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Alnimer Y, Ali MKM. Predictors of Secondary Lung Cancer Among Hodgkin Lymphoma Survivors: A Nationwide Analysis. Clin Lung Cancer 2022; 23:e510-e518. [PMID: 36008241 DOI: 10.1016/j.cllc.2022.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/21/2022] [Accepted: 08/03/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE There is insufficient data regarding the incidence rate of secondary lung cancer among Hodgkin lymphoma (HL) survivors and the predisposing factors. METHODS We analyzed the data from the cohort of patients who had HL between 1973 and 2015 using the Surveillance Epidemiology and End Results database (SEER). Data on patient's age, gender, year of diagnosis with HL, Ann-Arbor stage, Histology, racial groups, date of last follow-up, date of death, and treatment modalities were collected. RESULTS We identified a total of 56,856 patients with HL; of those, 862 had secondary lung cancer, with an incidence rate of 157 (95%CI: 147-168) per 100,000 person-years. The median overall survival from time of HL diagnosis for those with secondary lung cancer was 12.1 years (95% CI: 10.7-13) compared to 27.1 years (95% CI: 26.5-27.6) for those who did not develop lung cancer (log-rank P-value of <.01). After propensity score weighting, radiation therapy was associated with a higher risk of secondary lung cancer (hazard ratio (HR): 1.23, 95% CI: 1.002-1.55) with a P-value of 0.048. Older age at the time of HL diagnosis and male gender were associated with higher risk, with an HR of 1.07 (95% CI 1.062-1.073) and an HR of 1.602 (95% CI 1.33-1.94), respectively. Furthermore, chemotherapy increased the risk only among older age groups. CONCLUSION Older age at the time of HL diagnosis, male gender, radiation therapy, and chemotherapy only among older age groups were associated with higher risk for secondary lung cancer, with 50% of the cases occurring within 9.1 years following HL diagnosis.
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Affiliation(s)
- Yanal Alnimer
- Hospital Medicine, Virginia Commonwealth University, Richmond, VA; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
| | - Moaath K Mustafa Ali
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD; Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
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Fiorelli A, D'Andrilli A, Carlucci A, Vicidomini G, Loizzi D, Ardò NP, Marasco RD, Ventura L, Ampollini L, Carbognani P, Bocchialini G, Lococo F, Paci M, Di Stefano TS, Ardissone F, Gagliasso M, Mendogni P, Rosso L, Mazzucco A, Vanni C, Marinucci BT, Potenza R, Matricardi A, Ragusa M, Tassi V, Anile M, Poggi C, Serra N, Sica A, Nosotti M, Sollitto F, Venuta F, Rendina EA, Puma F, Santini M. Prognostic factors of lung cancer in lymphoma survivors (the LuCiLyS study). Transl Lung Cancer Res 2020; 9:90-102. [PMID: 32206557 PMCID: PMC7082280 DOI: 10.21037/tlcr.2019.12.28] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Second cancer is the leading cause of death in lymphoma survivors, with lung cancer representing the most common solid tumor. Limited information exists about the treatment and prognosis of second lung cancer following lymphoma. Herein, we evaluated the outcome and prognostic factors of Lung Cancer in Lymphoma Survivors (the LuCiLyS study) to improve the patient selection for lung cancer treatment. Methods This is a retrospective multicentre study including consecutive patients treated for lymphoma disease that subsequently developed non-small cell lung cancer (NSCLC). Data regarding lymphoma including age, symptoms, histology, disease stage, treatment received and lymphoma status at the time of lung cancer diagnosis, and data on lung carcinoma as age, smoking history, latency from lymphoma, symptoms, histology, disease stage, treatment received, and survival were evaluated to identify the significant prognostic factors for overall survival. Results Our study population included 164 patients, 145 of which underwent lung cancer resection. The median overall survival was 63 (range, 58–85) months, and the 5-year survival rate 54%. At univariable analysis no-active lymphoma (HR: 2.19; P=0.0152); early lymphoma stage (HR: 1.95; P=0.01); adenocarcinoma histology (HR: 0.59; P=0.0421); early lung cancer stage (HR: 3.18; P<0.0001); incidental diagnosis of lung cancer (HR: 1.71; P<0.0001); and lung cancer resection (HR: 2.79; P<0.0001) were favorable prognostic factors. At multivariable analysis, no-active lymphoma (HR: 2.68; P=0.004); early lung cancer stage (HR: 2.37; P<0.0001); incidental diagnosis of lung cancer (HR: 2.00; P<0.0001); and lung cancer resection (HR: 2.07; P<0.0001) remained favorable prognostic factors. Patients with non-active lymphoma (n=146) versus those with active lymphoma (n=18) at lung cancer diagnosis presented better median survival (64 vs. 37 months; HR: 2.4; P=0.02), but median lung cancer specific survival showed no significant difference (27 vs. 19 months; HR: 0.3; P=0.17). Conclusions The presence and/or a history of lymphoma should not be a contraindication to resection of lung cancer. Inclusion of lymphoma survivors in a lung cancer-screening program may lead to early detection of lung cancer, and improve the survival.
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Affiliation(s)
- Alfonso Fiorelli
- Translational Medical and Surgical Science, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Antonio D'Andrilli
- Thoracic Surgery, Università La Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Annalisa Carlucci
- Translational Medical and Surgical Science, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giovanni Vicidomini
- Translational Medical and Surgical Science, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | | | | | - Luigi Ventura
- Medicine and Surgery, Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Luca Ampollini
- Medicine and Surgery, Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Paolo Carbognani
- Medicine and Surgery, Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Giovanni Bocchialini
- Medicine and Surgery, Thoracic Surgery, University Hospital of Parma, Parma, Italy
| | - Filippo Lococo
- Department of General Thoracic Surgery, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimiliano Paci
- Unit of Thoracic Surgery, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Francesco Ardissone
- Department of Oncology, Thoracic Surgery Unit, University of Torino, San Luigi Hospital, Orbassano, Italy
| | - Matteo Gagliasso
- Department of Oncology, Thoracic Surgery Unit, University of Torino, San Luigi Hospital, Orbassano, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplant Unit, Foundation IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Rosso
- Thoracic Surgery and Lung Transplant Unit, Foundation IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Mazzucco
- Thoracic Surgery and Lung Transplant Unit, Foundation IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Camilla Vanni
- Thoracic Surgery, Università La Sapienza, Sant'Andrea Hospital, Rome, Italy
| | | | | | | | - Mark Ragusa
- Thoracic Surgery Unit, S. Maria Hospital at Terni, Perugia University Medical School, Terni, Italy
| | - Valentina Tassi
- Thoracic Surgery Unit, S. Maria Hospital at Terni, Perugia University Medical School, Terni, Italy
| | - Marco Anile
- Unit of Thoracic Surgery, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | - Camilla Poggi
- Unit of Thoracic Surgery, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | - Nicola Serra
- Statistic Unit, Department of Public Health, University of Federico II, Naples, Italy
| | - Antonello Sica
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mario Nosotti
- Thoracic Surgery and Lung Transplant Unit, Foundation IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Federico Venuta
- Unit of Thoracic Surgery, Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy
| | | | | | - Mario Santini
- Translational Medical and Surgical Science, University of Campania Luigi Vanvitelli, Naples, Italy
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Hollen PJ, Hobbie WL, Donnangelo SF, Shannon S, Erickson J. Substance Use Risk Behaviors and Decision-Making Skills Among Cancer-Surviving Adolescents. J Pediatr Oncol Nurs 2016; 24:264-73. [PMID: 17827492 DOI: 10.1177/1043454207304910] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aims of this study were to compare decision making and substance use risk behaviors of a cohort of cancer-surviving adolescents to those of 2 earlier cohorts as well as adolescents in the US general population and to determine the relationship of decision making to substance use risk behaviors. This correlational study used a semistructured interview at the time of the annual clinic visit to obtain data. Teen cancer survivors (N = 76), ages 14-19 years, were recruited from 5 clinics within the United States. Adherence to quality decision-making skills reported by different cancer-surviving adolescent cohorts appears to remain the same over time. However, reported substance use risk behaviors by these teen survivor cohorts have decreased over time. The prevalence rates for lifetime use for the 2004 cohort of teen cancer survivors were 25%, 49%, and 16%, for cigarettes, alcohol, and marijuana use, respectively. These rates are somewhat lower than those in the US general population; yet, they are high given the health vulnerability of cancer-surviving adolescents. Poor-quality decision making was significantly associated with higher levels of substance use risk behaviors for these teen cancer survivors. In conjunction with the statistics related to higher health risks in this vulnerable group of teens, these findings support continued efforts in developing interventions for risk behavior counseling.
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Lung cancer and other second neoplasms after treatment of Hodgkin lymphoma. Clin Transl Oncol 2015; 18:99-106. [DOI: 10.1007/s12094-015-1342-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/30/2015] [Indexed: 10/22/2022]
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Bond DA, Dunavin N, Otterson GA. Mutational Profiling of Second Primary Lung Cancers in Patients Who Have Received Radiation for the Treatment of Hodgkin's Disease. Cancer Invest 2015; 33:86-8. [DOI: 10.3109/07357907.2014.1000494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mordant P, Pages PB, Foucault C, Badia A, Fabre E, Dujon A, Le Pimpec Barthes F, Riquet M. Chirurgie des cancers bronchopulmonaires après traitement d’un premier cancer. Rev Mal Respir 2013; 30:357-66. [DOI: 10.1016/j.rmr.2013.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 01/05/2013] [Indexed: 10/27/2022]
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Milano MT, Li H, Constine LS, Travis LB. Variables affecting survival after second primary lung cancer: A population-based study of 187 Hodgkin's lymphoma patients. J Thorac Dis 2012; 4:22-9. [PMID: 22295164 DOI: 10.3978/j.issn.2072-1439.2011.12.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 11/30/2011] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients successfully treated for Hodgkin's lymphoma (HL) are at known risk for subsequent malignancies, the most common of which is lung cancer. To date, no population-based study has analyzed prognostic variables for overall survival (OS) among HL survivors who developed non-small cell lung cancer (NSCLC). METHODS For 187 HL patients who developed NSCLC (among 22,648 HL survivors), we examined the impact of the following variables on OS after NSCLC diagnosis: gender, race, sociodemographic status (based upon county of residence), calendar year and age at NSCLC diagnosis, NSCLC histology and grade, HL stage and subtype, radiation for HL and latency between HL and NSCLC. Patients were grouped by NSCLC stage as follows: localized, regional or distant. All patients were reported to the population-based Surveillance, Epidemiology, and End Results program. For those variables significant on univariate analyses, hazard ratios (HR) were derived from Cox proportional hazards model. RESULTS Sociodemogaphic status, gender and latency between NSCLC and HL did not significantly affect OS of any NSCLC stage group. For patients with localized NSCLC, a history of mixed celluarlity HL was associated with a 3-fold improved OS (P=0.006). For patients with regional NSCLC, prior radiotherapy for HL was associated with a 2-fold worse OS (P=0.025). CONCLUSIONS A history of mixed cellularity HL subtype and a history of no radiotherapy for HL are favorable prognostic factors among patients who develop NSCLC. Further research into clinicopathologic and treatment-associated variables potentially affecting OS after second primary NSCLC among HL survivors is warranted.
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Affiliation(s)
- Michael T Milano
- Department of Radiation Oncology and Rubin Center for Cancer Survivorship, University of Rochester School of Medicine, Rochester, NY 14642, USA
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Schoenfeld J, Mauch P, Das P, Silver B, Marcus K, Stevenson M, Ng A. Lung malignancies after Hodgkin lymphoma: disease characteristics, detection methods and clinical outcome. Ann Oncol 2012; 23:1813-8. [DOI: 10.1093/annonc/mdr551] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Melloni G, Muriana P, Sestini S, Bandiera A, Carretta A, Ciriaco P, Calori G, Muriana G, Zannini P. The surgical treatment of lung cancer in patients with previous lymphoproliferative disorders: a historical cohort study. Eur J Surg Oncol 2012; 38:711-7. [PMID: 22682710 DOI: 10.1016/j.ejso.2012.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 02/07/2012] [Accepted: 05/10/2012] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES We undertook a historical cohort study to compare, in terms of morbidity, mortality and long-term survival associated with lung cancer resection, a group of patients with previous lymphoproliferative disorders and a group without a hematological history. METHODS We identified 29 patients with a previous lymphoproliferative disorder who underwent lung cancer resection. These subjects (Group-A) were matched with 87 patients without a hematological history who underwent pulmonary resection during the same period (Group-B). RESULTS We found no significant difference between the two groups in length of hospitalization, comorbidities, spirometric parameters, type of surgery, histology, neoadjuvant chemotherapy, morbidity, mortality, median survival (Group-A = 37 months; Group-B = 52 months) and 5-year survival (Group-A = 37%; Group-B = 42%). The mean age of Group-A patients was significantly lower than that of Group-B patients (62 vs 66 years; p = 0.024). Group-A patients had a well differentiated lung cancer more frequently than Group-B patients (p = 0.001). Group-A patients had transitory bacteraemies more frequently than Group-B patients (p = 0.005). Multivariate Cox regression analysis showed that age (p = 0.01) and lung cancer stage (p = 0.04) were significantly associated with survival. CONCLUSIONS Patients with lymphoproliferative disorders had a lower age and more differentiated lung cancers than those without lymphoproliferative disorders. Patients with lymphoproliferative disorders and those without a hematological history had similar morbidity, mortality and long-term survival after pulmonary resection. Distinguishing patients with and without a lymphoproliferative disorder seems to be of limited value in the decision-making process of evaluating the indications for surgical treatment of lung cancer.
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Affiliation(s)
- G Melloni
- Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy.
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Milano MT, Li H, Constine LS, Travis LB. Survival after second primary lung cancer: a population-based study of 187 Hodgkin lymphoma patients. Cancer 2011; 117:5538-47. [PMID: 21692074 DOI: 10.1002/cncr.26257] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 04/12/2011] [Accepted: 04/12/2011] [Indexed: 01/02/2023]
Abstract
BACKGROUND Lung cancer accounts for the largest absolute risk of second malignancies among Hodgkin lymphoma (HL) survivors. However, no population-based studies have compared overall survival (OS) between HL survivors who developed nonsmall cell lung cancer (HL-NSCLC) versus patients with first primary NSCLC (NSCLC-1). METHODS The authors compared the OS of 178,431 patients who had NSCLC-1 and 187 patients who had HL-NSCLC (among 22,648 HL survivors), accounting for sex, race, sociodemographic status, calendar year, and age at NSCLC diagnosis, and NSCLC histology and stage. All patients were reported to the population-based Surveillance, Epidemiology, and End Results Program. Hazard ratios (HRs) were derived from a Cox proportional hazards model. RESULTS Although the NSCLC stage distribution was similar in both groups (20% localized, 30% regional, and 50% distant), HL survivors experienced significantly inferior stage-specific OS. For patients with localized, regional, and distant stage NSCLC, the HRs (95% confidence interval [CI]) for death among HL survivors were 1.60 (95% CI, 1.08-2.37; P < .0001), 1.67 (95% CI, 1.26-2.22; P = .0004), and 1.31 (95% CI, 1.06-1.61; P = .013), respectively. Among HL-NSCLC patients, significant associations were observed between more advanced NSCLC stage and the following variables: younger age at HL diagnosis (P = .003), younger age at NSCLC diagnosis (P = .048), and longer latency between HL and NSCLC diagnoses (P = .015). CONCLUSIONS Compared with patients who had de novo NSCLC, HL survivors experienced a significant 30% to 60% decrease in OS after an NSCLC diagnosis. Further research is needed to not only elucidate the clinical-biologic underpinnings of NSCLC after HL, including the influence of previous HL treatment, but also to define the role of lung cancer screening in selected patients.
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Affiliation(s)
- Michael T Milano
- Department of Radiation Oncology and Rubin Center for Cancer Survivorship, University of Rochester School of Medicine, Rochester, New York 14642, USA.
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Non-Small Cell Lung Cancer Resection in Lymphoma Patients. Ann Thorac Surg 2010; 90:210-6. [DOI: 10.1016/j.athoracsur.2010.02.114] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 02/24/2010] [Accepted: 02/26/2010] [Indexed: 11/18/2022]
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Das P, Ng AK, Earle CC, Mauch PM, Kuntz KM. Computed tomography screening for lung cancer in Hodgkin's lymphoma survivors: decision analysis and cost-effectiveness analysis. Ann Oncol 2006; 17:785-93. [PMID: 16500905 DOI: 10.1093/annonc/mdl023] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Hodgkin's lymphoma patients have an elevated risk of developing lung cancer and may be targeted for lung cancer screening. We used a decision-analytic model to estimate the potential clinical benefits and cost-effectiveness of computed tomography (CT) screening for lung cancer in Hodgkin's lymphoma survivors. MATERIALS AND METHODS We developed a Markov decision-analytic model to compare annual low-dose CT screening versus no screening in a hypothetical cohort of patients diagnosed with stage IA-IIB Hodgkin's lymphoma at age 25, with screening starting 5 years after initial diagnosis. We derived model parameters from published studies and the Surveillance, Epidemiology and End Results (SEER) Program, and assumed that stage-shift produces a survival benefit. RESULTS Annual CT screening increased survival by 0.64 years for smokers and 0.16 years for non-smokers. The corresponding benefits in quality-adjusted survival were 0.58 quality-adjusted life-years (QALYs) for smokers and 0.14 QALYs for non-smokers. The incremental cost-effectiveness ratios for annual CT screening compared with no screening were $34 100/QALY for smokers and $125 400/QALY for non-smokers. CONCLUSIONS Our analysis suggests that if early promising results for lung cancer screening hold, CT screening for lung cancer may increase survival and quality-adjusted survival among Hodgkin's lymphoma survivors, with a benefit and incremental cost-effectiveness ratio for smokers comparable to that of other recommended cancer screening strategies.
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Affiliation(s)
- P Das
- Department of Radiation Oncology, U.T. M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 97, Houston, TX 77030, USA.
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Lorigan P, Radford J, Howell A, Thatcher N. Lung cancer after treatment for Hodgkin's lymphoma: a systematic review. Lancet Oncol 2005; 6:773-9. [PMID: 16198983 DOI: 10.1016/s1470-2045(05)70387-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Developments in modern chemotherapy and radiotherapy mean that most patients with Hodgkin's lymphoma can now be cured. However, the long-term effects of anticancer treatment include an increased risk of a second malignant disease. We have done a systematic review of studies reporting long-term complications of the treatment of Hodgkin's lymphoma published in English since 1985. These studies show that risk of lung cancer is significantly increased in patients treated for Hodgkin's lymphoma, with a reported mean relative risk of 2.6-7.0 and a significantly increased absolute excess risk. The absolute excess risk increases with time from treatment, for as long as 20-25 years, and is highest in patients treated at age 45 years or older. Both chemotherapy and radiotherapy contribute to the risk, and evidence suggests that the effects are additive. Cigarette smoking seems to multiply the risk associated with both chemotherapy and radiotherapy. In the high-risk group of patients, 50-150 patients per 1000 are expected to develop lung cancer by 10-20 years after treatment. The role of screening in this group of patients has not yet been assessed, but an international study combining CT with genomic and proteomic assessment is planned.
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Affiliation(s)
- Paul Lorigan
- Cancer Research UK Department of Medical Oncology, Christie Hospital NHS Trust, Manchester M20 4BX, UK.
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Das P, Ng AK, Stevenson MA, Mauch PM. Clinical course of thoracic cancers in Hodgkin's disease survivors. Ann Oncol 2005; 16:793-7. [PMID: 15802277 DOI: 10.1093/annonc/mdi155] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hodgkin's disease survivors have a high risk of subsequently developing thoracic cancers. Our goal was to evaluate the prognosis and treatment outcomes of thoracic cancers after Hodgkin's disease. PATIENTS AND METHODS Thirty-three patients treated for Hodgkin's disease at Harvard-affiliated hospitals subsequently developed small-cell lung carcinoma, non-small-cell lung carcinoma (NSCLC) or mesothelioma. Information was obtained from medical records about the initial treatment for Hodgkin's disease, any salvage therapy, smoking history, and the stage, histology, treatment and survival for thoracic cancers. RESULTS Of the 33 patients, 29 (88%) had a history of radiotherapy to the thorax, 17 (52%) had received alkylating chemotherapy, and 24 (73%) had a known history of smoking. The median time between diagnosis of Hodgkin's disease and diagnosis of thoracic cancer was 17.3 years (range 1.2-27.9 years). Among patients with NSCLC and a known stage, 85% presented with stage III or stage IV disease. Among patients whose treatment details were available, 40% underwent surgery, 40% received radiotherapy and 65% received chemotherapy. The median survival was 9 months (range 1-47 months). CONCLUSIONS Most patients with thoracic cancers after Hodgkin's disease have a history of exposure to risk factors and present at an advanced stage. Patients with thoracic cancers after Hodgkin's disease have a poor survival.
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Affiliation(s)
- P Das
- Department of Radiation Oncology, U.T. M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Wu WKK, Cho CH. The pharmacological actions of nicotine on the gastrointestinal tract. J Pharmacol Sci 2004; 94:348-58. [PMID: 15107574 DOI: 10.1254/jphs.94.348] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Increasing use of tobacco and its related health problems are a great concern in the world. Recent epidemiological findings have demonstrated the positive association between cigarette smoking and several gastrointestinal (GI) diseases, including peptic ulcer and cancers. Interestingly, smoking also modifies the disease course of ulcerative colitis (UC). Nicotine, a major component of cigarette smoke, seems to mediate some of the actions of cigarette smoking on the pathogenesis of GI disorders. Nicotine worsens the detrimental effects of aggressive factors and attenuates the protective actions of defensive factors in the processes of development and repair of gastric ulceration. Nicotine also takes part in the initiation and promotion of carcinogenesis in the GI tract. In this regard, nicotine and its metabolites are found to be mutagenic and have the ability to modulate cell proliferation, apoptosis, and angiogenesis during tumoriogenesis through specific receptors and signalling pathways. However, to elucidate this complex pathogenic mechanism, further study at the molecular level is warranted. In contrast, findings of clinical trials give promising results on the use of nicotine as an adjuvant therapy for UC. The beneficial effect of nicotine on UC seems to be mediated through multiple mechanisms. More clinical studies are needed to establish the therapeutic value of nicotine in this disease.
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Affiliation(s)
- William K K Wu
- Department of Pharmacology, Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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