios regarding mortality, secondary malignancy and morbidity causing hospitalisation. Sixty (13·6%) survivors experienced late mortality with excess deaths from secondary cancer [standardised mortality ratio (SMR) 18·6; 95% confidence interval (CI) 11-29·4] and non-malignant disease (SMR 3·6; 95% CI 2·2-5·5). Excess secondary cancers (standardised incidence ratio 7·8; 95% CI 5·6-10·5) were associated with radiotherapy [Hazard ratio (HR) 2·7; 95% CI 1-7·7] and female gender (HR 1·8; 95% CI 1-3·4). Of 281 survivors treated between 1981 and 1999, 143 (51%) had morbidity resulting in hospitalisation (relative risk 1·45; 95% CI 1·22-1·73). Hospitalisation significantly increased with combined modality therapy, chemotherapy alone and recent treatment era. TYA HL survivors have excess risk of mortality and secondary malignancy continuing 30 years from diagnosis. Radiotherapy is associated with secondary malignancy and current response-adapted protocols attempt to minimise exposure, but late morbidity causing hospitalisation remains significant.
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Affiliation(s)
- Kaljit S Bhuller
- Paediatric, Teenage & Young Adult (TYA) Haematology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK.,Division of Hematology, Oncology and Bone Marrow Transplant, British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Yang Zhang
- Cancer Control Research Program, British Columbia Cancer Research Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Dongdong Li
- Cancer Control Research Program, British Columbia Cancer Research Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Laurie H Sehn
- Division of Medical Oncology and Centre for Lymphoid Cancer, British Columbia Cancer Agency and University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Goddard
- Division of Radiation Oncology, British Columbia Cancer Agency and University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary L McBride
- Cancer Control Research Program, British Columbia Cancer Research Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul C Rogers
- Division of Hematology, Oncology and Bone Marrow Transplant, British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
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Schaapveld M, Aleman BMP, van Eggermond AM, Janus CPM, Krol ADG, van der Maazen RWM, Roesink J, Raemaekers JMM, de Boer JP, Zijlstra JM, van Imhoff GW, Petersen EJ, Poortmans PMP, Beijert M, Lybeert ML, Mulder I, Visser O, Louwman MWJ, Krul IM, Lugtenburg PJ, van Leeuwen FE. Second Cancer Risk Up to 40 Years after Treatment for Hodgkin's Lymphoma. N Engl J Med 2015; 373:2499-511. [PMID: 26699166 DOI: 10.1056/nejmoa1505949] [Citation(s) in RCA: 413] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Survivors of Hodgkin's lymphoma are at increased risk for treatment-related subsequent malignant neoplasms. The effect of less toxic treatments, introduced in the late 1980s, on the long-term risk of a second cancer remains unknown. METHODS We enrolled 3905 persons in the Netherlands who had survived for at least 5 years after the initiation of treatment for Hodgkin's lymphoma. Patients had received treatment between 1965 and 2000, when they were 15 to 50 years of age. We compared the risk of a second cancer among these patients with the risk that was expected on the basis of cancer incidence in the general population. Treatment-specific risks were compared within the cohort. RESULTS With a median follow-up of 19.1 years, 1055 second cancers were diagnosed in 908 patients, resulting in a standardized incidence ratio (SIR) of 4.6 (95% confidence interval [CI], 4.3 to 4.9) in the study cohort as compared with the general population. The risk was still elevated 35 years or more after treatment (SIR, 3.9; 95% CI, 2.8 to 5.4), and the cumulative incidence of a second cancer in the study cohort at 40 years was 48.5% (95% CI, 45.4 to 51.5). The cumulative incidence of second solid cancers did not differ according to study period (1965-1976, 1977-1988, or 1989-2000) (P=0.71 for heterogeneity). Although the risk of breast cancer was lower among patients who were treated with supradiaphragmatic-field radiotherapy not including the axilla than among those who were exposed to mantle-field irradiation (hazard ratio, 0.37; 95% CI, 0.19 to 0.72), the risk of breast cancer was not lower among patients treated in the 1989-2000 study period than among those treated in the two earlier periods. A cumulative procarbazine dose of 4.3 g or more per square meter of body-surface area (which has been associated with premature menopause) was associated with a significantly lower risk of breast cancer (hazard ratio for the comparison with no chemotherapy, 0.57; 95% CI, 0.39 to 0.84) but a higher risk of gastrointestinal cancer (hazard ratio, 2.70; 95% CI, 1.69 to 4.30). CONCLUSIONS The risk of second solid cancers did not appear to be lower among patients treated in the most recent calendar period studied (1989-2000) than among those treated in earlier periods. The awareness of an increased risk of second cancer remains crucial for survivors of Hodgkin's lymphoma. (Funded by the Dutch Cancer Society.).
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Affiliation(s)
- Michael Schaapveld
- From the Departments of Epidemiology (M.S., A.M.E., I.M., I.M.K., F.E.L.), Radiation Oncology (B.M.P.A.), and Hematology (J.P.B.), Netherlands Cancer Institute, and the Department of Hematology, VU University Medical Center Amsterdam (J.M.Z.), Amsterdam, the Netherlands Comprehensive Cancer Organization (M.S., I.M., O.V., M.W.J.L.) and the Departments of Radiation Oncology (J.R.) and Hematology (E.J.P.), University Medical Center Utrecht, Utrecht, the Departments of Radiation Oncology (C.P.M.J.) and Hematology (P.J.L.), Erasmus Medical Center Cancer Institute, Rotterdam, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (A.D.G.K.), the Department of Radiation Oncology, Radboud University Medical Center (R.W.M.M., P.M.P.P.), and the Department of Education and Science, Canisius-Wilhelmina Hospital (I.M.), Nijmegen, the Department of Hematology, Radboud University Medical Center, Nijmegen-Rijnstate, Arnhem (J.M.M.R.), the Departments of Hematology (G.W.I.) and Radiation Oncology (M.B.), University Medical Center Groningen, Groningen, the Department of Radiation Oncology, Dr. Bernard Verbeeten Institute, Tilburg (P.M.P.P.), and the Department of Radiotherapy, Catharina Hospital, Eindhoven (M.L.L.) - all in the Netherlands
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Lee JS, DuBois SG, Coccia PF, Bleyer A, Olin RL, Goldsby RE. Increased risk of second malignant neoplasms in adolescents and young adults with cancer. Cancer 2015; 122:116-23. [DOI: 10.1002/cncr.29685] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/06/2015] [Accepted: 08/14/2015] [Indexed: 01/19/2023]
Affiliation(s)
- Jean S. Lee
- Department of Pediatrics; University of California San Francisco Benioff Children's Hospital San Francisco; San Francisco California
| | - Steven G. DuBois
- Department of Pediatrics; University of California San Francisco Benioff Children's Hospital San Francisco; San Francisco California
| | - Peter F. Coccia
- Department of Pediatrics; University of Nebraska Medical Center; Omaha Nebraska
| | - Archie Bleyer
- Department of Radiation Medicine; Oregon Health and Science University; Portland Oregon
| | - Rebecca L. Olin
- Department of Medicine; University of California San Francisco; San Francisco California
| | - Robert E. Goldsby
- Department of Pediatrics; University of California San Francisco Benioff Children's Hospital San Francisco; San Francisco California
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Schneider U, Walsh L. Age at exposure and attained age variations of cancer risk in the Japanese A-bomb and radiotherapy cohorts. Med Phys 2015; 42:4755-61. [DOI: 10.1118/1.4927062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Management of Nodular Lymphocyte Predominant Hodgkin Lymphoma in the Modern Era. Int J Radiat Oncol Biol Phys 2015; 92:67-75. [DOI: 10.1016/j.ijrobp.2015.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/15/2015] [Accepted: 02/02/2015] [Indexed: 11/22/2022]
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Giulino-Roth L, Keller FG, Hodgson DC, Kelly KM. Current approaches in the management of low risk Hodgkin lymphoma in children and adolescents. Br J Haematol 2015; 169:647-60. [PMID: 25824371 DOI: 10.1111/bjh.13372] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The outcome for children and adolescents with low risk Hodgkin lymphoma (HL) is excellent, with event-free survival >85% and overall survival >95%. Historically, however, treatment has come at the cost of significant long-term toxicity from chemotherapy, radiation or a combination of these. Recent treatment strategies have focused on maintaining high event-free and overall survival while minimizing the use of therapy associated with late effects. The strategies used to achieve this vary greatly among paediatric cooperative groups and there is no one standard treatment for children with low risk HL. This review summaries recent clinical trials in paediatric low risk HL and addresses some of the important considerations when comparing trials, including differences in the definition of low risk HL, differences in outcome among histological subtypes and varying approaches to reduce or eliminate radiation therapy. Recommendations are provided for the treatment of children with low risk HL outside the setting of a clinical trial.
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Affiliation(s)
- Lisa Giulino-Roth
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA.,Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Frank G Keller
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University, Atlanta, GA, USA
| | - David C Hodgson
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, ON, USA
| | - Kara M Kelly
- Division of Pediatric Hematology/Oncology/Stem Cell Transplant, Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
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Farvid MS, Eliassen AH, Cho E, Chen WY, Willett WC. Adolescent and Early Adulthood Dietary Carbohydrate Quantity and Quality in Relation to Breast Cancer Risk. Cancer Epidemiol Biomarkers Prev 2015; 24:1111-20. [PMID: 25805068 DOI: 10.1158/1055-9965.epi-14-1401] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/14/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We investigated quantity and quality of dietary carbohydrate as well as insulin load and insulin index during adolescence and also early adulthood in relation to risk of breast cancer in the Nurses' Health Study II. METHODS During 20 years of follow-up of 90,534 premenopausal women who completed a diet questionnaire in 1991, 2,833 invasive breast cancer cases were documented. In 1998, 44,263 of these women also completed a questionnaire about their diet during high school; among these women, we documented 1,118 cases of breast cancer. Multivariable-adjusted Cox proportional hazards regression was used to model relative risks (RR) and 95% confidence intervals (95% CI) for breast cancer across categories of dietary carbohydrate, glycemic index (GI), glycemic load (GL), as well as insulin load and insulin index scores. RESULTS Adolescent or early adult intakes of GI or GL were not associated with risk of breast cancer. Comparing women in the highest versus lowest quintile, the multivariable-adjusted RRs were 1.14 (0.95-1.38) for adolescent GI scores and 1.03 (0.91-1.16) for early adulthood GI scores. We also did not observe associations with insulin index and insulin load scores in adolescence or early adulthood and breast cancer risk. CONCLUSIONS We found that diets high in GI, GL, insulin index, and insulin load during adolescence or early adulthood were not associated with an increased risk of breast cancer in this cohort study. IMPACT Diets with a high glucose or insulin response in adolescence or early adulthood were not significant predictors of breast cancer incidence.
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Affiliation(s)
- Maryam S Farvid
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Eunyoung Cho
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Wendy Y Chen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Manem VSK, Kohandel M, Hodgson DC, Sharpe MB, Sivaloganathan S. The effect of radiation quality on the risks of second malignancies. Int J Radiat Biol 2015; 91:209-17. [PMID: 25356906 DOI: 10.3109/09553002.2014.980466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
UNLABELLED Abstract Purpose: Numerous studies have implicated elevated second cancer risks as a result of radiation therapy. Our aim in this paper was to contribute to an understanding of the effects of radiation quality on second cancer risks. In particular, we developed a biologically motivated model to study the effects of linear energy transfer (LET) of charged particles (including protons, alpha particles and heavy ions Carbon and Neon) on the risk of second cancer. MATERIALS AND METHODS A widely used approach to estimate the risk uses the so-called initiation-inactivation-repopulation model. Based on the available experimental data for the LET dependence of radiobiological parameters and mutation rate, we generalized this formulation to include the effects of radiation quality. We evaluated the secondary cancer risks for protons in the clinical range of LET, i.e., around 4-10 (KeV/μm), which lies in the plateau region of the Bragg peak. RESULTS For protons, at a fixed radiation dose, we showed that the increase in second cancer risks correlated directly with increasing values of LET to a certain point, and then decreased. Interestingly, we obtained a higher risk for proton LET of 10 KeV/μm compared to the lower LET of 4 KeV/μm in the low dose region. In the case of heavy ions, the risk was higher for Carbon ions than Neon ions (even though they have almost the same LET). We also compared protons and alpha particles with the same LET, and it was interesting to note that the second cancer risks were higher for protons compared to alpha particles in the low-dose region. CONCLUSION Overall, this study demonstrated the importance of including LET dependence in the estimation of second cancer risk. Our theoretical risk predictions were noticeably high; however, the biological end points should be tested experimentally for multiple treatment fields and to improve theoretical predictions.
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Affiliation(s)
- Venkata S K Manem
- Department of Applied Mathematics, University of Waterloo , Waterloo, Ontario , Canada
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Hauptmann M, Fossa SD, Stovall M, van Leeuwen FE, Johannesen TB, Rajaraman P, Gilbert ES, Smith SA, Weathers RE, Aleman BMP, Andersson M, Curtis RE, Dores GM, Fraumeni JF, Hall P, Holowaty EJ, Joensuu H, Kaijser M, Kleinerman RA, Langmark F, Lynch CF, Pukkala E, Storm HH, Vaalavirta L, van den Belt-Dusebout AW, Travis LB, Morton LM. Increased stomach cancer risk following radiotherapy for testicular cancer. Br J Cancer 2015; 112:44-51. [PMID: 25349972 PMCID: PMC4453604 DOI: 10.1038/bjc.2014.552] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 10/02/2014] [Accepted: 10/04/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Abdominal radiotherapy for testicular cancer (TC) increases risk for second stomach cancer, although data on the radiation dose-response relationship are sparse. METHODS In a cohort of 22,269 5-year TC survivors diagnosed during 1959-1987, doses to stomach subsites were estimated for 92 patients who developed stomach cancer and 180 matched controls. Chemotherapy details were recorded. Odds ratios (ORs) were estimated using logistic regression. RESULTS Cumulative incidence of second primary stomach cancer was 1.45% at 30 years after TC diagnosis. The TC survivors who received radiotherapy (87 (95%) cases, 151 (84%) controls) had a 5.9-fold (95% confidence interval (CI) 1.7-20.7) increased risk of stomach cancer. Risk increased with increasing stomach dose (P-trend<0.001), with an OR of 20.5 (3.7-114.3) for ⩾50.0 Gy compared with <10 Gy. Radiation-related risks remained elevated ⩾20 years after exposure (P<0.001). Risk after any chemotherapy was not elevated (OR=1.1; 95% CI 0.5-2.5; 14 cases and 23 controls). CONCLUSIONS Radiotherapy for TC involving parts of the stomach increased gastric cancer risk for several decades, with the highest risks after stomach doses of ⩾30 Gy. Clinicians should be aware of these excesses when previously irradiated TC survivors present with gastrointestinal symptoms and when any radiotherapy is considered in newly diagnosed TC patients.
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Affiliation(s)
- M Hauptmann
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - S D Fossa
- Department of Oncology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - M Stovall
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - F E van Leeuwen
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | | | - P Rajaraman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - E S Gilbert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - S A Smith
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R E Weathers
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - B M P Aleman
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Andersson
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - R E Curtis
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - G M Dores
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
- Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - J F Fraumeni
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - P Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - E J Holowaty
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - H Joensuu
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - M Kaijser
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - R A Kleinerman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | | | - C F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - E Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - H H Storm
- Cancer Prevention and Documentation, Danish Cancer Society, Copenhagen, Denmark
| | - L Vaalavirta
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - A W van den Belt-Dusebout
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - L B Travis
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - L M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
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Fujita S, Masago K, Takeshita J, Togashi Y, Hata A, Kaji R, Kokubo M, Katakami N. Multiple primary malignancies in patients with non-small cell lung cancer. Intern Med 2015; 54:325-31. [PMID: 25748742 DOI: 10.2169/internalmedicine.54.2921] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Information regarding multiple primary malignancies is important, as it has the potential to clarify etiological factors and may indicate the need to refine patient follow-up to include screening for associated malignancies. Upper aerodigestive tract cancer often develops in patients with smoking-related lung cancer; however, little is known about the frequencies or types of other primary malignancies in patients with non-small cell lung cancer (NSCLC) without a history of smoking. METHODS We retrospectively evaluated the records of patients examined and/or treated for NSCLC at the Institute of Biomedical Research and Innovation between January 2007 and June 2012. Patients In total, 938 patients, including 599 men (never-smoker/ever-smoker: 35/564) and 339 women (never-smoker/ever-smoker: 236/103), were analyzed. RESULTS Among the 209 patients (22.3%) with multiple primary malignancies, 151 had a history of smoking and 58 were never-smokers. The most common cancers were gastric (43 cases), colorectal (33 cases), and prostate (29 cases) cancer. Smoking-related cancer was more common in current smokers and ex-smokers for both men and women. Among women with NSCLC, never-smokers were more likely to have thyroid cancer than those with a history of smoking (5.1% vs. 0%, p=0.021). CONCLUSION In this study, several differences in malignancies were observed between never-smokers and patients with a history of smoking. Thyroid cancer and NSCLC co-existed in some women without a history of smoking, implicating predisposing factors other than tobacco smoke in the onset of these cancers.
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Affiliation(s)
- Shiro Fujita
- Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Japan
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Englund A, Hopstadius C, Enblad G, Gustafsson G, Ljungman G. Hodgkin lymphoma--a survey of children and adolescents treated in Sweden 1985-2009. Acta Oncol 2015; 54:41-8. [PMID: 25203597 PMCID: PMC4364274 DOI: 10.3109/0284186x.2014.948058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hodgkin lymphoma (HL) in children constitutes approximately 30% of all pediatric lymphomas in Sweden. The chance of cure is high, but the frequency of late effects has been considerable. Over recent years, efforts have been made to reduce treatment with maintained survival. MATERIAL AND METHODS All patients 0-17 years, identified in the Swedish Childhood Cancer Register as diagnosed between 1985 and 2009, were included. The material was analyzed using descriptive statistics and for survival estimates the Kaplan-Meier method was used. RESULTS Three hundred and thirty-four patients were identified during this time period. The median age was 14 years. Male sex was over-represented, especially in lower age groups and in nodular lymphocyte predominant Hodgkin lymphoma (NLPHL). In nodular sclerosis and in age group 15-17 years, female sex dominated. Most of the cases presented in stages I or II. B-symptoms were present in 38% of cHL, but only in 7% of NLPHL. The number of patients receiving radiotherapy has been significantly reduced during the period studied. The relapse rate in cHL was 10 ± 2% and in NLPHL 16 ± 7%. The relapse rate was significantly higher in cHL stage IIB compared to other stages in the same therapy group. In cHL 6% died, and in NLPHL 0%. The 5-, 10- and 20-year overall survival estimates in cHL were 96 ± 1%, 95 ± 1% and 90 ± 3%, respectively, with no significant difference when comparing different treatment regimens and time periods. The 5- and 10-year overall survival after relapse in cHL was 81 ± 8% and 75 ± 10%, respectively. CONCLUSION During the period studied there is no indication of a decline in survival despite changes in treatment. Survival rates in Sweden are high, and even after relapse chances of cure are high. We were not able to identify any characteristics specific for the group of patients that did not survive.
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Affiliation(s)
- Annika Englund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Correspondence: A. Englund, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. E-mail:
| | - Charlotte Hopstadius
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Gunilla Enblad
- Department of Radiology, Oncology, and Radiation Sciences, Uppsala University, Uppsala, Sweden
| | - Göran Gustafsson
- Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden
| | - Gustaf Ljungman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Farvid MS, Cho E, Chen WY, Eliassen AH, Willett WC. Adolescent meat intake and breast cancer risk. Int J Cancer 2014; 136:1909-20. [PMID: 25220168 DOI: 10.1002/ijc.29218] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 08/26/2014] [Accepted: 08/28/2014] [Indexed: 12/21/2022]
Abstract
The breast is particularly vulnerable to carcinogenic influences during adolescence due to rapid proliferation of mammary cells and lack of terminal differentiation. We investigated consumption of adolescent red meat and other protein sources in relation to breast cancer risk in the Nurses' Health Study II cohort. We followed prospectively 44,231 women aged 33-52 years who, in 1998, completed a detailed questionnaire about diet during adolescence. Relative risks (RR) and 95% confidence intervals (95%CI) were estimated using Cox proportional hazard regression. We documented 1132 breast cancer cases during 13-year follow-up. In multivariable Cox regression models with major breast cancer risk factors adjustment, greater consumption of total red meat in adolescence was significantly associated with higher premenopausal breast cancer risk (highest vs. lowest quintiles, RR, 1.43; 95%CI, 1.05-1.94; Ptrend = 0.007), but not postmenopausal breast cancer. Adolescent intake of poultry was associated with lower risk of breast cancer overall (RR, 0.76; 95%CI, 0.60-0.97; for each serving/day). Adolescent intakes of iron, heme iron, fish, eggs, legumes and nuts were not associated with breast cancer. Replacement of one serving/day of total red meat with one serving of combination of poultry, fish, legumes, and nuts was associated with a 15% lower risk of breast cancer overall (RR, 0.85; 95%CI, 0.74-0.96) and a 23% lower risk of premenopausal breast cancer (RR, 0.77; 95%CI, 0.64-0.92). In conclusion, higher consumption of red meat during adolescence was associated with premenopausal breast cancer. Substituting other dietary protein sources for red meat in adolescent diet may decrease premenopausal breast cancer risk.
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Affiliation(s)
- Maryam S Farvid
- Department of Nutrition, Harvard School of Public Health, Boston, MA; Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kubicka S. [Radiotherapy of bulky disease after completion of chemotherapy improves immune outcome of elderly patients with aggressive B-cell lymphoma. ]. Strahlenther Onkol 2014; 190:770-1. [PMID: 25187913 DOI: 10.1007/s00066-014-0701-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Holtzman AL, Hoppe BS, Li Z, Su Z, Slayton WB, Ozdemir S, Joyce M, Sandler E, Mendenhall NP, Flampouri S. Advancing the Therapeutic Index in Stage III/IV Pediatric Hodgkin Lymphoma with Proton Therapy. Int J Part Ther 2014. [DOI: 10.14338/ijpt.14.00001.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Norval EJG, Raubenheimer EJ. Second malignancies in Hodgkin's disease: A review of the literature and report of a case with a secondary Lennert's lymphoma. J Oral Maxillofac Pathol 2014; 18:S90-5. [PMID: 25364188 PMCID: PMC4211247 DOI: 10.4103/0973-029x.141332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 06/16/2014] [Indexed: 11/16/2022] Open
Abstract
A small percentage of patients treated for Hodgkin's disease are at risk of developing a second malignancy. The appearance of secondary malignancies such as leukemia, carcinoma or non-Hodgkin's lymphomas may be attributed to the mutagenic effects of chemotherapy and/or radiotherapy. Most secondary non-Hodgkin's lymphomas are of the B-cell type, but isolated cases were reportedly of a T-cell lineage. A review of the literature pertaining to the development of secondary peripheral T-cell lymphomas is presented along with the description of an additional case. The latter developed in the tonsil and was diagnosed as a Lennert's lymphoma (lymphoepithelioid T cell lymphoma)on histological and immunological grounds. This report also reviews the development of a of peripheral T-cell lymphoma described in patients following chemotherapy and/or radiotherapy for Hodgkin's disease.
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Affiliation(s)
- Ernst JG Norval
- Department of Diagnostics, University of the Western Cape, Tygerberg, South Africa
| | - Erich J Raubenheimer
- Department of Pathology, School of Oral Health Sciences, University of Limpopo, Limpopo, South Africa
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Barr RD. Risk of Premature Menopause After Treatment for Hodgkin's Lymphoma. J Natl Cancer Inst 2014; 106:dju231. [DOI: 10.1093/jnci/dju231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Wattson DA, Hunink MGM, DiPiro PJ, Das P, Hodgson DC, Mauch PM, Ng AK. Low-dose chest computed tomography for lung cancer screening among Hodgkin lymphoma survivors: a cost-effectiveness analysis. Int J Radiat Oncol Biol Phys 2014; 90:344-53. [PMID: 25104066 DOI: 10.1016/j.ijrobp.2014.06.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 05/29/2014] [Accepted: 06/03/2014] [Indexed: 01/02/2023]
Abstract
PURPOSE Hodgkin lymphoma (HL) survivors face an increased risk of treatment-related lung cancer. Screening with low-dose computed tomography (LDCT) may allow detection of early stage, resectable cancers. We developed a Markov decision-analytic and cost-effectiveness model to estimate the merits of annual LDCT screening among HL survivors. METHODS AND MATERIALS Population databases and HL-specific literature informed key model parameters, including lung cancer rates and stage distribution, cause-specific survival estimates, and utilities. Relative risks accounted for radiation therapy (RT) technique, smoking status (>10 pack-years or current smokers vs not), age at HL diagnosis, time from HL treatment, and excess radiation from LDCTs. LDCT assumptions, including expected stage-shift, false-positive rates, and likely additional workup were derived from the National Lung Screening Trial and preliminary results from an internal phase 2 protocol that performed annual LDCTs in 53 HL survivors. We assumed a 3% discount rate and a willingness-to-pay (WTP) threshold of $50,000 per quality-adjusted life year (QALY). RESULTS Annual LDCT screening was cost effective for all smokers. A male smoker treated with mantle RT at age 25 achieved maximum QALYs by initiating screening 12 years post-HL, with a life expectancy benefit of 2.1 months and an incremental cost of $34,841/QALY. Among nonsmokers, annual screening produced a QALY benefit in some cases, but the incremental cost was not below the WTP threshold for any patient subsets. As age at HL diagnosis increased, earlier initiation of screening improved outcomes. Sensitivity analyses revealed that the model was most sensitive to the lung cancer incidence and mortality rates and expected stage-shift from screening. CONCLUSIONS HL survivors are an important high-risk population that may benefit from screening, especially those treated in the past with large radiation fields including mantle or involved-field RT. Screening may be cost effective for all smokers but possibly not for nonsmokers despite a small life expectancy benefit.
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Affiliation(s)
| | - M G Myriam Hunink
- Departments of Radiology and Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands and Center for Health Decision Science, Harvard School of Public Health, Boston, Massachusetts
| | - Pamela J DiPiro
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Prajnan Das
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David C Hodgson
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Peter M Mauch
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Andrea K Ng
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
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Abstract
Key Points
Hodgkin lymphoma survivors who developed a second malignancy remain at high risk of developing subsequent malignancies. Treatment options for these malignancies may be more restricted making early detection especially important to improving outcome.
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Farvid MS, Cho E, Chen WY, Eliassen AH, Willett WC. Dietary protein sources in early adulthood and breast cancer incidence: prospective cohort study. BMJ 2014; 348:g3437. [PMID: 24916719 PMCID: PMC4051890 DOI: 10.1136/bmj.g3437] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To investigate the association between dietary protein sources in early adulthood and risk of breast cancer. DESIGN Prospective cohort study. SETTING Health professionals in the United States. PARTICIPANTS 88,803 premenopausal women from the Nurses' Health Study II who completed a questionnaire on diet in 1991. MAIN OUTCOME MEASURE Incident cases of invasive breast carcinoma, identified through self report and confirmed by pathology report. RESULTS We documented 2830 cases of breast cancer during 20 years of follow-up. Higher intake of total red meat was associated with an increased risk of breast cancer overall (relative risk 1.22, 95% confidence interval 1.06 to 1.40; P(trend) = 0.01, for highest fifth v lowest fifth of intake). However, higher intakes of poultry, fish, eggs, legumes, and nuts were not related to breast cancer overall. When the association was evaluated by menopausal status, higher intake of poultry was associated with a lower risk of breast cancer in postmenopausal women (0.73, 0.58 to 0.91; P(trend) =0.02, for highest fifth v lowest fifth of intake) but not in premenopausal women (0.93, 0.78 to 1.11; P(trend) = 0.60, for highest fifth v lowest fifth of intake). In estimating the effects of exchanging different protein sources, substituting one serving/day of legumes for one serving/day of red meat was associated with a 15% lower risk of breast cancer among all women (0.85, 0.73 to 0.98) and a 19% lower risk among premenopausal women (0.81, 0.66 to 0.99). Also, substituting one serving/day of poultry for one serving/day of red meat was associated with a 17% lower risk of breast cancer overall (0.83, 0.72 to 0.96) and a 24% lower risk of postmenopausal breast cancer (0.76, 0.59 to 0.99). Furthermore, substituting one serving/day of combined legumes, nuts, poultry, and fish for one serving/day of red meat was associated with a 14% lower risk of breast cancer overall (0.86, 0.78 to 0.94) and premenopausal breast cancer (0.86, 0.76 to 0.98). CONCLUSION Higher red meat intake in early adulthood may be a risk factor for breast cancer, and replacing red meat with a combination of legumes, poultry, nuts and fish may reduce the risk of breast cancer.
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Affiliation(s)
- Maryam S Farvid
- Department of Nutrition, Harvard School of Public Health, Boston 02115, MA, USA Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Eunyoung Cho
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Wendy Y Chen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Walter C Willett
- Department of Nutrition, Harvard School of Public Health, Boston 02115, MA, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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79
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Yurgelun MB, Hornick JL, Curry VK, Ukaegbu CI, Brown EK, Hiller E, Chittenden A, Goldberg JE, Syngal S. Therapy-associated polyposis as a late sequela of cancer treatment. Clin Gastroenterol Hepatol 2014; 12:1046-50. [PMID: 24362051 PMCID: PMC4032605 DOI: 10.1016/j.cgh.2013.11.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 11/28/2013] [Indexed: 02/07/2023]
Abstract
Survivors of childhood cancers are at increased risk of developing secondary gastrointestinal cancers, including colorectal cancer, later in life, possibly from exposure to abdominopelvic radiotherapy and/or alkylating chemotherapy. Profuse gastrointestinal polyposis is associated with rare, inherited colorectal cancer predisposition syndromes, most commonly caused by mutations in the adenomatous polyposis coli (APC) or mutY homolog (MUTYH) genes. We describe 5 patients who developed gastrointestinal polyposis many years after radiotherapy and chemotherapy for a childhood cancer. Genetic analysis of all 5 subjects did not identify pathogenic germline mutations in APC or MUTYH. Chemotherapy and/or radiotherapy therefore might cause gastrointestinal polyposis in some patients by undiscovered mechanisms.
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Affiliation(s)
- Matthew B. Yurgelun
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
,Harvard Medical School, Boston, Massachusetts, USA
,Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jason L. Hornick
- Harvard Medical School, Boston, Massachusetts, USA
,Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | | | | | - Emily K. Brown
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Elaine Hiller
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Anu Chittenden
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Joel E. Goldberg
- Harvard Medical School, Boston, Massachusetts, USA
,Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Sapna Syngal
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
,Harvard Medical School, Boston, Massachusetts, USA
,Brigham and Women’s Hospital, Boston, Massachusetts, USA
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80
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Morton LM, Swerdlow AJ, Schaapveld M, Ramadan S, Hodgson DC, Radford J, van Leeuwen FE. Current knowledge and future research directions in treatment-related second primary malignancies. EJC Suppl 2014; 12:5-17. [PMID: 26217162 PMCID: PMC4250537 DOI: 10.1016/j.ejcsup.2014.05.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 03/26/2014] [Indexed: 01/13/2023] Open
Abstract
Currently, 17-19% of all new primary malignancies occur in survivors of cancer, causing substantial morbidity and mortality. Research has shown that cancer treatments are important contributors to second malignant neoplasm (SMN) risk. In this paper we summarise current knowledge with regard to treatment-related SMNs and provide recommendations for future research. We address the risks associated with radiotherapy and systemic treatments, modifying factors of treatment-related risks (genetic susceptibility, lifestyle) and the potential benefits of screening and interventions. Research priorities were identified during a workshop at the 2014 Cancer Survivorship Summit organised by the European Organisation for Research and Treatment of Cancer. Recently, both systemic cancer treatments and radiotherapy approaches have evolved rapidly, with the carcinogenic potential of new treatments being unknown. Also, little knowledge is available about modifying factors of treatment-associated risk, such as genetic variants and lifestyle. Therefore, large prospective studies with biobanking, high quality treatment data (radiation dose-volume, cumulative drug doses), and data on other cancer risk factors are needed. International collaboration will be essential to have adequate statistical power for such investigations. While screening for SMNs is included in several follow-up guidelines for cancer survivors, its effectiveness in this special population has not been demonstrated. Research into the pathogenesis, tumour characteristics and survival of SMNs is essential, as well as the development of interventions to reduce SMN-related morbidity and mortality. Prediction models for SMN risk are needed to inform initial treatment decisions, balancing chances of cure and SMNs and to identify high-risk subgroups of survivors eligible for screening.
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Affiliation(s)
- Lindsay M. Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Anthony J. Swerdlow
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey SM2 5NG, United Kingdom
| | - Michael Schaapveld
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Safaa Ramadan
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - David C. Hodgson
- Radiation Medicine Program, Princess Margaret Hospital, University Health Network, and Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - John Radford
- The University of Manchester and The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Flora E. van Leeuwen
- Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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81
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Moteabbed M, Yock TI, Paganetti H. The risk of radiation-induced second cancers in the high to medium dose region: a comparison between passive and scanned proton therapy, IMRT and VMAT for pediatric patients with brain tumors. Phys Med Biol 2014; 59:2883-99. [PMID: 24828559 DOI: 10.1088/0031-9155/59/12/2883] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The incidence of second malignant tumors is a clinically observed adverse late effect of radiation therapy, especially in organs close to the treatment site, receiving medium to high doses (>2.5 Gy). For pediatric patients, choosing the least toxic radiation modality is of utmost importance, due to their high radiosensitivity and small size. This study aims to evaluate the risk of second cancer incidence in the vicinity of the primary radiation field, for pediatric patients with brain/head and neck tumors and compare four treatment modalities: passive scattering and pencil beam scanning proton therapy (PPT and PBS), intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). For a cohort of six pediatric patients originally treated with PPT, additional PBS, IMRT and VMAT plans were created. Dose distributions from these plans were used to calculate the excess absolute risk (EAR) and lifetime attributable risk (LAR) for developing a second tumor in soft tissue and skull. A widely used risk assessment formalism was employed and compared with a linear model based on recent clinical findings. In general, LAR was found to range between 0.01%-2.8% for PPT/PBS and 0.04%-4.9% for IMRT/VMAT. PBS was associated with the lowest risk for most patients using carcinoma and sarcoma models, whereas IMRT and VMAT risks were comparable and the highest among all modalities. The LAR for IMRT/VMAT relative to PPT ranged from 1.3-4.6 for soft tissue and from 3.5-9.5 for skull. Larger absolute LAR was observed for younger patients and using linear risk models. The number of fields used in proton therapy and IMRT had minimal effect on the risk. When planning treatments and deciding on the treatment modality, the probability of second cancer incidence should be carefully examined and weighed against the possibility of developing acute side effects for each patient individually.
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Affiliation(s)
- Maryam Moteabbed
- Massachusetts General Hospital, Boston, MA 02114, USA. Harvard Medical School, Boston, MA 02115, USA
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82
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Kahl BS. Bulky Aggressive B-Cell Lymphoma: To Radiate or Not to Radiate—That Is the Question. J Clin Oncol 2014; 32:1097-8. [DOI: 10.1200/jco.2013.54.1730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Brad S. Kahl
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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83
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Farvid MS, Cho E, Chen WY, Eliassen AH, Willett WC. Premenopausal dietary fat in relation to pre- and post-menopausal breast cancer. Breast Cancer Res Treat 2014; 145:255-65. [PMID: 24715379 DOI: 10.1007/s10549-014-2895-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 02/19/2014] [Indexed: 11/26/2022]
Abstract
We examined the association between fat intake and breast cancer incidence in the Nurses' Health Study II. We followed 88,804 women aged 26-45 years from 1991 to 2011 and documented incident breast cancers. Dietary fat, assessed by questionnaires in 1991, was examined in relation to total, premenopausal, and postmenopausal breast cancers. Multivariable-adjusted Cox proportional hazards models were used to estimate relative risk (RR) and 95 % confidence intervals (95 % CI). During 20 years of follow-up, 2,830 incident invasive breast cancer cases were diagnosed. Total fat intake was not associated with risk of breast cancer overall. After adjustment for demographic, anthropometric, lifestyle, and dietary factors, a positive association was observed between animal fat intake and breast cancer overall (RR for highest vs lowest quintile, 1.18; 95 % CI 1.04-1.33; P trend = 0.01). A positive association with animal fat intake was also seen among premenopausal women, but not among postmenopausal women. Higher intakes of saturated fat and monounsaturated fat were each associated with modestly higher breast cancer risk among all women, and higher cholesterol intake was associated with higher premenopausal breast cancer risk. However, the associations of saturated fat, monounsaturated fat and animal fat, were attenuated and non-significant after adjustment for red meat intake. Intakes of other types of fat including vegetable fat, dairy fat, polyunsaturated fat, and trans fat were not associated with breast cancer risk. Our finding suggests a positive association between early adult intake of animal fat and breast cancer risk.
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Affiliation(s)
- Maryam S Farvid
- Department of Nutrition, Harvard School of Public Health, Boston, 02115, MA, USA,
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84
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O'Flynn EAM, Wilson RM, Allen SD, Locke I, Scurr E, deSouza NM. Diffusion-weighted imaging of the high-risk breast: Apparent diffusion coefficient values and their relationship to breast density. J Magn Reson Imaging 2014; 39:805-11. [PMID: 24038529 DOI: 10.1002/jmri.24243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/03/2013] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To document the apparent diffusion coefficient (ADC) of fibroglandular breast tissue in women at high-risk of developing breast cancer and investigate the relationship between ADC and breast density. MATERIALS AND METHODS Local research ethics approval was obtained. A total of 33 high-risk women including 17 BRCA1/2 mutation carriers (mean age, 43 years) and 16 women postmantle irradiation (mean age 40 years) underwent diffusion-weighted MRI between days 6 and 16 of their menstrual cycle. ADC histograms from a region of interest in fibroglandular tissue and mammographic breast density measurements were obtained. Mean, percentile ADC values (10th, 25th, 50th, 75th, 90th) and skew were compared for the two groups; ADC and mammographic breast density were correlated. RESULTS Mean ADC values (×10(-6) mm(2) /s) were 2017 ± 197 in postmantle irradiated women and 1827 ± 289 in BRCA1/2 mutation carriers (P = 0.035) with significant differences at all percentiles (P < 0.0001) but not skew (P = 0.44). ADC values showed weak positive correlation with mammographic breast density in BRCA1/2 mutation carriers (r = 0.51, P = 0.043) but not in postmantle radiotherapy patients (r = 0.49, P = 0.13). CONCLUSION Higher ADC values seen in fibroglandular tissue postmantle irradiation compared with BRCA1/2 mutation carriers has potential to improve tumor detection in these patients. Lack of correlation between ADC and breast density postmantle irradiation may be a result of microstructural changes.
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Affiliation(s)
- Elizabeth A M O'Flynn
- Clinical Magnetic Resonance Group, Cancer Research UK and EPSRC Cancer Imaging Centre, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, United Kingdom
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85
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Travis LB, Ng AK, Allan JM, Pui CH, Kennedy AR, Xu XG, Purdy JA, Applegate K, Yahalom J, Constine LS, Gilbert ES, Boice JD. Second malignant neoplasms and cardiovascular disease following radiotherapy. HEALTH PHYSICS 2014; 106:229-246. [PMID: 24378498 DOI: 10.1097/hp.0000000000000013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Second malignant neoplasms (SMNs) and cardiovascular disease (CVD) are among the most serious and life-threatening late adverse effects experienced by the growing number of cancer survivors worldwide and are due in part to radiotherapy. The National Council on Radiation Protection and Measurements (NCRP) convened an expert scientific committee to critically and comprehensively review associations between radiotherapy and SMNs and CVD, taking into account radiobiology; genomics; treatment (i.e., radiotherapy with or without chemotherapy and other therapies); type of radiation; and quantitative considerations (i.e., dose-response relationships). Major conclusions of the NCRP include: (1) the relevance of older technologies for current risk assessment when organ-specific absorbed dose and the appropriate relative biological effectiveness are taken into account and (2) the identification of critical research needs with regard to newer radiation modalities, dose-response relationships, and genetic susceptibility. Recommendation for research priorities and infrastructural requirements include (1) long-term large-scale follow-up of extant cancer survivors and prospectively treated patients to characterize risks of SMNs and CVD in terms of radiation dose and type; (2) biological sample collection to integrate epidemiological studies with molecular and genetic evaluations; (3) investigation of interactions between radiotherapy and other potential confounding factors, such as age, sex, race, tobacco and alcohol use, dietary intake, energy balance, and other cofactors, as well as genetic susceptibility; (4) focusing on adolescent and young adult cancer survivors, given the sparse research in this population; and (5) construction of comprehensive risk prediction models for SMNs and CVD to permit the development of follow-up guidelines and prevention and intervention strategies.
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Affiliation(s)
- Lois B Travis
- *Rubin Center for Cancer Survivorship and Department of Radiation Oncology, James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY; †Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; and the Dana-Farber Cancer Institute, Boston, MA; ‡Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK; §Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN; and the University of Tennessee Health Science Center, Memphis, TN; **Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA; ††Nuclear Engineering and Engineering Physics Program, Rensselaer Polytechnic Institute, Troy, NY; ‡‡Department of Radiation Oncology, University of California at Davis, Davis, CA; §§Department of Radiology, Emory University, Atlanta, GA; ***Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY; †††Division ofCancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; ‡‡‡National Council on Radiation Protection and Measurements, Bethesda, MD, and the Department of Medicine, Vanderbilt University, Nashville, TN
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86
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Abstract
With the favorable trend regarding survival of cancer in the Western world, there is an increasing focus among patients, clinicians, researchers, and politicians regarding cancer survivors' health and well-being. Their number is rapidly growing and more than 3 % of the adult populations in Western countries have survived cancer for 5 years or more. Cancer survivors are at increased risk for a variety of late effects after treatment, some life-threatening such as secondary cancer and cardiac diseases, others might negatively impact on their daily functioning and quality of life. The latter might include fatigue, anxiety disorders and difficulties returning to work while depression does not seem to be more common among survivors than in the general population. Still, the majority of survivors regain their health and social functioning. The field of cancer survivorship research has been rapidly growing. Models for follow-up care of cancer survivors have been proposed, but how to best integrate the knowledge of the field into clinical practice with adequate follow-up of cancer survivors at risk for developing late effects is still an unsolved question.
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Affiliation(s)
- Cecilie E Kiserud
- National Resource Center for late effects after Cancer Treatment, Oslo University Hospital, Radiumhospitalet, 4953 Nydalen, 0424, Oslo, Norway,
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87
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Lorenzo Bermejo J, Pukkala E, Johannesen TB, Sundquist J, Hemminki K. Age-time risk patterns of solid cancers in 60 901 non-Hodgkin lymphoma survivors from Finland, Norway and Sweden. Br J Haematol 2013; 164:675-83. [PMID: 24528128 DOI: 10.1111/bjh.12684] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 10/21/2013] [Indexed: 11/28/2022]
Abstract
Survival after non-Hodgkin lymphoma (NHL) has increased thanks to improved treatment but NHL survivors have an increased risk of second neoplasms. The assessment of cancer risk patterns after NHL may help to quantify the late side-effects of therapy. Poisson regression was used to estimate relative risks (RRs) and absolute incidence rates for nine solid tumours based on a nationwide cohort of 60 901 NHL survivors from Finland, Norway and Sweden. Patients were diagnosed between 1980 and 2006 and developed 6815 s neoplasms. NHL patients showed an increased risk of each of the nine investigated cancer sites: prostate and pancreas (both RRs 1·28), breast (1·37), colorectum (1·48), urinary bladder (1·52), stomach and lung (both RRs 1·87), skin (melanoma 2·27) and kidney (2·56). The RRs showed a U-shaped relationship with time after NHL for all nine-second cancer types. NHL diagnosis early in life was a risk factor for the development of second cancers with the exception of melanoma, but a risk excess was even observed in patients diagnosed with NHL at age 80+ years. The present study provides accurate estimates on the adverse late effects of NHL therapy, which should guide the establishment of cancer prevention strategies in NHL survivors.
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Affiliation(s)
- Justo Lorenzo Bermejo
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany; Division of Molecular Genetic Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
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88
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Age related risk of myelodysplastic syndrome and acute myeloid leukemia among breast cancer survivors. Breast Cancer Res Treat 2013; 142:629-36. [PMID: 24265034 DOI: 10.1007/s10549-013-2773-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 11/10/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED Increased incidence of acute myeloid leukemia (AML) has been identified among breast cancer (BC) survivors but measurement has not included myelodysplastic syndrome (MDS). Our aim is to identify age and stage related MDS/AML incidence post BC diagnosis. We used the 2001-2009 Surveillance, Epidemiology, and end results (SEER) database to identify first primary stage I-III BC patients. Subsequent MDS or AML diagnosis was identified with observed rates compared to expected MDS/AML incidence in the general population. Age adjusted observed/expected rate ratios and 95 % confidence intervals (CI) were calculated. The unadjusted all age and stage MDS/AML incidence rate was .15 % (470/306,691) with a progressively higher rate by age (age 20-49 = .11, age 50-64 = .14, age 65+ =.21, and age 75+ =.18) and stage (stage I = .11, stage II = .18, and stage III = .22). Compared to the general population, BC patients had a 2.75-fold [95 % CI 2.51-3.00] increased relative risk of being diagnosed with MDS/AML. Young age survivors had highest relative risk [age 20-49: relative risk (RR) = 10.60 (95 % CI 8.57-12.93); age 50-64: 5.96 (95 % CI 5.13, 6.88); age 65-74 year-olds: 2.94 (95 % CI 2.45, 3.50); and age ≥75 year-olds: 1.28 (95 % CI 1.03, 1.56)]. Separately MDS relative risk was highest among young women [30.44 (95 % CI = 19.63, 44.62)]. MDS/AML relative risk increased from 1.87 to 5.66 for stage I-III. CONCLUSIONS Myelodysplastic syndrome and acute myeloid leukemia relative risk is substantially elevated among breast cancer survivors especially those aged 20-49. While the actual number is small, MDS/AML is a serious disease. More research is needed to identify the treatments that put women at risk and find less leukemogenic options, especially for young women.
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89
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Abstract
Chromosomal rearrangements that lead to oncogenic kinase activation are observed in many epithelial cancers. These cancers express activated fusion kinases that drive the initiation and progression of malignancy, and often have a considerable response to small-molecule kinase inhibitors, which validates these fusion kinases as 'druggable' targets. In this Review, we examine the aetiologic, pathogenic and clinical features that are associated with cancers harbouring oncogenic fusion kinases, including anaplastic lymphoma kinase (ALK), ROS1 and RET. We discuss the clinical outcomes with targeted therapies and explore strategies to discover additional kinases that are activated by chromosomal rearrangements in solid tumours.
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Affiliation(s)
- Alice T Shaw
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts 02114, USA
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90
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Morton LM, Dores GM, Curtis RE, Lynch CF, Stovall M, Hall P, Gilbert ES, Hodgson DC, Storm HH, Johannesen TB, Smith SA, Weathers RE, Andersson M, Fossa SD, Hauptmann M, Holowaty EJ, Joensuu H, Kaijser M, Kleinerman RA, Langmark F, Pukkala E, Vaalavirta L, van den Belt-Dusebout AW, Fraumeni JF, Travis LB, Aleman BM, van Leeuwen FE. Stomach cancer risk after treatment for hodgkin lymphoma. J Clin Oncol 2013; 31:3369-77. [PMID: 23980092 PMCID: PMC3770865 DOI: 10.1200/jco.2013.50.6832] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Treatment-related stomach cancer is an important cause of morbidity and mortality among the growing number of Hodgkin lymphoma (HL) survivors, but risks associated with specific HL treatments are unclear. PATIENTS AND METHODS We conducted an international case-control study of stomach cancer nested in a cohort of 19,882 HL survivors diagnosed from 1953 to 2003, including 89 cases and 190 matched controls. For each patient, we quantified cumulative doses of specific alkylating agents (AAs) and reconstructed radiation dose to the stomach tumor location. RESULTS Stomach cancer risk increased with increasing radiation dose to the stomach (Ptrend < .001) and with increasing number of AA-containing chemotherapy cycles (Ptrend = .02). Patients who received both radiation to the stomach ≥ 25 Gy and high-dose procarbazine (≥ 5,600 mg/m(2)) had strikingly elevated stomach cancer risk (25 cases, two controls; odds ratio [OR], 77.5; 95% CI, 14.7 to 1452) compared with those who received radiation < 25 Gy and procarbazine < 5,600 mg/m(2) (Pinteraction < .001). Risk was also elevated (OR, 2.8; 95% CI, 1.3 to 6.4) among patients who received radiation to the stomach ≥ 25 Gy but procarbazine < 5,600 mg/m(2); however, no procarbazine-related risk was evident with radiation < 25 Gy. Treatment with dacarbazine also increased stomach cancer risk (12 cases, nine controls; OR, 8.8; 95% CI, 2.1 to 46.6), after adjustment for radiation and procarbazine doses. CONCLUSION Patients with HL who received subdiaphragmatic radiotherapy had dose-dependent increased risk of stomach cancer, with marked risks for patients who also received chemotherapy containing high-dose procarbazine. For current patients, risks and benefits of exposure to both procarbazine and subdiaphragmatic radiotherapy should be weighed carefully. For patients treated previously, GI symptoms should be evaluated promptly.
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Affiliation(s)
- Lindsay M. Morton
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Graça M. Dores
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Rochelle E. Curtis
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Charles F. Lynch
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Marilyn Stovall
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Per Hall
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Ethel S. Gilbert
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - David C. Hodgson
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Hans H. Storm
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Tom Børge Johannesen
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Susan A. Smith
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Rita E. Weathers
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Michael Andersson
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Sophie D. Fossa
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Michael Hauptmann
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Eric J. Holowaty
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Heikki Joensuu
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Magnus Kaijser
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Ruth A. Kleinerman
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Frøydis Langmark
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Eero Pukkala
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Leila Vaalavirta
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Alexandra W. van den Belt-Dusebout
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Joseph F. Fraumeni
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Lois B. Travis
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Berthe M. Aleman
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
| | - Flora E. van Leeuwen
- Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY
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91
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Abstract
Hematology Oncology has a rich history including few crucial therapeutic innovations. These were possible because of the evolution of the cell and molecular biology allowing a better understanding of basic mechanisms of cancerogenesis. We propose here to summarize the most important therapeutic innovations since the beginning of Hematology/Oncology history. We also describe evolution of therapeutic strategies themselves. New insights and therapeutic perspectives for next future are also discussed.
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92
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Daniëls LA, Krol ADG, Schaapveld M, Putter H, Jansen PM, Marijt EWA, van Leeuwen FE, Creutzberg CL. Long-term risk of secondary skin cancers after radiation therapy for Hodgkin's lymphoma. Radiother Oncol 2013; 109:140-5. [PMID: 23932152 DOI: 10.1016/j.radonc.2013.06.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 06/13/2013] [Accepted: 06/15/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE Survivors of Hodgkin's lymphoma (HL) are at risk of secondary tumors. We investigated the risk of secondary skin cancers after radiotherapy compared to treatment without radiation and to an age-matched population. MATERIAL AND METHODS We conducted a retrospective cohort study of 889 HL patients treated between 1965 and 2005. Data on secondary skin cancers and treatment fields were retrieved. Incidence rates were compared to observed rates in the Dutch population. RESULTS 318 skin cancers were diagnosed in 86 patients, showing significantly higher risks of skin cancers, the majority being BCC. The standardized incidence ratio (SIR) of BCC in HL survivors was significantly increased (SIR 5.2, 95% CI 4.0-6.6), especially in those aged <35 years at diagnosis (SIR 8.0, 95% CI 5.8-10.7). SIR increased with longer follow-up to 15.9 (95% CI 9.1-25.9) after 35 years, with 626 excess cases per 10,000 patients per year. Most (57%) skin cancers developed within the radiation fields, with significantly increased risk in patients treated with radiotherapy compared to chemotherapy alone (p=0·047, HR 2·75, 95% CI 1·01-7.45). CONCLUSION Radiotherapy for HL is associated with a strongly increased long-term risk of secondary skin cancers, both compared to the general population and to treatment with chemotherapy alone.
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Affiliation(s)
- Laurien A Daniëls
- Department of Clinical Oncology, Leiden University Medical Center, The Netherlands.
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93
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Gowda TM, Thomas R, Shanmukhappa SM, Agarwal G, Mehta DS. Gingival enlargement as an early diagnostic indicator in therapy-related acute myeloid leukemia: A rare case report and review of literature. J Indian Soc Periodontol 2013; 17:248-52. [PMID: 23869136 PMCID: PMC3713761 DOI: 10.4103/0972-124x.113090] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 02/24/2013] [Indexed: 12/26/2022] Open
Abstract
Treatment for Hodgkin's lymphoma (HL) has resulted in excellent survival rates but is associated with increased risks of secondary therapy-related acute myeloid leukemia (t-AML). Gingival enlargement associated with bleeding and ulceration is the most common rapidly appearing oral manifestations of leukemic involvement. An 8 months pregnant patient reported with generalized gingival enlargement, with localized cyanotic and necrotic papillary areas. Co-relating the hematological report with the oral lesions and her past medical history of HL, a diagnosis of t-AML secondary to treatment for HL was made by the oncologist. As oral lesions are one of the initial manifestations of acute leukemia, they may serve as a significant diagnostic indicator for the dental surgeons and their important role in diagnosing and treating such cases. Furthermore, this case report highlights the serious complication of t-AML subsequent to HL treatment and the important role that a general and oral health care professional may play in diagnosing and treating such cases.
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Affiliation(s)
- Triveni M Gowda
- Department of Periodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India
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94
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Abe S, Oda I, Inaba K, Suzuki H, Yoshinaga S, Nonaka S, Morota M, Murakami N, Itami J, Kobayashi Y, Maeshima AM, Saito Y. A retrospective study of 5-year outcomes of radiotherapy for gastric mucosa-associated lymphoid tissue lymphoma refractory to Helicobacter pylori eradication therapy. Jpn J Clin Oncol 2013; 43:917-22. [PMID: 23878345 DOI: 10.1093/jjco/hyt097] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The favorable response rate of radiotherapy for localized gastric mucosa-associated lymphoid tissue lymphoma refractory to Helicobacter pylori eradication has been demonstrated. However, there are limited data available on the long-term outcomes. The aim of this retrospective study was to evaluate the long-term outcomes of radiotherapy for localized gastric mucosa-associated lymphoid tissue lymphoma refractory to Helicobacter pylori eradication. METHODS Thirty-four consecutive patients with localized gastric mucosa-associated lymphoid tissue lymphoma that were refractory to eradication were treated with radiotherapy (a total dose of 30 Gy). The response and adverse events of radiotherapy were retrospectively analyzed as short-term outcomes, and recurrence-free, overall and disease-specific survival rates were calculated as long-term outcomes. RESULTS Thirty-three (97.1%) patients achieved complete remission and radiotherapy was well tolerated. One patient underwent emergency gastrectomy due to severe hematemesis. Of the 34 patients during the median follow-up period of 7.5 (1.2-13.0) years, one patient had local recurrence after 8.8 years, one patient underwent surgery for bowel obstruction secondary to small bowel metastasis after 5.1 years and one patient had pulmonary metastasis after 10.9 years. Pathologically, all three recurrences revealed mucosa-associated lymphoid tissue lymphoma without any transformation to high-grade lymphoma. None died of gastric mucosa-associated lymphoid tissue lymphoma. The 5-year recurrence-free survival rate was 97.0%. The 5-year overall survival rates and disease-specific survival rates were 97.0 and 100%, respectively. CONCLUSIONS Radiotherapy in patients with localized gastric mucosa-associated lymphoid tissue lymphoma refractory to Helicobacter pylori eradication can achieve excellent overall survival. However, long-term surveillance is necessary to identify late recurrences.
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Affiliation(s)
- Seiichiro Abe
- *Endoscopy Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
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95
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Palumbo MO, Kavan P, Miller WH, Panasci L, Assouline S, Johnson N, Cohen V, Patenaude F, Pollak M, Jagoe RT, Batist G. Systemic cancer therapy: achievements and challenges that lie ahead. Front Pharmacol 2013; 4:57. [PMID: 23675348 PMCID: PMC3646247 DOI: 10.3389/fphar.2013.00057] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/16/2013] [Indexed: 12/20/2022] Open
Abstract
In the last half of the century, advances in the systemic therapy of cancer, including chemotherapy, hormonal therapy, targeted therapy, and immunotherapy have been responsible for improvements in cancer related mortality in developed countries even as the population continues to age. Although such advancements have yet to benefit all cancer types, systemic therapies have led to an improvement in overall survival in both the adjuvant and metastatic setting for many cancers. With the pressure to make therapies available as soon as possible, the side-effects of systemic therapies, in particular long-term side-effects are not very well characterized and understood. Increasingly, a number of cancer types are requiring long-term and even lifelong systemic therapy. This is true for both younger and older patients with cancer and has important implications for each subset. Younger patients have an overall greater expected life-span, and as a result may suffer a greater variety of treatment related complications in the long-term, whereas older patients may develop earlier side-effects as a result of their frailty. Because the incidence of cancer in the world will increase over the next several decades and there will be more people living with cancer, it is important to have an understanding of the potential side-effects of new systemic therapies. As an introductory article, in this review series, we begin by describing some of the major advances made in systemic cancer therapy along with some of their known side-effects and we also make an attempt to describe the future of systemic cancer therapy.
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Affiliation(s)
- Michael O Palumbo
- Department of Medicine and Oncology, Sir Mortimer B. Davis Jewish General Hospital, Segal Cancer Centre, McGill University Montreal, QC, Canada
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96
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Antoni D, Natarajan-Ame S, Meyer P, Niederst C, Bourahla K, Noel G. Contribution of three-dimensional conformal intensity-modulated radiation therapy for women affected by bulky stage II supradiaphragmatic Hodgkin disease. Radiat Oncol 2013; 8:112. [PMID: 23638873 PMCID: PMC3671200 DOI: 10.1186/1748-717x-8-112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 04/16/2013] [Indexed: 12/25/2022] Open
Abstract
Purpose To analyze the outcome and dose distribution of intensity-modulated radiation therapy (IMRT) by helical tomotherapy in women treated for large supradiaphragmatic Hodgkin’s disease. Material and methods A total of 13 patients received adjuvant radiation at a dose of 30 Gy to the initially involved sites with a boost of 6 Gy to those areas suspected of harboring residual disease on the simulation CT scan. Results With a median follow-up of 23 months, the two-year progression-free survival was 91.6%, and the 2- and 3-year overall survivals were 100%. We did not report any heart or lung acute side effects. The conformity index of PTV (Planning Target Volume) was better for IMRT than for 3D-CRT (p=0.001). For the breasts, lungs, heart, thyroid and esophagus, the volume distributions favored the IMRT plans. For the breasts, the V20Gy, V25Gy and V30Gy were 1.5, 2.5 and 3.5 times lower, respectively, for IMRT than for 3D-CRT. For the lung tissues, the V20Gy and V30Gy were 2 times and 4.5 times lower, respectively, for IMRT than for 3D-CRT. For the heart, the V20Gy and V30Gy were 1.4 and 2 times lower, respectively, for IMRT than for 3D-CRT. For the esophagus, the V35Gy was 1.7 lower for IMRT than for 3D-CRT, and for the thyroid, the V30Gy was 1.2 times lower for IMRT. Conclusion IMRT by helical tomotherapy improved the PTV coverage and dramatically decreased the dose in organs at risk. The treatment was well tolerated, but a longer follow-up is necessary to prove a translation of these dosimetric improvements in the outcome of the patients.
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97
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Straus DJ. Long-term survivorship at a price: late-term, therapy-associated toxicities in the adult hodgkin lymphoma patient. Ther Adv Hematol 2013; 2:111-9. [PMID: 23556081 DOI: 10.1177/2040620711402414] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There have been an increasing number of survivors of successful treatment of Hodgkin lymphoma (HL) over the past 30 years. Although these survivors may be cured of their HL, long-term morbidity and mortality are associated with late toxicities of treatment. Identification of these late complications will lead to strategies to manage them when they occur and hopefully to decrease the risk of their development. Second malignancies followed by cardiovascular disease are the leading causes of late morbidity and mortality. Musculoskeletal difficulties, endocrine abnormalities including sterility and thyroid disease, heart and lung damage, persistent fatigue and psychosocial distress have also been seen. The subjects of this review are the late complications of primary treatment of HL and autologous stem cell transplantation, usually for relapsed disease.
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98
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Wilson CL, Ness KK, Neglia JP, Hammond S, Shnorhavorian M, Leisenring WL, Stovall M, Robison LL, Armstrong GT. Renal carcinoma after childhood cancer: a report from the childhood cancer survivor study. J Natl Cancer Inst 2013; 105:504-8. [PMID: 23515901 DOI: 10.1093/jnci/djt014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Adult survivors of childhood cancer are known to be at increased risk of subsequent malignancy, but only limited data exist describing the incidence and risk factors for secondary renal carcinoma. Among 14 358 5-year survivors diagnosed between 1970 and 1986, we estimated standardized incidence ratios (SIRs) for subsequent renal carcinoma and identified associations with primary cancer therapy using Poisson regression. Twenty-six survivors were diagnosed with renal carcinoma (median = 22.6 years from diagnosis; range = 6.3-35.7 years), reflecting a statistically significant excess (SIR = 8.0, 95% confidence interval [CI] = 5.2 to 11.7) compared with the general population. Highest risk was observed among neuroblastoma survivors (SIR = 85.8, 95% CI = 38.4 to 175.2) and, in multivariable analyses, with renal-directed radiotherapy of 5 Gy or greater (relative risk [RR] = 3.8, 95% CI = 1.6 to 9.3) and platinum-based chemotherapy (RR = 3.5, 95% CI = 1.0 to 11.2). To our knowledge, this is the first report of an association between cisplatin and subsequent renal carcinoma among survivors of childhood cancer.
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Affiliation(s)
- Carmen L Wilson
- Department of Epidemiology & Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, MS-735, Memphis, TN 38105, USA.
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99
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Appel BE, Chen L, Buxton A, Wolden SL, Hodgson DC, Nachman JB. Impact of low-dose involved-field radiation therapy on pediatric patients with lymphocyte-predominant Hodgkin lymphoma treated with chemotherapy: a report from the Children's Oncology Group. Pediatr Blood Cancer 2012; 59:1284-9. [PMID: 22847767 PMCID: PMC3468707 DOI: 10.1002/pbc.24258] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 06/14/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Treatment of pediatric lymphocyte-predominant Hodgkin lymphoma (LPHL) is controversial but has typically consisted of both chemotherapy and radiation. Radiation therapy is associated with potential late effects in children and adolescents. We examined the impact of radiation therapy on long-term outcome of patients with LPHL treated on CCG-5942, a large pediatric cooperative group study of Hodgkin lymphoma (HL). PROCEDURE Eighty-two patients with LPHL were registered on CCG-5942. Fifty-two patients (63%) received chemotherapy alone; 29 patients (35%) received chemotherapy followed by involved-field radiation therapy (IFRT). RESULTS The median follow-up of the LPHL patients is 7.7 years; 63 patients (77%) have >5 years of follow-up. The 5-year event-free survival (EFS) and overall survival (OS) were 97% and 100%. Two relapses occurred, both in patients who did not receive IFRT. There were no significant differences in EFS or OS between patients who received or did not receive IFRT. CONCLUSIONS This subset analysis demonstrates the chemosensitivity of pediatric LPHL. Patients who had a complete response to chemotherapy had an excellent EFS and OS without the addition of radiotherapy.
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Affiliation(s)
- Burton E. Appel
- Tomorrows Children’s Institute, Hackensack University Medical Center, Hackensack, NJ
| | - Lu Chen
- Children’s Oncology Group Operations Center, Arcadia, CA
| | - Allen Buxton
- Children’s Oncology Group Operations Center, Arcadia, CA
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100
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Sasse S, Klimm B, Görgen H, Fuchs M, Heyden-Honerkamp A, Lohri A, Koch O, Wilhelm M, Trenn G, Finke J, Müller RP, Diehl V, Eich HT, Borchmann P, Engert A. Comparing long-term toxicity and efficacy of combined modality treatment including extended- or involved-field radiotherapy in early-stage Hodgkin's lymphoma. Ann Oncol 2012; 23:2953-2959. [PMID: 22767583 DOI: 10.1093/annonc/mds110] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND To evaluate long-term toxicity and efficacy of a combined modality strategy including extended-field radiotherapy (EF-RT) or involved-field radiotherapy (IF-RT), the German Hodgkin Study Group carried out a follow-up analysis in patients with early unfavorable Hodgkin's lymphoma (HL). PATIENTS AND METHODS One thousand two hundred and four patients were randomized to four cycles of chemotherapy followed by either 30 Gy EF- or 30 Gy IF-RT (HD8 trial); 532 patients in each treatment arm were eligible. RESULTS At 10 years, no arm differences were revealed with respect to freedom from treatment failure (FFTF) (79.8% versus 79.7%), progression-free survival (79.8% versus 80.0%), and overall survival (86.4% versus 87.3%). Non-inferiority of IF-RT was demonstrated for the primary end point FFTF (95% confidence interval for hazard ratio 0.72-1.25). Elderly patients had a poorer outcome when treated with EF-RT. So far, 15.0% of patients in arm A and 12.2% in arm B died, mostly due to secondary malignancies (5.3% versus 3.4%) or HL (3.2% versus 3.4%). After EF-RT, there were more secondary malignancies overall (58 versus 45), especially acute myeloid leukemias (11 versus 4). CONCLUSION Radiotherapy intensity reduction to IF-RT does not result in poorer long-term outcome but is associated with less acute toxicity and might be associated with less secondary malignancies.
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Affiliation(s)
- S Sasse
- First Department of Internal Medicine, University Hospital Cologne, Cologne; German Hodgkin Study Group, Cologne, Germany
| | - B Klimm
- First Department of Internal Medicine, University Hospital Cologne, Cologne; German Hodgkin Study Group, Cologne, Germany
| | - H Görgen
- German Hodgkin Study Group, Cologne, Germany
| | - M Fuchs
- German Hodgkin Study Group, Cologne, Germany
| | | | - A Lohri
- Department of Internal Medicine, Kantonsspital Liestal, Liestal, Switzerland
| | - O Koch
- Third Department of Internal Medicine, Klinikum Osnabrück, Osnabrück
| | - M Wilhelm
- Fifth Department of Internal Medicine, Klinikum Nuernberg, Nuernberg
| | - G Trenn
- Department of Internal Medicine, Knappschaftskrankenhaus Bottrop, Bottrop
| | - J Finke
- First Department of Internal Medicine, University Hospital Freiburg, Freiburg
| | - R P Müller
- Department of Radiotherapy, University Hospital Cologne, Cologne
| | - V Diehl
- German Hodgkin Study Group, Cologne, Germany
| | - H T Eich
- Department of Radiotherapy, University Hospital Muenster, Muenster, Germany
| | - P Borchmann
- German Hodgkin Study Group, Cologne, Germany
| | - A Engert
- First Department of Internal Medicine, University Hospital Cologne, Cologne; German Hodgkin Study Group, Cologne, Germany.
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