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Halmágyi SR, Ungureanu L, Trufin II, Apostu AP, Șenilă SC. Melanoma as Subsequent Primary Malignancy in Hematologic Cancer Survivors-A Literature Review. J Clin Med 2024; 13:4501. [PMID: 39124768 PMCID: PMC11313577 DOI: 10.3390/jcm13154501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
The occurrence of second primary malignancies is becoming increasingly important among cancer survivors. Melanoma, an aggressive neoplasm originating from the melanocytes, is responsible for most skin cancer-related deaths. This review aims to explore the risk of melanoma occurrence as a second primary cancer after the most common subtypes of hematologic neoplasia, a malignant disease originating from myeloid or lymphocytic cell lineages. Chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma (NHL) are among the most associated subtypes with melanoma development. We also discuss the underlying hypotheses that may explain the associations between these malignancies and the impact of melanoma on survival. The review emphasizes the importance of increasing awareness of melanoma risk in hematologic cancer survivors, as it can lead to prompt recognition, improved skin surveillance, and better survival outcomes.
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Affiliation(s)
- Salomea-Ruth Halmágyi
- Clinical Hospital of Infectious Diseases, 400000 Cluj-Napoca, Romania; (S.-R.H.); (I.-I.T.); (A.P.A.)
- Department of Dermatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Loredana Ungureanu
- Department of Dermatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Department of Dermatology, Emergency County Hospital, 400006 Cluj-Napoca, Romania
| | - Ioana-Irina Trufin
- Clinical Hospital of Infectious Diseases, 400000 Cluj-Napoca, Romania; (S.-R.H.); (I.-I.T.); (A.P.A.)
| | - Adina Patricia Apostu
- Clinical Hospital of Infectious Diseases, 400000 Cluj-Napoca, Romania; (S.-R.H.); (I.-I.T.); (A.P.A.)
- Department of Dermatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Simona Corina Șenilă
- Department of Dermatology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Department of Dermatology, Emergency County Hospital, 400006 Cluj-Napoca, Romania
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2
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Neppelenbroek SI, Geurts YM, Aleman BM, Lugtenburg PJ, Rademakers SE, de Weijer RJ, Schippers MG, Ta BD, Plattel WJ, Zijlstra JM, van der Maazen RW, Nijziel MR, Ong F, Schimmel EC, Posthuma EF, Kersten MJ, Böhmer LH, Muller K, Koene HR, te Boome LC, Bilgin YM, de Jongh E, Janus CP, van Leeuwen FE, Schaapveld M. Doxorubicin Exposure and Breast Cancer Risk in Survivors of Adolescent and Adult Hodgkin Lymphoma. J Clin Oncol 2024; 42:1903-1913. [PMID: 38359378 PMCID: PMC11191044 DOI: 10.1200/jco.23.01386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/17/2023] [Accepted: 12/13/2023] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Female Hodgkin lymphoma (HL) survivors treated with chest radiotherapy (RT) at a young age have a strongly increased risk of breast cancer (BC). Studies in childhood cancer survivors have shown that doxorubicin exposure may also increase BC risk. Although doxorubicin is the cornerstone of HL chemotherapy, the association between doxorubicin and BC risk has not been examined in HL survivors treated at adult ages. METHODS We assessed BC risk in a cohort of 1,964 female 5-year HL survivors, treated at age 15-50 years in 20 Dutch hospitals between 1975 and 2008. We calculated standardized incidence ratios, absolute excess risks, and cumulative incidences. Doxorubicin exposure was analyzed using multivariable Cox regression analyses. RESULTS After a median follow-up of 21.6 years (IQR, 15.8-27.1 years), 252 women had developed invasive BC or ductal carcinoma in situ. The 30-year cumulative incidence was 20.8% (95% CI, 18.2 to 23.4). Survivors treated with a cumulative doxorubicin dose of >200 mg/m2 had a 1.5-fold increased BC risk (95% CI, 1.08 to 2.1), compared with survivors not treated with doxorubicin. BC risk increased 1.18-fold (95% CI, 1.05 to 1.32) per additional 100 mg/m2 doxorubicin (Ptrend = .004). The risk increase associated with doxorubicin (yes v no) was not modified by age at first treatment (hazard ratio [HR]age <21 years, 1.5 [95% CI, 0.9 to 2.6]; HRage ≥21 years, 1.3 [95% CI, 0.9 to 1.9) or chest RT (HRwithout mantle/axillary field RT, 1.9 [95% CI, 1.06 to 3.3]; HRwith mantle/axillary field RT, 1.2 [95% CI, 0.8 to 1.8]). CONCLUSION This study shows that treatment with doxorubicin is associated with increased BC risk in both adolescent and adult HL survivors. Our results have implications for BC surveillance guidelines for HL survivors and treatment strategies for patients with newly diagnosed HL.
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Affiliation(s)
| | - Yvonne M. Geurts
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Berthe M.P. Aleman
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Pieternella J. Lugtenburg
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Saskia E. Rademakers
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Roel J. de Weijer
- Department of Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Bastiaan D.P. Ta
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Wouter J. Plattel
- Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Josée M. Zijlstra
- Department of Hematology, Amsterdam UMC, Location Vrije Universiteit, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | | | - Marten R. Nijziel
- Catharina Cancer Institute, Department of Hemato-Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Francisca Ong
- Department of Radiotherapy, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Erik C. Schimmel
- Department of Radiotherapy, Radiotherapiegroep, Arnhem, the Netherlands
| | | | - Marie José Kersten
- Department of Hematology, Amsterdam University Medical Centers, Location University of Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Lara H. Böhmer
- Department of Hematology, Haga Teaching Hospital, Den Haag, the Netherlands
| | - Karin Muller
- Department of Radiotherapy, Radiotherapiegroep, Deventer, the Netherlands
| | - Harry R. Koene
- Department of Hematology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Liane C.J. te Boome
- Department of Hematology, Haaglanden Medical Center, Den Haag, the Netherlands
| | - Yavuz M. Bilgin
- Department of Internal Medicine, Admiraal De Ruyter Hospital, Goes, the Netherlands
| | - Eva de Jongh
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Cécile P.M. Janus
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Flora E. van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Michael Schaapveld
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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McGarrity TJ, Aynardi J, Peiffer L, Ashktorab H, Razjouyan H. Therapy-Associated Polyposis, Late Presentation of a Childhood-Treated Disease. ACG Case Rep J 2024; 11:e01379. [PMID: 38883581 PMCID: PMC11177831 DOI: 10.14309/crj.0000000000001379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/02/2024] [Indexed: 06/18/2024] Open
Abstract
Therapy-associated polyposis (TAP), an acquired gastrointestinal polyposis in childhood cancer survivors, poses diagnostic challenges resembling hereditary syndromes. Four TAP patients were studied, revealing upper gastrointestinal lesions after radiotherapy in 2 patients, managed by endoscopic resection. Two underwent total colectomy; 1 had adenocarcinoma from a polyp. Next-generation sequencing on diseased tissue revealed no alteration in mismatch repair genes with stable microsatellite status; however, there was somatic mutation in APC gene altering Wnt signaling pathway in all 3 precancerous lesions. Integrating endoscopic and surgical interventions is crucial, although ongoing studies aim to elucidate pathophysiology for potential targeted therapies in TAP management.
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Affiliation(s)
- Thomas J McGarrity
- Division of Gastroenterology, Department of Internal Medicine, Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
| | - Jason Aynardi
- Department of Pathology, Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
| | - Laurie Peiffer
- Division of Gastroenterology, Department of Internal Medicine, Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
| | - Hassan Ashktorab
- Division of Gastroenterology, Department of Medicine, Howard University, Washington, DC
| | - Hadie Razjouyan
- Division of Gastroenterology, Department of Internal Medicine, Hershey Medical Center, Penn State University College of Medicine, Hershey, PA
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4
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Armenian SH, Chao C. Burden of Morbidity and Mortality in Adolescent and Young Adult Cancer Survivors. J Clin Oncol 2024; 42:735-742. [PMID: 37983585 DOI: 10.1200/jco.23.01751] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/29/2023] [Accepted: 09/28/2023] [Indexed: 11/22/2023] Open
Abstract
There are an estimated 650,00 survivors of adolescent and young adult (AYA) cancers in the United States, a number that is expected to markedly increase in the coming decades. The recognition of the potential for some cancer treatments to affect the health of patients for many years after the initial diagnosis has prompted investigators to examine the evolving burden of late morbidity and mortality in AYAs with cancer after treatment completion. Studies in large international cohorts of AYA cancer survivors have now shown that the burden of late effects in survivors treated during the past four decades is substantial, affecting the health and well-being of the survivor, health systems' preparedness to meet their health care needs in the future, and societal economic costs that are largely affected by loss of productivity. We highlight the unique considerations for AYA cancer survivors, identify gaps in knowledge for future research, and provide an overview of emerging efforts to mitigate late effects in these survivors. Ongoing multidisciplinary bench-to-bedside collaborations are critical to understanding the biology of late effects in AYA cancer survivors and to developing personalized interventions to mitigate them. The growing population of AYA cancer survivors makes it imperative that these efforts extend across the cancer care continuum, which will allow survivors to ultimately live to their fullest potential.
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Affiliation(s)
- Saro H Armenian
- Department of Pediatrics, City of Hope, Duarte, CA
- Division of Outcomes Research, Department of Population Science, City of Hope, Duarte, CA
| | - Chun Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
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5
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Geurts YM, Neppelenbroek SIM, Aleman BMP, Janus CPM, Krol ADG, van Spronsen DJ, Plattel WJ, Roesink JM, Verschueren KMS, Zijlstra JM, Koene HR, Nijziel MR, Schimmel EC, de Jongh E, Ong F, Te Boome LCJ, van Rijn RS, Böhmer LH, Ta BDP, Visser HPJ, Posthuma EFM, Bilgin YM, Muller K, van Kampen D, So-Osman C, Vermaat JSP, de Weijer RJ, Kersten MJ, van Leeuwen FE, Schaapveld M. Treatment-specific risk of subsequent malignant neoplasms in five-year survivors of diffuse large B-cell lymphoma. ESMO Open 2024; 9:102248. [PMID: 38350338 PMCID: PMC10937196 DOI: 10.1016/j.esmoop.2024.102248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The introduction of rituximab significantly improved the prognosis of diffuse large B-cell lymphoma (DLBCL), emphasizing the importance of evaluating the long-term consequences of exposure to radiotherapy, alkylating agents and anthracycline-containing (immuno)chemotherapy among DLBCL survivors. METHODS Long-term risk of subsequent malignant neoplasms (SMNs) was examined in a multicenter cohort comprising 2373 5-year DLBCL survivors treated at ages 15-61 years in 1989-2012. Observed SMN numbers were compared with expected cancer incidence to estimate standardized incidence ratios (SIRs) and absolute excess risks (AERs/10 000 person-years). Treatment-specific risks were assessed using multivariable Cox regression. RESULTS After a median follow-up of 13.8 years, 321 survivors developed one or more SMNs (SIR 1.5, 95% CI 1.3-1.8, AER 51.8). SIRs remained increased for at least 20 years after first-line treatment (SIR ≥20-year follow-up 1.5, 95% CI 1.0-2.2, AER 81.8) and were highest among patients ≤40 years at first DLBCL treatment (SIR 2.7, 95% CI 2.0-3.5). Lung (SIR 2.0, 95% CI 1.5-2.7, AER 13.4) and gastrointestinal cancers (SIR 1.5, 95% CI 1.2-2.0, AER 11.8) accounted for the largest excess risks. Treatment with >4500 mg/m2 cyclophosphamide/>300 mg/m2 doxorubicin versus ≤2250 mg/m2/≤150 mg/m2, respectively, was associated with increased solid SMN risk (hazard ratio 1.5, 95% CI 1.0-2.2). Survivors who received rituximab had a lower risk of subdiaphragmatic solid SMNs (hazard ratio 0.5, 95% CI 0.3-1.0) compared with survivors who did not receive rituximab. CONCLUSION Five-year DLBCL survivors have an increased risk of SMNs. Risks were higher for survivors ≤40 years at first treatment and survivors treated with >4500 mg/m2 cyclophosphamide/>300 mg/m2 doxorubicin, and may be lower for survivors treated in the rituximab era, emphasizing the need for studies with longer follow-up for rituximab-treated patients.
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Affiliation(s)
- Y M Geurts
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam
| | | | - B M P Aleman
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam
| | - C P M Janus
- Department of Radiotherapy, Erasmus Medical Centre, Rotterdam
| | - A D G Krol
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden
| | - D J van Spronsen
- Department of Hematology, Radboud University Medical Centre, Nijmegen
| | - W J Plattel
- Department of Hematology, University Medical Centre Groningen, Groningen
| | - J M Roesink
- Department of Radiotherapy, University Medical Centre Utrecht, Utrecht
| | | | - J M Zijlstra
- Department of Hematology, Amsterdam UMC location Vrije Universiteit, Cancer Centre Amsterdam, Amsterdam
| | - H R Koene
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein
| | - M R Nijziel
- Catharina Cancer Institute, Department of Hemato-Oncology, Catharina Hospital, Eindhoven
| | | | - E de Jongh
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht
| | - F Ong
- Department of Radiotherapy, Medisch Spectrum Twente, Enschede
| | - L C J Te Boome
- Department of Hematology, Haaglanden Medical Centre, The Hague
| | - R S van Rijn
- Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden
| | - L H Böhmer
- Department of Hematology, Haga Teaching Hospital, The Hague
| | - B D P Ta
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht
| | - H P J Visser
- Department of Hematology, Noordwest Ziekenhuisgroep Alkmaar, Alkmaar
| | - E F M Posthuma
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft
| | - Y M Bilgin
- Department of Internal Medicine, ADRZ, Goes
| | | | - D van Kampen
- Zuidwest Radiotherapeutisch Instituut, Vlissingen
| | - C So-Osman
- Department of Hematology, Erasmus Medical Centre, Rotterdam; Unit Transfusion Medicine, Sanquin Blood Supply Foundation, Amsterdam
| | - J S P Vermaat
- Department of Hematology, Leiden University Medical Centre, Leiden
| | - R J de Weijer
- Department of Hematology, University Medical Centre Utrecht, Utrecht
| | - M J Kersten
- Department of Hematology, Amsterdam UMC location University of Amsterdam, Cancer Centre Amsterdam and LYMMCARE, Amsterdam, The Netherlands
| | - F E van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam
| | - M Schaapveld
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam.
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Wong SM. Best practice & research clinical haematology: Screening for breast cancer in hodgkin lymphoma survivors. Best Pract Res Clin Haematol 2023; 36:101525. [PMID: 38092481 DOI: 10.1016/j.beha.2023.101525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023]
Abstract
Childhood and young adult survivors of Hodgkin lymphoma are at an elevated risk of developing breast cancer. Breast cancer risk is felt to originate from chest wall radiation exposure prior to the third decade of life, with incidence beginning to rise approximately eight to ten years following Hodgkin lymphoma treatment. Although incidence varies according to age at radiation exposure, dosage, and treatment fields, cohort studies have documented a cumulative incidence of breast cancer of 10-20% by 40 years of age. Women with a history of chest radiation for Hodgkin lymphoma are counselled to begin screening with bilateral breast MRI at 25 years of age, or eight years after radiation, whichever occurs later. Outside of high-risk surveillance, the optimal management approach for women with prior radiation exposure continues to evolve. When diagnosed with breast malignancy, evidence supports consideration of unilateral therapeutic and contralateral prophylactic mastectomy, although breast conserving surgery may be considered following multidisciplinary assessment. This review will address the epidemiology, characteristics, screening and management guidelines, and breast-cancer prevention efforts for Hodgkin lymphoma survivors treated with radiation therapy in adolescence and young adulthood.
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Affiliation(s)
- Stephanie M Wong
- Department of Surgery and Oncology, McGill University Medical School, Montreal, QC, Canada; Jewish General Hospital Stroll Cancer Prevention Centre, Montreal, QC, Canada.
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7
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Touati R, Pauly L, Reyal F, Kirova Y. Breast Cancer and Mediastinal Hodgkin's Lymphomas: Multidisciplinary Discussion. Clin Breast Cancer 2023; 23:681-686. [PMID: 37419747 DOI: 10.1016/j.clbc.2023.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 07/09/2023]
Abstract
Treatment for Hodgkin's lymphoma (HL) has evolved, with modern treatments combining less toxic chemotherapy and radiation, leading to improved long-term disease-free survival. However, there is a higher chance of second cancer, especially breast cancer, following effective HL treatment. The impact of reduced radiation doses and volumes, as well as the use of advanced irradiation techniques, on the risk of second malignancy is not clear. According to medical organizations, the history of chest irradiation is a relative contraindication to breast preservation therapy for women with initial breast cancer, leading to a paradigm of mastectomy. This article proposes a discussion between radiation oncologists and surgeons to review major trials and recent developments on the prevalence of breast cancer following HL therapy, the risk of contralateral cancer, the feasibility of breast conserving surgery (BCS), as well as breast reconstruction modalities.
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Affiliation(s)
- Ruben Touati
- Department of Radiation Oncology, Institut Curie Hospital, Paris, France
| | - Lea Pauly
- Department of Surgical Oncology, Institut Curie Hospital, Paris, France
| | - Fabien Reyal
- Department of Surgical Oncology, Institut Curie Hospital, Paris, France
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie Hospital, Paris, France.
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8
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Geurts YM, Shakir R, Ntentas G, Roberti S, Aznar MC, John KM, Ramroth J, Janus CPM, Krol ADG, Roesink JM, van der Maazen RWM, Zijlstra JM, Darby SC, Aleman BMP, van Leeuwen FE, Cutter DJ, Schaapveld M. Association of Radiation and Procarbazine Dose With Risk of Colorectal Cancer Among Survivors of Hodgkin Lymphoma. JAMA Oncol 2023; 9:481-489. [PMID: 36729438 PMCID: PMC9896374 DOI: 10.1001/jamaoncol.2022.7153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Importance Hodgkin lymphoma (HL) survivors have higher rates of colorectal cancer, which may be associated with subdiaphragmatic radiation therapy and/or alkylating chemotherapy. Although radiation dose-response associations with breast, lung, stomach, pancreatic, and esophageal cancer after HL have been demonstrated, the association of radiation therapy with colorectal cancer remains unclear. Objective To quantify the rate of colorectal cancer according to radiation dose to the large bowel and procarbazine dose among HL survivors. Design, Setting, and Participants A nested case-control study examined 5-year HL survivors at 5 hospital centers in the Netherlands. Participants had been diagnosed with HL in 1964 to 2000, when they were 15 to 50 years of age, and were followed for a median of approximately 26 years. Survivors of HL who developed colorectal cancer and survivors who were selected as controls were individually matched on sex, age at HL diagnosis, and date of HL diagnosis. Data were analyzed from July 2021 to October 2022. Exposures Mean radiation doses to the large bowel were estimated by reconstructing individual radiation therapy treatments on representative computed tomography data sets. Main Outcomes and Measures Excess rate ratios (ERRs) were modeled to evaluate the excess risk associated with each 1-gray increase in radiation dose, and potential effect modification by procarbazine was explored. Results The study population included 316 participants (mean [SD] age at HL diagnosis, 33.0 [9.8] years; 221 [69.9%] men), 78 of whom were HL survivors who developed colorectal cancer (cases) and 238 who did not (controls). The median (IQR) interval between HL and colorectal cancer was 25.7 (18.2-31.6) years. Increased colorectal cancer rates were seen for patients who received subdiaphragmatic radiation therapy (rate ratio [RR], 2.4; 95% CI, 1.4-4.1) and those who received more than 8.4 g/m2 procarbazine (RR, 2.5; 95% CI, 1.3-5.0). Overall, colorectal cancer rate increased linearly with mean radiation dose to the whole large bowel and dose to the affected bowel segment. The association between radiation dose and colorectal cancer rate became stronger with increasing procarbazine dose: the ERR per gray to the whole bowel was 3.5% (95% CI, 0.4%-12.6%) for patients who did not receive procarbazine, and increased 1.2-fold (95% CI, 1.1-1.3) for each 1-g/m2 increase in procarbazine dose. Conclusions and Relevance This nested case-control study of 5-year HL survivors found a dose-response association between radiation therapy and colorectal cancer risk, and modification of this association by procarbazine. These findings may enable individualized colorectal cancer risk estimations, identification of high-risk survivors for subsequent screening, and optimization of treatment strategies.
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Affiliation(s)
- Yvonne M. Geurts
- Department of Epidemiology and Biostatistics, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Rebecca Shakir
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Georgios Ntentas
- Nuffield Department of Population Health, University of Oxford, Oxford, UK,Department of Medical Physics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK,School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Sander Roberti
- Department of Epidemiology and Biostatistics, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Marianne C. Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - Katinka M. John
- Department of Epidemiology and Biostatistics, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Johanna Ramroth
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Cécile P. M. Janus
- Department of Radiotherapy, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Augustinus D. G. Krol
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Judith M. Roesink
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Josée M. Zijlstra
- Department of Hematology, Amsterdam University Medical Center, Vrije Universiteit, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Sarah C. Darby
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Berthe M. P. Aleman
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Flora E. van Leeuwen
- Department of Epidemiology and Biostatistics, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - David J. Cutter
- Nuffield Department of Population Health, University of Oxford, Oxford, UK,Oxford Cancer and Hematology Center, Oxford University Hospitals National Health Service Foundation Trust, Churchill Hospital, Oxford, UK
| | - Michael Schaapveld
- Department of Epidemiology and Biostatistics, the Netherlands Cancer Institute, Amsterdam, the Netherlands
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Dudley IM, Sunguc C, Heymer EJ, Winter DL, Teepen JC, Belle FN, Bárdi E, Bagnasco F, Gudmundsdottir T, Skinner R, Michel G, Byrne J, Øfstaas H, Jankovic M, Mazić MČ, Mader L, Loonen J, Garwicz S, Wiebe T, Alessi D, Allodji RS, Haddy N, Grabow D, Kaatsch P, Kaiser M, Maule MM, Jakab Z, Gunnes MW, Terenziani M, Zaletel LZ, Kuehni CE, Haupt R, de Vathaire F, Kremer LC, Lähteenmäki PM, Winther JF, Hjorth L, Hawkins MM, Reulen RC. Risk of subsequent primary lymphoma in a cohort of 69,460 five-year survivors of childhood and adolescent cancer in Europe: The PanCareSurFup study. Cancer 2023; 129:426-440. [PMID: 36444554 PMCID: PMC10099796 DOI: 10.1002/cncr.34561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Survivors of Hodgkin lymphoma (HL) are at risk of developing non-Hodgkin lymphoma (NHL) after treatment; however, the risks of developing subsequent primary lymphomas (SPLs), including HL and NHL, after different types of childhood cancer are unknown. The authors quantified the risk of SPLs using the largest cohort of childhood cancer survivors worldwide. METHODS The Pan-European Network for Care of Survivors After Childhood and Adolescent Cancer (PanCare) Survivor Care and Follow-Up Studies (PanCareSurFup) cohort includes 69,460 five-year survivors of childhood cancer, diagnosed during 1940 through 2008, from 12 European countries. Risks of SPLs were quantified by standardized incidence ratios (SIRs) and relative risks (RRs) using multivariable Poisson regression. RESULTS Overall, 140 SPLs, including 104 NHLs and 36 HLs, were identified. Survivors were at 60% increased risk of an SPL compared with the general population (SIR, 1.6; 95% confidence interval [CI], 1.4-1.9). Survivors were twice as likely to develop NHL (SIR, 2.3; 95% CI, 1.9-2.8), with the greatest risks among survivors of HL (SIR, 7.1; 95% CI, 5.1-10.0), Wilms tumor (SIR, 3.1; 95% CI, 1.7-5.7), leukemia (SIR, 2.8; 95% CI, 1.8-4.4), and bone sarcoma (SIR, 2.7; 95% CI, 1.4-5.4). Treatment with chemotherapy for any cancer doubled the RR of NHL (RR, 2.1; 95% CI, 1.2-3.9), but treatment with radiotherapy did not (RR, 1.2; 95% CI, 0.7-2.0). Survivors were at similar risk of developing a subsequent HL as the general population (SIR, 1.1; 95% CI, 0.8-1.5). CONCLUSIONS In addition to HL, the authors show here for the first time that survivors of Wilms tumor, leukemia, and bone sarcoma are at risk of NHL. Survivors and health care professionals should be aware of the risk of NHL in these survivors and in any survivors treated with chemotherapy.
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Affiliation(s)
- Isabelle M. Dudley
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Ceren Sunguc
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Emma J. Heymer
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - David L. Winter
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Jop C. Teepen
- Princess Maxima Center for Pediatric OncologyUtrechtThe Netherlands
| | - Fabiën N. Belle
- Childhood Cancer Research GroupInstitute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Center for Primary Care and Public Health (Unisante)University of LausanneLausanneSwitzerland
| | - Edit Bárdi
- St Anna Children's HospitalViennaAustria
- Department of Pediatrics and Adolescent MedicineJohannes Kepler University LinzKepler University HospitalLinzAustria
| | | | - Thorgerdur Gudmundsdottir
- Danish Cancer Society Research CenterChildhood Cancer Research GroupCopenhagenDenmark
- Children's HospitalLandspitali University HospitalReykjavikIceland
| | - Roderick Skinner
- Great North Children's HospitalNewcastle upon Tyne Hospitals National Health Service Foundation TrustNewcastle upon TyneUK
- Newcastle University Center for CancerNewcastle UniversityNewcastle upon TyneUK
| | - Gisela Michel
- Department of Health Sciences and MedicineUniversity of LucerneLucerneSwitzerland
| | | | - Hilde Øfstaas
- Division of Pediatric and Adolescent MedicineOslo University Hospital RikshospitaletOsloNorway
| | - Momcilo Jankovic
- Pediatric ClinicUniversity of Milano‐BicoccaHospital San GerardoMonzaItaly
| | - Maja Česen Mazić
- University Children's Hospital LjubljanaUniversity Medical Center LjubljanaLjubljanaSlovenia
| | - Luzius Mader
- Childhood Cancer Research GroupInstitute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Jaqueline Loonen
- Department of HematologyRadboud University Medical CenterNijmegenNetherlands
| | - Stanislaw Garwicz
- Department of Clinical Sciences Lund, PediatricsLund UniversitySkane University HospitalLundSweden
| | - Thomas Wiebe
- Department of Clinical Sciences Lund, PediatricsLund UniversitySkane University HospitalLundSweden
| | - Daniela Alessi
- Childhood Cancer Registry of PiedmontCancer Epidemiology UnitDepartment of Medical SciencesUniversity of TurinTurinItaly
- Reference Center for Epidemiology and Cancer Prevention‐PiemonteUniversity Hospital Citta della Salute e della Scienza di TorinoTurinItaly
| | - Rodrigue S. Allodji
- Radiation Epidemiology TeamCenter for Research in Epidemiology and Population HealthNational Institute of Health and Medical Research Unit 1018University Paris SaclayGustave RoussyVillejuifFrance
| | - Nadia Haddy
- Radiation Epidemiology TeamCenter for Research in Epidemiology and Population HealthNational Institute of Health and Medical Research Unit 1018University Paris SaclayGustave RoussyVillejuifFrance
| | - Desiree Grabow
- German Childhood Cancer RegistryDivision of Childhood Cancer EpidemiologyInstitute of Medical Biostatistics, Epidemiology, and InformaticsJohannes‐Gutenberg University MainzMainzGermany
| | - Peter Kaatsch
- German Childhood Cancer RegistryDivision of Childhood Cancer EpidemiologyInstitute of Medical Biostatistics, Epidemiology, and InformaticsJohannes‐Gutenberg University MainzMainzGermany
| | - Melanie Kaiser
- German Childhood Cancer RegistryDivision of Childhood Cancer EpidemiologyInstitute of Medical Biostatistics, Epidemiology, and InformaticsJohannes‐Gutenberg University MainzMainzGermany
| | - Milena M. Maule
- Childhood Cancer Registry of PiedmontCancer Epidemiology UnitDepartment of Medical SciencesUniversity of TurinTurinItaly
- Reference Center for Epidemiology and Cancer Prevention‐PiemonteUniversity Hospital Citta della Salute e della Scienza di TorinoTurinItaly
| | - Zsuzsanna Jakab
- Hungarian Childhood Cancer RegistrySecond Department of PediatricsSemmelweis UniversityBudapestHungary
| | - Maria Winther Gunnes
- Division of Pediatric and Adolescent MedicineOslo University Hospital RikshospitaletOsloNorway
- Department of RegistrationCancer Registry of NorwayOsloNorway
| | - Monica Terenziani
- Pediatric Oncology UnitFondazione IRCCS Istituto Nazionale dei TumoriMilanItaly
| | | | - Claudia E. Kuehni
- Childhood Cancer Research GroupInstitute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Division of Pediatric Hematology/OncologyDepartment of PediatricsUniversity Children's Hospital of BernUniversity of BernBernSwitzerland
| | - Riccardo Haupt
- Diagnosis, Observation, Prevention After Oncologic Treatment (DOPO) ClinicDivision of Hematology/OncologyIRCCS Istituto Giannina GasliniGenovaItaly
| | - Florent de Vathaire
- Radiation Epidemiology TeamCenter for Research in Epidemiology and Population HealthNational Institute of Health and Medical Research Unit 1018University Paris SaclayGustave RoussyVillejuifFrance
| | - Leontien C. Kremer
- Princess Maxima Center for Pediatric OncologyUtrechtThe Netherlands
- Emma Children's HospitalAmsterdamNetherlands
| | - Päivi M. Lähteenmäki
- Department of Pediatrics and Adolescent MedicineTurku University and Turku University HospitalTurkuFinland
| | - Jeanette F. Winther
- Danish Cancer Society Research CenterChildhood Cancer Research GroupCopenhagenDenmark
- Department of Clinical MedicineFaculty of HealthAarhus University and University HospitalAarhusDenmark
| | - Lars Hjorth
- Department of Clinical Sciences Lund, PediatricsLund UniversitySkane University HospitalLundSweden
| | - Michael M. Hawkins
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Raoul C. Reulen
- Center for Childhood Cancer Survivor StudiesInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
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10
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Rigter LS, Snaebjornsson P, Rosenberg EH, Altena E, van Grieken NCT, Aleman BMP, Kerst JM, Morton L, Schaapveld M, Meijer GA, van Leeuwen FE, van Leerdam ME. Molecular characterization of gastric adenocarcinoma diagnosed in patients previously treated for Hodgkin lymphoma or testicular cancer. PLoS One 2022; 17:e0270591. [PMID: 35877698 PMCID: PMC9312836 DOI: 10.1371/journal.pone.0270591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 06/14/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction The risk of developing gastric cancer is increased in patients treated with radiotherapy for Hodgkin lymphoma (HL) or testicular cancer (TC). This study aims to assess if gastric adenocarcinoma after treatment for HL/TC (t-GC) is molecularly different from gastric adenocarcinoma in the general population. Methods Patients were diagnosed with t-GC ≥5 years after treatment for HL/TC. Four molecular subtypes were identified using immunohistochemical and molecular analyses: Epstein-Barr virus (EBV), mismatch repair (MMR) deficiency or microsatellite instability (MSI), aberrant p53 staining as surrogate for chromosomal instability (sCIN), and a surrogate for genomic stability (sGS) without these aberrations. Results were compared with gastric cancer in the general population (p-GC) described in literature. Results Molecular subtyping of 90 t-GCs resulted in 3% EBV, 8% MSI, 36% sCIN and 53% sGS. 3/6 of MSI t-GCs had MLH1 promoter methylation and 2/6 were explained by double somatic mutations in MMR genes. T-GCs were more frequently sGS than p-GCs (53% vs. 38%, p = 0.04). T-GC was more frequently sGS in HL/TC patients diagnosed before 1990, than after 1990 (63% vs. 38%, p = 0.03). T-GCs located in the antrum, an area that receives high irradiation doses, were more frequently sGS (61% vs. 28% in p-GCs, p = 0.02). Conclusion Our results demonstrate that t-GCs are more frequently of the sGS subtype than p-GCs. An association of t-GC of the sGS subtype with prior anticancer treatment is suggested by the high frequency in HL/TC patients who were treated before 1990, a time period in which HL/TC treatments were more extensive.
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Affiliation(s)
- Lisanne S. Rigter
- Department of Gastroenterology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Petur Snaebjornsson
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Efraim H. Rosenberg
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Estelle Altena
- Department of Gastroenterology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Berthe M. P. Aleman
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan M. Kerst
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lindsay Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Michael Schaapveld
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gerrit A. Meijer
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Flora E. van Leeuwen
- Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Monique E. van Leerdam
- Department of Gastroenterology, Netherlands Cancer Institute, Amsterdam, The Netherlands
- * E-mail:
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11
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Gudapati P, Abouamara M. Treatment-related peripheral small cell lung carcinoma in a Hodgkin lymphoma survivor. BMJ Case Rep 2022; 15:e249104. [PMID: 35264395 PMCID: PMC8915357 DOI: 10.1136/bcr-2022-249104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 12/31/2022] Open
Abstract
Hodgkin lymphoma (HL) survivors have an increased risk of developing subsequent treatment-related primary malignancies. In the last few decades, advances in knowledge, radiotherapy, chemotherapy and autologous stem cell transplantation have led to the transformation of lethal malignancy into highly curable malignancy, thereby improving outcomes. With prolonged survival, the risk of developing subsequent treatment-related late adverse effects, such as malignancies, steadily increases over time. Herein, we present the first case of a treatment-related second primary stage IV peripheral small cell lung carcinoma in a female HL survivor who was also diagnosed with right breast cancer 13 years after HL treatment and 1 year before her lung cancer diagnosis.
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Affiliation(s)
- Prathyusha Gudapati
- Internal Medicine, UNC Health Southeastern, Lumberton, North Carolina, USA
- Internal Medicine, Campbell University Jerry M Wallace School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Mouna Abouamara
- Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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12
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Xiao H, He J, Liang S, Cai D, Zhou Q, Liu L, Yan X, Chi J, Xiao Q, Wang L. Racial/Ethnic Disparities on the Risk of Second Malignant Neoplasm Among Hodgkin Lymphoma Survivors. Front Oncol 2022; 11:790891. [PMID: 35141149 PMCID: PMC8818723 DOI: 10.3389/fonc.2021.790891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/28/2021] [Indexed: 11/25/2022] Open
Abstract
Background Hodgkin lymphoma survivors are at risk for second malignant neoplasm (SMN). How race/ethnicity affects the risk remains unclear. Methods This retrospective cohort study included 22,415 patients diagnosed with primary Hodgkin lymphoma from January 1992 to December 2015 in 13 Surveillance, Epidemiology, and End Results-based registries and divided patients into four groups: non-Hispanic whites, non-Hispanic blacks, Hispanics, and Asian/others. Taking non-Hispanic whites as a reference, both the proportional subdistribution hazard (PSH) and the cause-specific hazard (CSH) methods were used to calculate the SMN hazard ratio for other racial/ethnic groups with and without considering the competing mortality risk. Results 1,778 patients developed SMN with a median follow-up of 11.63 years. In the adjusted PSH model, Hispanic, Asian/others, and non-Hispanic black patients had 26% (PSH, 0.74; 95% CI, 0.63–0.87), 20% (PSH, 0.80; 95% CI, 0.64–1.01), and 12% (PSH, 0.88; 95% CI, 0.75–1.03) decreased overall SMN hazard, respectively. Moreover, the PSH method revealed the racial/ethnic difference in the SMN risk in the skin, the respiratory system, and the endocrine system. These hazards were slightly higher and different with the use of the CSH approach. In addition to the aforementioned overall SMN and subtypes, adjusted CSH analysis also revealed the racial/ethnic disparities in the risk of subsequent female breast cancer, digestive cancer, and non-Hodgkin lymphoma. Conclusions The subtype and SMN risk among Hodgkin lymphoma survivors varied by race/ethnicity. The use of CSH and PSH provides a dynamic view of racial/ethnic effects on SMN risk in Hodgkin lymphoma survivors.
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Affiliation(s)
- Han Xiao
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Jianghua He
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS, United States
| | - Simin Liang
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Duo Cai
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Qiao Zhou
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Lanxiang Liu
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Xinyu Yan
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Jianxiang Chi
- The Center for the Study of Hematological Malignancies, Karaiskakio Foundation, Nicosia, Cyprus
| | - Qing Xiao
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Li Wang
- Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
- *Correspondence: Li Wang,
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13
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Rosenbrock J, Baues C, Vasquez-Torres A, Clivio A, Fogliata A, Borchmann P, Marnitz S, Cozzi L. Volumetric modulated arc therapy versus intensity-modulated proton therapy in the irradiation of infra diaphragmatic Hodgkin Lymphoma in female patients. Acta Oncol 2022; 61:81-88. [PMID: 34596491 DOI: 10.1080/0284186x.2021.1986230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the role of infra diaphragmatic intensity-modulated proton therapy (IMPT) compared to volumetric modulated arc therapy (VMAT) for female Hodgkin Lymphoma (HL) patients and to estimate the risk of secondary cancer and ovarian failure. METHODS A comparative treatment planning study was performed on 14 patients, and the results were compared according to conventional dose-volume metrics. In addition, estimates of the excess absolute risk (EAR) of secondary cancer induction were determined for the bowel, the bladder and the rectum. For the ovaries, the risk of ovarian failure was estimated. RESULTS The dosimetric findings demonstrate the equivalence between VMAT and IMPT in terms of target coverage. A statistically significant reduction of the mean and near-to-maximum doses was proven for the organs at risk. The EAR ratio estimated for IMPT to VMAT was 0.51 ± 0.32, 0.32 ± 0.35 and 0.05 ± 0.11 for the bowel, bladder and rectum, respectively. Concerning the risk of ovarian failure for the chronologic age ranging from 18 to 46 years, the expected net loss in fertility years ranged from 4.8 to 3.0 years for protons and 12.0 to 5.7 years for photons. CONCLUSION This in-silico study confirmed the beneficial role of IMPT from a dosimetric point of view. Mathematical models suggested that the use of protons might be further advantageous due to the expected reduction of the risk of secondary cancer induction and its milder impact on the reduction of fertility.
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Affiliation(s)
- Johannes Rosenbrock
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christian Baues
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andres Vasquez-Torres
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Antonella Fogliata
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Peter Borchmann
- German Hodgkin Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy
| | - Simone Marnitz
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Luca Cozzi
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
- Department of Hematology and Oncology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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14
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Ykema BLM, Rigter LS, Spaander MCW, Moons LMG, Bisseling TM, Aleman BMP, Dekker E, Verbeek WHM, Kuipers EJ, de Boer JP, Lugtenburg PJ, Janus CPM, Petersen EJ, Roesink JM, van der Maazen RWM, Meijer GA, Schaapveld M, van Leeuwen FE, Carvalho B, Snaebjornsson P, van Leerdam ME. Clinicopathological features and risk factors for developing colorectal neoplasia in Hodgkin's lymphoma survivors. Dig Endosc 2022; 34:163-170. [PMID: 33928678 PMCID: PMC9290704 DOI: 10.1111/den.14004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hodgkin's lymphoma (HL) survivors treated with abdominal radiotherapy and/or procarbazine have an increased risk of developing colorectal neoplasia. AIMS We evaluated the clinicopathological characteristics and risk factors for developing (advanced) neoplasia (AN) in HL survivors. METHODS In all, 101 HL survivors (median age 51 years, median age of HL diagnosis 25 years) underwent colonoscopy and 350 neoplasia and 44 AN (classified as advanced adenomas/serrated lesions or colorectal cancer), mostly right-sided, were detected, as published previously. An average-risk asymptomatic cohort who underwent screening colonoscopy were controls (median age 60 years). Clinicopathological characteristics of AN were evaluated in both groups. Mismatch repair (MMR) status was assessed using immunohistochemistry (MLH1/MSH2/MSH6/PMS2). Logistic regression analysis was performed to evaluate the risk factors for AN in HL survivors, including age at HL diagnosis and interval between HL and colonoscopy. RESULTS In 101 colonoscopies in HL survivors, AN was primarily classified based on polyp size ≥10 mm, whereas (high-grade)dysplasia was more often seen in AN in controls. An interval between HL diagnosis and colonoscopy >26 years was associated with more AN compared with an interval of <26 years, with an odds ratio for AN of 3.8 (95% confidence interval 1.4-9.1) (p < 0.01). All 39 AN that were assessed were MMR proficient. CONCLUSIONS Colorectal neoplasia in HL survivors differ from average-risk controls; classification AN was primarily based on polyp size (≥10 mm) in HL survivors. Longer follow-up between HL diagnosis and colonoscopy was associated with a higher prevalence of AN in HL survivors.
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Affiliation(s)
- Berbel L. M. Ykema
- Department ofGastroenterology and HepatologyNetherlands Cancer InstituteAmsterdamThe Netherlands
| | - Lisanne S. Rigter
- Department ofGastroenterology and HepatologyNetherlands Cancer InstituteAmsterdamThe Netherlands
| | - Manon C. W. Spaander
- Department of Gastroenterology and HepatologyErasmus Medical Center University HospitalRotterdamThe Netherlands
| | - Leon M. G. Moons
- Department ofGastroenterology and HepatologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Tanya M. Bisseling
- Department ofGastroenterology and HepatologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Berthe M. P. Aleman
- Department ofRadiation OncologyNetherlands Cancer InstituteAmsterdamThe Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and HepatologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Wieke H. M. Verbeek
- Department ofGastroenterology and HepatologyNetherlands Cancer InstituteAmsterdamThe Netherlands
| | - Ernst J. Kuipers
- Department of Gastroenterology and HepatologyErasmus Medical Center University HospitalRotterdamThe Netherlands
| | - Jan Paul de Boer
- Department ofMedical OncologyNetherlands Cancer InstituteAmsterdamThe Netherlands
| | | | - Cecile P. M. Janus
- Department ofRadiation OncologyErasmus MC Cancer InstituteRotterdamThe Netherlands
| | - Eefke J. Petersen
- Department ofHematologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Judith M. Roesink
- Department ofRadiation OncologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Gerrit A. Meijer
- Department ofPathologyNetherlands Cancer InstituteAmsterdamThe Netherlands
| | - Michael Schaapveld
- Department ofEpidemiologyNetherlands Cancer InstituteAmsterdamThe Netherlands
| | | | - Beatriz Carvalho
- Department ofPathologyNetherlands Cancer InstituteAmsterdamThe Netherlands
| | | | - Monique E. van Leerdam
- Department ofGastroenterology and HepatologyNetherlands Cancer InstituteAmsterdamThe Netherlands,Department of Gastroenterology and HepatologyLeiden University Medical CenterLeidenThe Netherlands
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15
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Butler E, Ludwig K, Pacenta HL, Klesse LJ, Watt TC, Laetsch TW. Recent progress in the treatment of cancer in children. CA Cancer J Clin 2021; 71:315-332. [PMID: 33793968 DOI: 10.3322/caac.21665] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 12/12/2022] Open
Abstract
Although significant improvements have been made in the outcomes of children with cancer, the pace of improvement has slowed in recent years as the limits of therapy intensification may have been reached for many pediatric cancers. Furthermore, with increasing numbers of pediatric cancer survivors, the long-term side effects of treatment have become increasingly apparent. Therefore, attention has shifted to the use of molecularly targeted agents and immunotherapies to improve the outcomes of children who are not cured by traditional cytotoxic chemotherapies and to decrease exposure to cytotoxic chemotherapy and reduce late effects. This review describes the recent progress in the treatment of children with cancer, focusing in particular on diseases in which targeted and immunotherapeutic agents have made an impact.
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Affiliation(s)
- Erin Butler
- Department of Pediatrics and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas
| | - Kathleen Ludwig
- Department of Pediatrics and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas
| | - Holly L Pacenta
- Division of Hematology and Oncology, Cook Children's Medical Center, Fort Worth, Texas
| | - Laura J Klesse
- Department of Pediatrics and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas
| | - Tanya C Watt
- Department of Pediatrics and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center and Children's Health, Dallas, Texas
| | - Theodore W Laetsch
- Division of Oncology and Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
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16
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ABVD followed by BV consolidation in risk-stratified patients with limited-stage Hodgkin lymphoma. Blood Adv 2021; 4:2548-2555. [PMID: 32516414 DOI: 10.1182/bloodadvances.2020001871] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/24/2020] [Indexed: 01/12/2023] Open
Abstract
Approximately 90% of limited-stage Hodgkin lymphoma (HL) patients are projected to be cured with standard therapy, but many do not live their expected life span because of late treatment-related complications. New treatment paradigms are needed to reduce the use of radiation therapy (RT) as well as conventional chemotherapy drugs while improving upon current standard-of-care survival outcomes. In this phase 2 multicenter study, patients with non-bulky limited-stage HL received doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by brentuximab vedotin (BV) consolidation. Forty-one patients were enrolled, and patient characteristics included median age of 29 years (range, 19 to 67 years), 58% were female, 45% had unfavorable disease, and 98% had stage II disease. Based on positron emission tomography (PET)-based risk stratification, patients received 2 to 6 cycles of ABVD followed by 6 cycles of BV. After ABVD followed by BV, 95% of evaluable patients (37 out of 39; 95% confidence interval [CI], 83%-99%) achieved PET-negative status. In the intent-to-treat patient population, the estimated 3-year progression-free survival (PFS) rate was 92%, and the overall survival (OS) rate was 97%, with a median follow-up of 47 months. All 37 patients who achieved negative PET status after BV consolidation effectively avoided RT and remain in remission with estimated 3-year PFS and OS rates of 100%. In conclusion, BV demonstrates encouraging clinical activity when it follows ABVD therapy in limited-stage HL. Early incorporation of BV may reduce the use of RT as well as conventional chemotherapy drugs while achieving favorable survival outcomes in risk-stratified patients with non-bulky limited-stage HL. This trial was registered at www.clinicaltrials.gov as #NCT01578967.
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Wong RX, Faught J, Gargone M, Myers W, Krasin M, Faught A, Acharya S. Cardiac-Sparing and Breast-Sparing Whole Lung Irradiation Using Intensity-Modulated Proton Therapy. Int J Part Ther 2021; 7:65-73. [PMID: 33829074 PMCID: PMC8019572 DOI: 10.14338/ijpt-20-00079.1] [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: 10/23/2020] [Accepted: 01/12/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Whole lung irradiation (WLI) is indicated for certain pediatric patients with lung metastases. This study investigated whether WLI delivered as intensity-modulated proton therapy (IMPT) could significantly spare the heart and breasts when compared with conventional WLI delivered with anteroposterior/posteroanterior photon fields and with intensity-modulated photon therapy (IMRT) WLI. MATERIALS AND METHODS Conventional, IMRT, and IMPT plans were generated for 5 patients (aged 5-22 years). The prescription dose was 16.5 GyRBE in 1.5-GyRBE fractions. Conventional plans used 6-MV photons prescribed to the midline and a field-in-field technique to cover the planning target volume (the internal target volume [ITV] + 1 cm). IMRT plans used 6-MV photons with a 7-beam arrangement with dose prescribed to the planning target volume. IMPT plans used scenario-based optimization with 5% range uncertainty and 5-mm positional uncertainty to cover the ITV robustly. Monte Carlo dose calculation was used for all IMPT plans. Doses were compared with paired Student t test. RESULTS The ITV Dmean was similar for the IMPT, conventional, and IMRT plans, but the IMPT plans had a lower Dmin and a higher Dmax at tissue interfaces than conventional plans (Dmean ratio: 0.96, P > .05; Dmin ratio: 0.9, P < .001; Dmax ratio: 1.1, P = .014). Dmeans for breast and heart substructures were lower with IMPT plans than with conventional/IMRT plans (heart ratios, 0.63:0.73; left ventricle ratios, 0.61:0.72; right ventricle ratios, 0.45:0.57; left atrium ratios, 0.79:0.85; right atrium ratios, 0.81:0.86; left breast ratios, 0.40:0.51; right breast ratio, 0.46:0.52; all P < .05). CONCLUSIONS IMPT resulted in comparable ITV coverage and lower mean doses to the heart and breasts when compared with other techniques. Whole lung irradiation delivered as IMPT warrants prospective evaluation in pediatric patients.
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Affiliation(s)
- Ru Xin Wong
- Department of Radiation Oncology, National Cancer Centre, Singapore
| | - Jacqueline Faught
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Melissa Gargone
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - William Myers
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew Krasin
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Austin Faught
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sahaja Acharya
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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18
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Reményi Kissné D, Gede N, Szakács Z, Kiss I. Breast cancer screening knowledge among Hungarian women: a cross-sectional study. BMC WOMENS HEALTH 2021; 21:69. [PMID: 33588813 PMCID: PMC7885515 DOI: 10.1186/s12905-021-01204-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 02/01/2021] [Indexed: 12/29/2022]
Abstract
Background Breast cancer (BC) is the leading malignant tumor among women worldwide. Although attending regular BC screening effectively reduces cancer-related mortality, surveys testify that screening knowledge is critically low among women. We aimed to conduct a comparative cross-sectional survey to assess BC and BC screening-related knowledge in Hungary. Methods Women between 25 and 65 years of age without a previous history of malignant tumors were included with non-probability sampling in 2017. Respondents were recruited either from primary care (laywomen) or from the waiting rooms of mammography (screening attendees). A self-completion questionnaire was constructed with questions about BC (risk factors, signs and symptoms, curability, and mortality), BC screening (mammography and breast self-examination), and BC-related information sources to assess knowledge among laywomen and screening attendees. In addition to descriptive statistics, odds ratios with 95% confidence intervals were calculated in univariate analysis and logistic regression was used in multivariate analysis. Results Altogether, 480 women completed the questionnaire, of which 429 (227 laywomen and 202 screening attendees) were eligible for inclusion. Laywomen and screening attendees knew the recommended age at first mammography in 35.2% and 86.6%, the recommended frequency of screening in 33.9% and 12.9%, the recommended age at first breast-self examination in 38.8% and 51.2%, had sufficient knowledge of the risk factors of BC in 7.0% and 5.9%, and that of signs and symptoms of BC in 16.7% and 28.9%, respectively. A higher proportion of screening attendees correctly identified the recommended age of first BC screening correctly than that of laywomen (86.6% vs. 35.2%; p < 0.001). The most popular information sources were television among laywomen and general practitioners or specialists among screening attendees. In multivariate analysis, older age, higher education, and place of residency were significant predictors of the right answers. Conclusions Although knowledge was insufficient in almost all fields of the questionnaire, the most prominent gap was observed concerning risk factors and signs and symptoms of BC both in laywomen and, unexpectedly, screening attendees. Most laywomen were lacking knowledge of screening protocol. These results urge breast health and BC knowledge interventions in Hungary. Supplementary information The online version contains supplementary material available at 10.1186/s12905-021-01204-9.
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Affiliation(s)
| | - Noémi Gede
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12., 7624, Pecs, Hungary.
| | - Zsolt Szakács
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12., 7624, Pecs, Hungary.,János Szentágothai Research Center, University of Pécs, Pecs, Hungary
| | - István Kiss
- Department of Public Health Medicine, Medical School, University of Pécs, Pecs, Hungary
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19
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Andersson A, Enblad G, Erlanson M, Johansson AS, Molin D, Tavelin B, Näslund U, Melin B. High risk of cardiovascular side effects after treatment of Hodgkin's lymphoma - is there a need for intervention in long-term survivors? Ups J Med Sci 2021; 126:6117. [PMID: 33889307 PMCID: PMC8043572 DOI: 10.48101/ujms.v126.6117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/02/2021] [Accepted: 02/14/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hodgkin lymphoma (HL) patients have a good prognosis after adequate treatment. Previous treatment with mantle field irradiation has been accompanied by an increased long-term risk of cardiovascular disease (CVD). This study identified co-morbidity factors for the development of cardiovascular side effects and initiated an intervention study aimed to decrease morbidity and mortality of CVD in HL survivors. DESIGN Hodgkin lymphoma patients aged ≤45 years diagnosed between 1965 and 1995 were invited to participate. In total, 453 patients completed a questionnaire that addressed co-morbidity factors and clinical symptoms. Of these, 319 accepted to participate in a structured clinical visit. The statistical analyses compared individuals with CVD with those with no CVD. RESULTS Cardiovascular disease was reported by 27.9%. Radiotherapy (odds ratio [OR]: 3.27), hypertension and hypercholesterolemia were shown to be independent risk factors for the development of CVD. The OR for CVD and valve disease in patients who received radiotherapy towards mediastinum was 4.48 and 6.07, respectively. At clinical visits, 42% of the patients were referred for further investigation and 24% of these had a cardiac ultrasound performed due to previously unknown heart murmurs. CONCLUSION Radiotherapy towards mediastinum was an independent risk factor for CVD as well as hypercholesterolemia and hypertension. A reasonable approach as intervention for this cohort of patients is regular monitoring of hypertension and hypercholesterolemia and referral to adequate investigation when cardiac symptoms appear. Broad knowledge about the side effects from radiotherapy in the medical community and well-structured information regarding late side effects to the patients are all reasonable approaches as late effects can occur even 40 years after cancer treatment.
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Affiliation(s)
- Anne Andersson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Section Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden
| | - Martin Erlanson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | | | - Daniel Molin
- Department of Immunology, Genetics and Pathology, Section Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden
| | - Björn Tavelin
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Ulf Näslund
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Beatrice Melin
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
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20
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Benveniste MF, Gomez D, Carter BW, Betancourt Cuellar SL, Shroff GS, Benveniste APA, Odisio EG, Marom EM. Recognizing Radiation Therapy-related Complications in the Chest. Radiographics 2020; 39:344-366. [PMID: 30844346 DOI: 10.1148/rg.2019180061] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Radiation therapy is one of the cornerstones for the treatment of thoracic malignancies. Although advances in radiation therapy technology have improved the delivery of radiation considerably, adverse effects are still common. Postirradiation changes affect the organ or tissue treated and the neighboring structures. Advances in external-beam radiation delivery techniques and how these techniques affect the expected thoracic radiation-induced changes are described. In addition, how to distinguish these expected changes from complications such as infection and radiation-induced malignancy, and identify treatment failure, that is, local tumor recurrence, is reviewed. ©RSNA, 2019.
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Affiliation(s)
- Marcelo F Benveniste
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Daniel Gomez
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Brett W Carter
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Sonia L Betancourt Cuellar
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Girish S Shroff
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Ana Paula A Benveniste
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Erika G Odisio
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
| | - Edith M Marom
- From the Departments of Diagnostic Radiology (M.F.B., B.W.C., S.L.B.C., G.S.S., E.G.O.) and Radiation Oncology (D.G.), University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (A.P.A.B.); and Department of Diagnostic Imaging, Chaim Sheba Medical Center, Ramat Gan, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel (E.M.M.)
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21
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Holtzman AL, Stahl JM, Zhu S, Morris CG, Hoppe BS, Kirwan JE, Mendenhall NP. Does the Incidence of Treatment-Related Toxicity Plateau After Radiation Therapy: The Long-Term Impact of Integral Dose in Hodgkin's Lymphoma Survivors. Adv Radiat Oncol 2019; 4:699-705. [PMID: 31673663 PMCID: PMC6817558 DOI: 10.1016/j.adro.2019.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/21/2019] [Accepted: 07/15/2019] [Indexed: 12/04/2022] Open
Abstract
Background Conventional radiation therapy (RT) has produced unprecedented cure rates in patients with Hodgkin's lymphoma (HL) but exposed large volumes of nontargeted tissue to radiation (integral dose). Objective Our goal was to report the effects of integral radiation dose on health outcomes in patients with at least 20 years of potential follow-up time. Methods and Materials We reviewed the medical records of 365 patients who were treated with RT for HL between 1965 and 1995. All patients were confirmed to have received primary RT with curative intent at our institution for de novo HL. Serious adverse events were classified as HL progression or death, grade ≥3 treatment- or staging-related acute or late effects, second malignancies, or cardiovascular events. Results The minimum potential follow-up time was 20 years, and the actual median follow-up time 22 years (range, <1-49 years) for all patients and 27 years (range, 5-49 years) for surviving patients. The overall survival rates at 5, 10, 20, 30, and 40 years were 86%, 76%, 64%, 44%, and 27%, respectively. The observed-to-expected ratio for second malignancy was 3.6 (95% confidence interval, 2.9-4.4). Grade ≥3 cardiovascular events occurred in 31% of all patients (n = 112). At the time of the most recent follow up, serious adverse events occurred in 70% of the entire cohort (n = 256) and 58% (n = 103), 77% (n = 103), and 93% (n = 50) among those with a potential 20, 30, and 40 years of follow up, respectively. Conclusions With increased survivorship, the long-term impact of the integral radiation dose may result in clinically significant adverse events, which suggests the importance of surveillance and affirms advances in both chemotherapy and RT that minimize the integral dose in future patients with HL.
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Affiliation(s)
- Adam L Holtzman
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - John M Stahl
- Department of Radiation Oncology, University of Alabama-Birmingham School of Medicine, Birmingham, Alabama
| | - Simeng Zhu
- Department of Radiation Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Bradford S Hoppe
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Jessica E Kirwan
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Nancy P Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
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22
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Abstract
Classic Hodgkin lymphoma (cHL) is one of the most common lymphomas in the Western world. Advances in the management of cHL have led to high cure rates exceeding 80%. Nevertheless, relapse or refractory disease in a subset of patients and treatment-related toxicity still represents unsolved clinical problems. The introduction of targeted treatments such as PD-1 blockade and the CD30 antibody drug conjugate, brentuximab vedotin, has broadened treatment options in cHL, emphasizing the critical need to identify biomarkers with the goal to provide rationales for treatment selection, increase effective drug utilization, and minimize toxicity. The unique biology of cHL featuring low abundant tumor cells and numerous nonmalignant immune cells in the tumor microenvironment can provide various types of promising biomarkers related to the tumor cells directly, tumor microenvironment cross-talk, and host immune response. Here, we comprehensively review novel biomarkers including circulating tumor DNA and gene expression-based prognostic models that might guide the ideal management of cHL in the future.
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23
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Chao C, Bhatia S, Xu L, Cannavale KL, Wong FL, Huang PYS, Cooper R, Armenian SH. Incidence, Risk Factors, and Mortality Associated With Second Malignant Neoplasms Among Survivors of Adolescent and Young Adult Cancer. JAMA Netw Open 2019; 2:e195536. [PMID: 31173129 PMCID: PMC6563559 DOI: 10.1001/jamanetworkopen.2019.5536] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Detailed data describing the epidemiology of second malignant neoplasms (SMN) are needed for survivors of adolescent and young adult (AYA) cancer to inform the development of age-appropriate survivorship care guidelines. OBJECTIVE To describe the incidence, risk factors, and mortality for SMN in survivors of AYA cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective matched cohort study included 10 574 two-year survivors diagnosed with cancer between January 1, 1990, and December 31, 2012, at age 15 to 39 years in an integrated health care delivery system in Southern California. A comparison cohort without a history of cancer was individually matched 13:1 to survivors of AYA cancer by age, sex, and calendar year. Data analysis was completed in July 2018. EXPOSURES Secondary malignant neoplasm risk factors of interest included age, stage, and calendar year at first cancer diagnosis; sex; race/ethnicity; radiation therapy; and chemotherapy. MAIN OUTCOMES AND MEASURES Diagnoses of SMN were ascertained using cancer registries from the National Cancer Institute Surveillance, Epidemiology, and End Results Program through December 31, 2014. Poisson regression was used to evaluate the association between cancer survivor status and developing SMN and risk factors for SMN, while risk of all-cause mortality by SMN status was examined in Cox regression. RESULTS A total of 10 574 survivors of AYA cancer (6853 [64.8%] female; median [range] age, 33 [15-39] years; 622 with SMN) and 136 683 participants in the comparison cohort (88 513 [64.8%] female; median [range] age, 33 [15-39] years; 3437 with first cancer) were included. In survivors of AYA cancer, 20-year cumulative incidence of SMN was 12.5%. The incidence rate ratio (IRR) of developing SMN in survivors of AYA cancer was 2.6 (95% CI, 2.4-2.9) compared with the comparison cohort. Survivors of breast cancer, melanoma, and testicular cancer had substantially elevated risk for SMN of the same organ (IRR, 5.6 [95% CI, 4.6-6.8], 11.2 [95% CI, 7.3-17.2], and 16.2 [95% CI, 6.8-38.4], respectively). Among survivors of AYA cancer, older age (IRR for age 30-39 years, 1.79 [95% CI, 1.21-2.65]), female sex (IRR, 1.31 [95% CI, 1.09-1.57]), white race/ethnicity (IRR for Asian race, 0.61 [95% CI, 0.43-0.87]), advanced stage at first cancer diagnosis (IRR for stage II, 1.29 [95% CI, 1.11-1.65]), and use of radiotherapy (IRR, 1.50 [95% CI, 1.26-1.79]) were associated with increased risk of SMN. Survivors of AYA cancer who developed SMN had an all-cause mortality rate 7.2 (95% CI, 6.1-8.5) times greater than survivors without SMN. CONCLUSIONS AND RELEVANCE This study suggests that SMN risk is elevated in survivors of AYA cancer and varies across survivor subgroups. Survival following SMN may be significantly compromised. These data may form the basis for identifying individuals at high risk, as well as informing screening for SMN.
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Affiliation(s)
- Chun Chao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham
| | - Lanfang Xu
- MedHealth Statistical Consulting Inc, Solon, Ohio
| | - Kimberly L. Cannavale
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - F. Lennie Wong
- Department of Population Sciences, City of Hope, Duarte, California
| | - Po-Yin Samuel Huang
- Department of Family Medicine, Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles
| | - Robert Cooper
- Department of Pediatric Oncology, Los Angeles Medical Center, Kaiser Permanente Southern California, Los Angeles
| | - Saro H. Armenian
- Department of Population Sciences, City of Hope, Duarte, California
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Farvid MS, Eliassen AH, Cho E, Chen WY, Willett WC. Dairy Consumption in Adolescence and Early Adulthood and Risk of Breast Cancer. Cancer Epidemiol Biomarkers Prev 2019; 27:575-584. [PMID: 29716928 DOI: 10.1158/1055-9965.epi-17-0345] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/15/2017] [Accepted: 03/05/2018] [Indexed: 01/07/2023] Open
Abstract
Background: Carcinogenic exposure in early life may be critical for subsequent breast cancer risk. Dairy consumption was examined during adolescence and early adulthood in relation to incident breast cancer in the Nurses' Health Study II cohort.Methods: For the analyses of early adulthood dairy consumption, we included 90,503 premenopausal women ages 27 to 44 years in 1991 who reported dairy consumption using a validated food-frequency questionnaire. From 1991 to 2013, 3,191 invasive breast cancer cases were identified. In 1998, 44,264 women recalled adolescent dairy consumption. This subgroup of women was followed up from 1998 to 2013; 1,318 invasive breast cancer cases were identified. Multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using the Cox proportional hazard regression.Results: Adolescent and early adulthood total dairy consumption was not associated with overall breast cancer risk (each serving/day during adolescence, total dairy HR = 1.02, 95% CI, 0.97-1.07; for early adulthood total dairy HR = 1.01, 95% CI, 0.97-1.04), as were intakes of calcium, vitamin D, and lactose. Adolescent consumption of total and high-fat dairy was associated with higher risk of estrogen and progesterone receptor negative (each serving/day: total dairy HR = 1.11, 95% CI, 1.00-1.24; high-fat dairy HR = 1.17, 95% CI, 1.04-1.31). However, higher adolescent high-fat dairy consumption was associated with lower risk of estrogen and progesterone receptor positive tumors (each serving/day HR = 0.91, 95% CI, 0.86-0.97).Conclusions: Our results suggest no overall association between dairy consumption during adolescence or early adulthood and breast cancer risk, but the findings may differ by hormone receptor status of tumors.Impact: Dairy consumption in adolescence or early adulthood may not be a significant predictor of breast cancer incidence. Cancer Epidemiol Biomarkers Prev; 27(5); 575-84. ©2018 AACR.
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Affiliation(s)
- Maryam S Farvid
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - 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.,Department of Epidemiology, Brown University School of Public Health, 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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25
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Calip GS, Moran KM, Sweiss K, Patel PR, Wu Z, Adimadhyam S, Lee TA, Ko NY, Quigley JG, Chiu BCH. Myelodysplastic syndrome and acute myeloid leukemia after receipt of granulocyte colony-stimulating factors in older patients with non-Hodgkin lymphoma. Cancer 2019; 125:1143-1154. [PMID: 30548485 PMCID: PMC6420387 DOI: 10.1002/cncr.31914] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/30/2018] [Accepted: 11/08/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Granulocyte colony-stimulating factors (G-CSFs), which are used for the prevention of complications from chemotherapy-related neutropenia, are linked to the risk of developing second primary myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). The objective of this study was to examine the correlation between using a specific G-CSF agent and the risk of MDS/AML among older patients with non-Hodgkin lymphoma (NHL). METHODS This was a retrospective cohort study of adults aged >65 years who were diagnosed with first primary NHL between 2001 and 2011. With data from the Surveillance, Epidemiology, and End Results-Medicare-linked database, adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for the risk of MDS/AML associated with the receipt of G-CSF(filgrastim and pegfilgrastim) in Cox proportional-hazards models, which were stratified according to treatment accounting for confounding by indication. RESULTS Among 18,245 patients with NHL patients who had a median follow-up of 3.5 years, 56% received chemotherapy and/or immunotherapy, and G-CSF was most commonly used in those who received rituximab plus multiple chemotherapy regimens (77%). Subsequent MDS/AML diagnoses were identified in 666 patients (3.7%). A modest increased risk of MDS/AML was observed with the receipt of G-CSF (HR, 1.28; 95% CI, 1.01-1.62) and a trend was observed with increasing doses (Ptrend < .01). When specific agents were analyzed, an increased risk of MDS/AML was consistently observed with filgrastim (≥10 doses: HR, 1.67; 95% CI, 1.25-2.23), but not with pegfilgrastim (≥10 + doses: HR, 1.11; 95% CI, 0.84-1.45). CONCLUSIONS A higher of MDS/AML was observed in patients with NHL risk among those who received G-CSF that was specific to the use of filgrastim (≥10 doses), but not pegfilgrastim. Neutropenia prophylaxis is an essential component of highly effective NHL treatment regimens. The differential risk related to the types of G-CSF agents used warrants further study given their increasing use and newly available, US Food and Drug Administration-approved, biosimilar products.
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Affiliation(s)
- Gregory S. Calip
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL
- Epidemiology Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Kellyn M. Moran
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL
| | - Karen Sweiss
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL
| | - Pritesh R. Patel
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Zhaoju Wu
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL
| | - Sruthi Adimadhyam
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL
| | - Todd A. Lee
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL
| | - Naomi Y. Ko
- Section of Hematology Oncology, Boston University School of Medicine, Boston, MA
| | - John G. Quigley
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Brian C.-H. Chiu
- Department of Public Health Sciences, The University of Chicago, Chicago, IL
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26
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Allodji RS, Haddy N, Vu-Bezin G, Dumas A, Fresneau B, Mansouri I, Demoor-Goldschmidt C, El-Fayech C, Pacquement H, Munzer M, Bondiau PY, Berchery D, Oberlin O, Rubino C, Diallo I, de Vathaire F. Risk of subsequent colorectal cancers after a solid tumor in childhood: Effects of radiation therapy and chemotherapy. Pediatr Blood Cancer 2019; 66:e27495. [PMID: 30345604 DOI: 10.1002/pbc.27495] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Very few previous studies have addressed the question of colorectal cancer (CRC) after childhood cancer treatment. We aimed to quantify the roles of radiation therapy and chemotherapy agents in the occurrence of subsequent CRC. METHODS A nested case-control study was conducted using 36 CRC cases and 140 controls selected from 7032 five-year survivors of the French Childhood Cancer Survivor Study (FCCSS) cohort, treated from 1945 to 2000 in France. The radiation dose-distribution metrics at the site of CRC and doses of individual chemotherapeutic agents were calculated. Conditional logistic regressions were performed to calculate odds ratios (ORs). RESULTS Overall, patients who received radiotherapy with estimated dose to colon had a 4.3-fold (95% CI, 1.3-17.6) increased risk for CRC compared with patients who did not receive radiotherapy, after adjustment for chemotherapy. This risk increased to 8.9-fold and 19.3-fold among patients who received radiation doses ranging from 20 to 29.99 Gy and ≥30 Gy, respectively. Our data reported a significantly elevated OR for anthracyclines, after controlling for radiotherapy and MOPP regimen. But, restricted analyses excluding patients who had received ≥30 Gy showed that only radiation doses ranging from 20 to 29.99 Gy produced a significant increase in subsequent CRC risk (OR = 7.8; 95% CI, 1.3-56.0), after controlling for anthracyclines and MOPP regimen. CONCLUSIONS The risk of subsequent CRC was significantly increased after radiation dose (even < 30 Gy). This novel finding supports the need to update monitoring guidelines for CRC to optimize the long-term follow-up for subsequent CRC in survivors of childhood cancer.
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Affiliation(s)
- Rodrigue S Allodji
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France.,INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France.,Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Nadia Haddy
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France.,INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France.,Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Giao Vu-Bezin
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France.,INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France.,Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Agnès Dumas
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France.,INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France.,Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Brice Fresneau
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France.,INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France.,Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France.,Gustave Roussy, Université Paris-Saclay, Department of Pediatric Oncology, F-94805 Villejuif, France
| | - Imene Mansouri
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France.,INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France.,Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Charlotte Demoor-Goldschmidt
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France.,INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France.,Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France.,Chu Angers, Pediatric Oncology, F-49933 Angers, France
| | - Chiraz El-Fayech
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric Oncology, F-94805 Villejuif, France
| | | | | | | | | | - Odile Oberlin
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric Oncology, F-94805 Villejuif, France
| | - Carole Rubino
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France.,INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France.,Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Ibrahima Diallo
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France.,INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France.,Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Florent de Vathaire
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France.,INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France.,Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
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27
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Hayek S, Dichtiar R, Shohat T, Silverman B, Ifrah A, Boker LK. Risk of second primary neoplasm and mortality in childhood cancer survivors based on a national registry database. Cancer Epidemiol 2018; 57:127-133. [PMID: 30399484 DOI: 10.1016/j.canep.2018.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/13/2018] [Accepted: 10/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although overall childhood cancer survival has improved, survivors may still have an elevated risk for second primary neoplasm (SPN) and excess mortality. The aim of the current study was to estimate the risks for SPN and mortality in childhood cancer survivors in Israel as compared to the general population. METHODS All children aged 0-19 diagnosed with primary neoplasm between 1980-2007 who survived at least 5 years following diagnosis were included in the study. Follow-up continued until December 31st, 2013, or diagnosis of SPN, or death due to any cause (the earliest of these events). Standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) were calculated. Cox proportional hazards regression was employed to assess predictors of SPN and mortality. RESULTS The cohort consisted of 6637 childhood cancer survivors. A total of 244 all-site SPN cases were observed. Compared to the general population, the risks for SPN and for mortality were significantly increased (SIR = 5.48; 95%CI: 4.82-6.22 and SMR = 13.99; 95%CI = 12.54-15.56, respectively). Factors predicting SPN were sex (female), older age at first diagnosis, and initial cancer diagnosis (lymphomas). Factors predicting mortality were older age at first diagnosis, initial cancer diagnosis (myeloproliferative diseases) and earlier years, according to calendar period of initial diagnosis. CONCLUSIONS Although 5-year childhood cancer survival is high, survivors are at elevated risk for SPN and mortality, and the risks are associated with baseline characteristics of the patients. The increased risks should be considered when planning treatment, follow-up and surveillance of the survivors.
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Affiliation(s)
- Samah Hayek
- Israel Center for Disease Control, Israel Ministry of Health, Israel.
| | - Rita Dichtiar
- Israel Center for Disease Control, Israel Ministry of Health, Israel
| | - Tamy Shohat
- Israel Center for Disease Control, Israel Ministry of Health, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Barbara Silverman
- Israel Center for Disease Control, Israel Ministry of Health, Israel
| | - Anneke Ifrah
- Israel Center for Disease Control, Israel Ministry of Health, Israel
| | - Lital Keinan Boker
- Israel Center for Disease Control, Israel Ministry of Health, Israel; School of Public Health, University of Haifa, Israel
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28
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Farruggia P, Puccio G, Locatelli F, Vetro M, Pillon M, Trizzino A, Sala A, Buffardi S, Garaventa A, Rossi F, Bianchi M, Zecca M, Pession A, Favre C, D’Amico S, Provenzi M, Zanazzo GA, Sau A, Santoro N, Mura R, Elia C, Casini T, Mascarin M, Burnelli R. Classical pediatric Hodgkin lymphoma in very young patients: the Italian experience. Leuk Lymphoma 2018; 60:696-702. [DOI: 10.1080/10428194.2018.1493732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Piero Farruggia
- Pediatric Hematology and Oncology Unit Oncology Department, A.R.N.A.S. Ospedali Civico Di Cristina e Benfratelli, Palermo, Italy
| | - Giuseppe Puccio
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy
| | - Francesco Locatelli
- Dipartimento di Oncoematologia Pediatrica, IRCCS Ospedale Bambino Gesù, Roma, University of Pavia, Italy
| | - Mariarita Vetro
- Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy
| | - Marta Pillon
- Dipartimento di Oncoematologia Pediatrica, Università di Padova, Padova, Italy
| | - Angela Trizzino
- Pediatric Hematology and Oncology Unit Oncology Department, A.R.N.A.S. Ospedali Civico Di Cristina e Benfratelli, Palermo, Italy
| | - Alessandra Sala
- Clinica Pediatrica, Universita’ Milano – Bicocca A.O. San Gerardo – Fondazione MBBM, Monza, Italy
| | - Salvatore Buffardi
- Dipartimento di Oncologia Pediatrica A.O. Santobono-Pausilipon, Napoli, Italy
| | - Alberto Garaventa
- Dipartimento di Ematologia e Oncologia Pediatrica, Istituto G. Gaslini, Genova, Italy
| | - Francesca Rossi
- Dipartimento di Pediatria II Ateneo di Napoli, Servizio di Oncologia Pediatrica, Napoli, Italy
| | - Maurizio Bianchi
- S.C. Oncoematologia Pediatria e Centro Trapianti, Ospedale Infantile Regina Margherita, Torino, Italy
| | - Marco Zecca
- Oncoematologia Pediatrica, Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - Andrea Pession
- Dipartimento di Oncoematologia Pediatrica, ‘Lalla Seragnoli’ Clinica Pediatrica Policlinico Sant’Orsola Malpighi, Bologna, Italy
| | - Claudio Favre
- Oncologia Clinica Pediatrica e Trapianto Midollo Osseo, Azienda Ospedaliera – Università, Pisa, Italy
| | | | - Massimo Provenzi
- Sezione Oncoematologia Pediatrica, Dipartimento di Pediatria, Ospedali Riuniti di Bergamo, Bergamo, Italy
| | - Giulio Andrea Zanazzo
- U.O. Emato-Oncologia Pediatrica, Università degli Studi di Trieste Osp.le Infantile Burlo Garofolo, Trieste, Italy
| | - Antonella Sau
- U.O. Oncoematologia Pediatrica, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Nicola Santoro
- Unità Operativa Complessa di Oncologia ed Ematologia Oncologica Pediatrica-Policlinico, Bari, Italy
| | - Rosamaria Mura
- Oncoematologia Pediatrica e Patologia della coagulazione, Ospedale Regionale per le Microcitemie, Cagliari, Italy
| | - Caterina Elia
- S.S. Radioterapia Pediatrica e Area Giovani, IRCCS Centro di Riferimento Oncologico Aviano, Pordenone, Italy
| | - Tommaso Casini
- Dipartimento di Oncoematologia Pediatrica A.O.U Meyer, Firenze, Italy
| | - Maurizio Mascarin
- S.S. Radioterapia Pediatrica e Area Giovani, IRCCS Centro di Riferimento Oncologico Aviano, Pordenone, Italy
| | - Roberta Burnelli
- Oncoematologia Pediatrica, Azienda Ospedaliera Universitaria Ospedale Sant’Anna, Ferrara, Italy
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Kahn JM, Kelly KM. Adolescent and young adult Hodgkin lymphoma: Raising the bar through collaborative science and multidisciplinary care. Pediatr Blood Cancer 2018; 65:e27033. [PMID: 29603618 PMCID: PMC5980713 DOI: 10.1002/pbc.27033] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/04/2018] [Accepted: 02/05/2018] [Indexed: 12/27/2022]
Abstract
Hodgkin lymphoma (HL) is one of the most common cancers in the adolescent and young adult (AYA) population (15-39 years). Despite continued improvements in HL outcomes, AYAs have not exhibited survival gains to the same extent as other age groups. At present, details about tumor biology, optimal therapeutic approaches, supportive care needs, and long-term toxicities in AYAs with HL remain understudied. Herein, we summarize the current state of the AYA population with HL, specifically focusing on how collaborations across the pediatric and medical oncology divide, coupled with multidisciplinary patient care, can further optimize outcomes for this group of patients.
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Affiliation(s)
- Justine M. Kahn
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University, Medical Center, New York, NY, USA
| | - Kara M. Kelly
- Roswell Park Comprehensive Cancer Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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30
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Sud A. Survivors at risk: Hodgkin lymphoma survivors at high risk of second cancers. Int J Hematol Oncol 2018; 6:5-8. [PMID: 29881540 PMCID: PMC5985503 DOI: 10.2217/ijh-2017-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/30/2017] [Indexed: 11/21/2022] Open
Abstract
Amit Sud speaks to Sebastian Dennis-Beron, Commissioning Editor: Amit Sud is a clinical research fellow in Hematology at the Institute of Cancer Research, UK. He undertook his undergraduate medical training at the University of Manchester, gaining an honors degree. He completed his Masters in Medical Research at Manchester University, gaining a distinction. He continued his medical training in Manchester and London and started his specialization in Hematology in South West London. He was successful in obtaining a Cancer Research UK funded clinical research fellowship in Hematology under the supervision of Professor Richard Houlston at the Institute of Cancer Research. His current research focus is that of genetic susceptibility to Hodgkin lymphoma. He is a trainee member of the NCRI Lymphoma Clinical Studies Group.
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Affiliation(s)
- Amit Sud
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, SW7 3RP, UK
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31
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Kumar V, Garg M, Chandra AB, Mayorga VS, Ahmed S, Ailawadhi S. Trends in the Risks of Secondary Cancers in Patients With Hodgkin Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:576-589.e1. [PMID: 29934060 DOI: 10.1016/j.clml.2018.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/08/2018] [Accepted: 05/21/2018] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The present study analyzed the trends in secondary cancer (SC) risks among Hodgkin lymphoma (HL) patients in the United States. MATERIALS AND METHODS Patients with HL diagnosed from 1973 to 2014 were identified from the Surveillance, Epidemiology, and End Results database. We compared the risk of SCs in HL patients relative to the risk in the US general population across 3 periods: 1973 to 1986, 1987 to 2000, and 2001 to 2014 to study the effect of treatment practices on the development of SCs. RESULTS In a follow-up study of 23,864 HL survivors for 284,730 person-years, 3260 SCs were diagnosed with a standardized incidence ratio (SIR) of 1.97 (95% confidence interval [CI], 1.9-2.04). A statistically significant decrease was found in the overall SIRs of SCs diagnosed in HL patients from 1987 to 2000 (SIR, 1.82; 95% CI, 1.72-1.93) and from 2001 to 2014 (SIR, 1.66; 95% CI, 1.51-1.82) relative to patients with SCs diagnosed from 1973 to 1986 (SIR, 2.24; 95% CI, 2.13-2.35). The decline in the overall SIR mostly resulted from declines in digestive tract and breast cancers. The SIRs of most other solid tumors and hematologic malignancies did not decrease. After adjusting for age, gender, and race, patients with a diagnosis from 1973 to 1986 had a 12% greater risk of developing SCs (hazard ratio, 1.12; 95% CI, 1.03-1.23; P = .01) compared with the patients with a diagnosis from 1987 to 2000. CONCLUSION Although the overall risk of SCs in patients with HL declined after modifications in HL treatment, the risk did not change significantly at most individual sites. Thus, close follow-up with active surveillance for SCs is crucial for long-term survivors of HL.
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Affiliation(s)
- Vivek Kumar
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Mohit Garg
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA; Maimonides Medical Center, Brooklyn, NY
| | - Abhinav B Chandra
- Department of Hematology and Oncology, Yuma Regional Medical Center Cancer Center, Yuma, AZ
| | | | - Salman Ahmed
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL
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Herrera AF, Moskowitz AJ, Bartlett NL, Vose JM, Ramchandren R, Feldman TA, LaCasce AS, Ansell SM, Moskowitz CH, Fenton K, Ogden CA, Taft D, Zhang Q, Kato K, Campbell M, Advani RH. Interim results of brentuximab vedotin in combination with nivolumab in patients with relapsed or refractory Hodgkin lymphoma. Blood 2018; 131:1183-1194. [PMID: 29229594 PMCID: PMC5855021 DOI: 10.1182/blood-2017-10-811224] [Citation(s) in RCA: 236] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 11/30/2017] [Indexed: 12/13/2022] Open
Abstract
In this phase 1/2 study, brentuximab vedotin (BV) and nivolumab (Nivo) administered in combination were evaluated as initial salvage therapy in patients with relapsed or refractory (R/R) classical Hodgkin lymphoma (HL). Patients received up to 4 cycles of combination treatment, with BV administered on day 1 and Nivo on day 8 of the first cycle. For cycles 2 to 4, BV and Nivo were both administered on day 1. After study treatment, responses were evaluated by investigators per the 2014 Lugano classification, and patients could proceed to autologous stem cell transplantation (ASCT). Sixty-two patients were enrolled; the complete response rate among all treated patients (n = 61) was 61%, with an objective response rate of 82%. Before ASCT, adverse events (AEs) occurred in 98% of patients, mostly grades 1 and 2. Infusion-related reactions (IRRs) occurred in 44% of patients overall, with 41% of patients experiencing an IRR during at least 1 infusion of BV. Five patients (8%) were treated with systemic steroids for immune-related AEs. A reduction of peripheral T-cell subsets including regulatory T cells was observed after the first dose of BV, and reduced serum levels of thymus- and activation-regulated chemokine concurrent with an increase in proinflammatory cytokines and chemokines were seen after the first BV plus Nivo infusions. The combination of BV plus Nivo was an active and well-tolerated first salvage regimen, potentially providing patients with R/R HL an alternative to traditional chemotherapy. This trial was registered at www.clinicaltrials.gov as #NCT02572167.
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Affiliation(s)
| | | | - Nancy L Bartlett
- Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO
| | - Julie M Vose
- University of Nebraska Medical Center, Omaha, NE
| | | | | | | | | | | | | | | | | | - Qu Zhang
- Seattle Genetics, Inc, Bothell, WA
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Kilickap S, Barista I, Ulger S, Celik I, Selek U, Gullu I, Yildiz F, Kars A, Ozisik Y, Tekuzman G. Long-Term Complications in Hodgkin's Lymphoma Survivors. TUMORI JOURNAL 2018; 98:601-6. [DOI: 10.1177/030089161209800510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Although patients with Hodgkin's lymphoma (HL) achieve prolonged survival, long-term complications are a major cause of morbidity and mortality among long-term survivors of HL. Methods We retrospectively evaluated long-term complications in 336 HL survivors treated between January 1990 and January 2006 at the Department of Medical Oncology of the Hacettepe University Institute of Oncology who were >16 years old at presentation. All patients were regularly followed up every 3 months for the first 2 years after complete response, biannually for 3 years, and annually after 5 years. Results Median follow-up was 8.5 years. The mean age (±SD) of the patients at the time of diagnosis was 35.7 ± 13.1 years. The male to female ratio was 61%/39%. During follow-up, 29 second malignancies (8.6%) were diagnosed in 28 patients with HL; 22 were solid tumors and 7 were hematological malignancies. Forty-seven (14.0%) of all patients with HL were found to have thyroid abnormalities. During follow-up, 54 (16.1%) patients developed cardiovascular complications. Overall, 29 (8.6%) patients developed late pulmonary toxicities. The cumulative number of chronic viral infections was 13 (3.9%). Conclusions Long-term survivors of HL need to be properly followed up not only for disease control but also for evaluation of possible late morbidities to minimize the consequences.
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Affiliation(s)
- Saadettin Kilickap
- Department of Medical Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey
| | - Ibrahim Barista
- Department of Medical Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey
| | - Sukran Ulger
- Radiotherapy Center, Ataturk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey
| | - Ismail Celik
- Department of Medical Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey
| | - Ugur Selek
- Department of Radiation Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey
| | - Ibrahim Gullu
- Department of Medical Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey
| | - Ferah Yildiz
- Department of Radiation Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey
| | - Ayse Kars
- Department of Medical Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey
| | - Yavuz Ozisik
- Department of Medical Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey
| | - Gulten Tekuzman
- Department of Medical Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey
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Late Complications of Hematologic Diseases and Their Therapies. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00093-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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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. The number of survivors grows rapidly, 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, while others mainly have negative impact on daily functioning and health-related quality of life (HRQOL). The latter factors include fatigue, anxiety disorders, sexual problems, insomnia, and reduced work ability, while depression does not seem to be more common among survivors than in the general population. Life style factors are highly relevant for cancer survivors concerning risk of relapse and somatic comorbidity. The field of cancer survivorship research has grown rapidly. 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 unresolved question, although several models are under consideration.
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Chao PJ, Lee HF, Lan JH, Guo SS, Ting HM, Huang YJ, Chen HC, Lee TF. Propensity-score-matched evaluation of the incidence of radiation pneumonitis and secondary cancer risk for breast cancer patients treated with IMRT/VMAT. Sci Rep 2017; 7:13771. [PMID: 29062118 PMCID: PMC5653804 DOI: 10.1038/s41598-017-14145-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 10/05/2017] [Indexed: 11/09/2022] Open
Abstract
Propensity score matching evaluates the treatment incidence of radiation-induced pneumonitis (RP) and secondary cancer risk (SCR) after intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) for breast cancer patients. Of 32 patients treated with IMRT and 58 who received VMAT were propensity matched in a 1:1 ratio. RP and SCR were evaluated as the endpoints of acute and chronic toxicity, respectively. Self-fitted normal tissue complication probability (NTCP) parameter values were used to analyze the risk of RP. SCRs were evaluated using the preferred Schneider's parameterization risk models. The dosimetric parameter of the ipsilateral lung volume receiving 40 Gy (IV40) was selected as the dominant risk factor for the RP NTCP model. The results showed that the risks of RP and NTCP, as well as that of SCR of the ipsilateral lung, were slightly lower than the values in patients treated with VMAT versus IMRT (p ≤ 0.01). However, the organ equivalent dose and excess absolute risk values in the contralateral lung and breast were slightly higher with VMAT than with IMRT (p ≤ 0.05). When compared to IMRT, VMAT is a rational radiotherapy option for breast cancer patients, based on its reduced potential for inducing secondary malignancies and RP complications.
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Affiliation(s)
- Pei-Ju Chao
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC
| | - Hsiao-Fei Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC
| | - Jen-Hong Lan
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC
| | - Shih-Sian Guo
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC
| | - Hui-Min Ting
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC
| | - Yu-Jie Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC
| | - Hui-Chun Chen
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC.
| | - Tsair-Fwu Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, 80778, Taiwan, ROC. .,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83342, Taiwan, ROC. .,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan, ROC. .,Department of Radiation Oncology, Kaohsiung Yuan's General Hospital, Kaohsiung, 80249, Taiwan, ROC.
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Shan S, She J, Xue ZQ, Su CX, Ren SX, Wu FY. Clinical characteristics and survival of lung cancer patients associated with multiple primary malignancies. PLoS One 2017; 12:e0185485. [PMID: 28957405 PMCID: PMC5619777 DOI: 10.1371/journal.pone.0185485] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 09/13/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To investigate the characteristics and survival of lung cancer patients with additional malignant primary cancers. METHODS Records of lung cancer patients newly diagnosed in Shanghai Pulmonary Hospital between January 2000 and January 2010 were retrospectively reviewed. Patients with second primary lung cancer and those with lung cancer only were included for detailed analysis. RESULTS Of 27642 newly diagnosed lung cancer patients, 283 patients (1.02%) suffered previous additional primary cancers. Compared with single primary lung cancer, patients with secondary lung cancer associated other primary cancers were more often women (female to male ratio 1:1.72 vs 1:2.58, P = 0.018), older (64.2 vs 60.5 years old, P<0.001), more squamous cell type (30.7% vs 20.5%, P = 0.004), less small cell (3.9% vs 15.5%, P<0.001) type, at earlier stages (17.7% vs 11.0% for stage I, P = 0.014), and more frequently with family history of cancers (7.8% vs 3.9%, P = 0.038). The most common previous primary cancers observed were colorectal (22.0%), breast (18.4%), gastric (14.4%) and larynx cancers (11.9%). Approximately 42.9% of patients were diagnosed with lung cancer 2 to 6 years after diagnosis of initial primary cancers. The survival of patients with secondary lung cancer associated other malignancies was not significantly different from those with single lung cancer (P = 0.491), while synchronous multiple primary malignancies showed worse prognosis compared with those with metachronous ones or single lung cancer (p = 0.012). CONCLUSION The possibility of second primary lung cancer should always be considered during the follow-up of related cancer types, especially those with family history of cancers. Patients with secondary lung cancer associated other primary malignancies have non-inferior survival than those with single lung cancer.
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Affiliation(s)
- Shan Shan
- Department of Respirology, Shanghai sixth people's hospital, Shanghai Jiaotong University, Shanghai, China
| | - Jun She
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhi-qiang Xue
- Department of Thoracic Surgery, PLA General Hospital, Shanghai, China
| | - Chun-xia Su
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shen-xiang Ren
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Feng-ying Wu
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Franklin J, Eichenauer DA, Becker I, Monsef I, Engert A. Optimisation of chemotherapy and radiotherapy for untreated Hodgkin lymphoma patients with respect to second malignant neoplasms, overall and progression-free survival: individual participant data analysis. Cochrane Database Syst Rev 2017; 9:CD008814. [PMID: 28901021 PMCID: PMC6483617 DOI: 10.1002/14651858.cd008814.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Efficacy and the risk of severe late effects have to be well-balanced in treatment of Hodgkin lymphoma (HL). Late adverse effects include secondary malignancies which often have a poor prognosis. To synthesise evidence on the risk of secondary malignancies after current treatment approaches comprising chemotherapy and/or radiotherapy, we performed a meta-analysis based on individual patient data (IPD) from patients treated for newly diagnosed HL. OBJECTIVES We investigated several questions concerning possible changes in the risk of secondary malignancies when modifying chemotherapy or radiotherapy (omission of radiotherapy, reduction of the radiation field, reduction of the radiation dose, use of fewer chemotherapy cycles, intensification of chemotherapy). We also analysed whether these modifications affect progression-free survival (PFS) and overall survival (OS). SEARCH METHODS We searched MEDLINE and Cochrane CENTRAL trials databases comprehensively in June 2010 for all randomised trials in HL since 1984. Key international trials registries were also searched. The search was updated in March 2015 without collecting further IPD (one further eligible study found) and again in July 2017 (no further eligible studies). SELECTION CRITERIA We included randomised controlled trials (RCTs) for untreated HL patients which enrolled at least 50 patients per arm, completed recruitment by 2007 and performed a treatment comparison relevant to our objectives. DATA COLLECTION AND ANALYSIS Study groups submitted IPD, including age, sex, stage and the outcomes secondary malignant neoplasm (SMN), OS and PFS as time-to-event data. We meta-analysed these data using Petos method (SMN) and Cox regression with inverse-variance pooling (OS, PFS) for each of the five study questions, and performed subgroup and sensitivity analyses to assess the applicability and robustness of the results. MAIN RESULTS We identified 21 eligible trials and obtained IPD for 16. For four studies no data were supplied despite repeated efforts, while one study was only identified in 2015 and IPD were not sought. For each study question, between three and six trials with between 1101 and 2996 participants in total and median follow-up between 6.7 and 10.8 years were analysed. All participants were adults and mainly under 60 years. Risk of bias was assessed as low for the majority of studies and outcomes. Chemotherapy alone versus same chemotherapy plus radiotherapy. Omitting additional radiotherapy probably reduces secondary malignancy incidence (Peto odds ratio (OR) 0.43, 95% confidence interval (CI) 0.23 to 0.82, low quality of evidence), corresponding to an estimated reduction of eight-year SMN risk from 8% to 4%. This decrease was particularly true for secondary acute leukemias. However, we had insufficient evidence to determine whether OS rates differ between patients treated with chemotherapy alone versus combined-modality (hazard ratio (HR) 0.71, 95% CI 0.46 to 1.11, moderate quality of evidence). There was a slightly higher rate of PFS with combined modality, but our confidence in the results was limited by high levels of statistical heterogeneity between studies (HR 1.31, 95% CI 0.99 to 1.73, moderate quality of evidence). Chemotherapy plus involved-field radiation versus same chemotherapy plus extended-field radiation (early stages) . There is insufficient evidence to determine whether smaller radiation field reduces SMN risk (Peto OR 0.86, 95% CI 0.64 to 1.16, low quality of evidence), OS (HR 0.89, 95% C: 0.70 to 1.12, high quality of evidence) or PFS (HR 0.99, 95% CI 0.81 to 1.21, high quality of evidence). Chemotherapy plus lower-dose radiation versus same chemotherapy plus higher-dose radiation (early stages). There is insufficient evidence to determine the effect of lower-radiation dose on SMN risk (Peto OR 1.03, 95% CI 0.71 to 1.50, low quality of evidence), OS (HR 0.91, 95% CI 0.65 to 1.28, high quality of evidence) or PFS (HR 1.20, 95% CI 0.97 to 1.48, high quality of evidence). Fewer versus more courses of chemotherapy (each with or without radiotherapy; early stages). Fewer chemotherapy courses probably has little or no effect on SMN risk (Peto OR 1.10, 95% CI 0.74 to 1.62), OS (HR 0.99, 95% CI 0.73 to1.34) or PFS (HR 1.15, 95% CI 0.91 to 1.45).Outcomes had a moderate (SMN) or high (OS, PFS) quality of evidence. Dose-intensified versus ABVD-like chemotherapy (with or without radiotherapy in each case). In the mainly advanced-stage patients who were treated with intensified chemotherapy, the rate of secondary malignancies was low. There was insufficient evidence to determine the effect of chemotherapy intensification (Peto OR 1.37, CI 0.89 to 2.10, low quality of evidence). The rate of secondary acute leukemias (and for younger patients, all secondary malignancies) was probably higher than among those who had treatment with standard-dose ABVD-like protocols. In contrast, the intensified chemotherapy protocols probably improved PFS (eight-year PFS 75% versus 69% for ABVD-like treatment, HR 0.82, 95% CI 0.7 to 0.95, moderate quality of evidence). Evidence suggesting improved survival with intensified chemotherapy was not conclusive (HR: 0.85, CI 0.70 to 1.04), although escalated-dose BEACOPP appeared to lengthen survival compared to ABVD-like chemotherapy (HR 0.58, 95% CI 0.43 to 0.79, moderate quality of evidence).Generally, we could draw valid conclusions only in terms of secondary haematological malignancies, which usually occur less than 10 years after initial treatment, while follow-up within the present analysis was too short to record all solid tumours. AUTHORS' CONCLUSIONS The risk of secondary acute myeloid leukaemia and myelodysplastic syndrome (AML/MDS) is increased but efficacy is improved among patients treated with intensified chemotherapy protocols. Treatment decisions must be tailored for individual patients. Consolidating radiotherapy is associated with an increased rate of secondary malignancies; therefore it appears important to define which patients can safely be treated without radiotherapy after chemotherapy, both for early and advanced stages. For early stages, treatment optimisation methods such as use of fewer chemotherapy cycles and reduced field or reduced-dose radiotherapy did not appear to markedly affect efficacy or secondary malignancy risk. Due to the limited amount of long-term follow-up in this meta-analysis, further long-term investigations of late events are needed, particularly with respect to secondary solid tumours. Since many older studies have been included, possible improvement of radiotherapy techniques must be considered when interpreting these results.
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Affiliation(s)
- Jeremy Franklin
- University Hospital of CologneInstitute of Medical Statistics, Informatics and EpidemiologyKerpener Str. 62CologneGermany50937
| | - Dennis A. Eichenauer
- University Hospital of CologneDepartment I of Internal Medicine, Center of Integrated Oncology Köln BonnCologneGermany50924
| | - Ingrid Becker
- University Hospital of CologneInstitute of Medical Statistics, Informatics and EpidemiologyKerpener Str. 62CologneGermany50937
| | - Ina Monsef
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50924
| | - Andreas Engert
- University Hospital of CologneDepartment I of Internal MedicineKerpener Str. 62CologneGermany50924
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Abstract
Between the years 2010 and 2012, the lifetime probability of developing female breast cancer was 12.3%, or approximately 1 in 8. Worldwide, breast cancer is the most common cancer in women. Survival is increasing. Between 2005 and 2011, the 5-year relative survival was found to be 89%. This is thought to be due to both the increase in utilization of population-wide screening, as well as advances in treatment. Less than 10% of breast cancers can be attributed to an inherited genetic mutation. Breast cancer is more commonly associated with environmental, reproductive, and lifestyle factors, some of which are potentially modifiable.
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Abstract
This topic addresses the treatment of newly diagnosed patients with favorable prognosis stage I and II Hodgkin lymphoma. In most cases, combined modality therapy (chemotherapy followed by involved site radiation therapy) constitutes the current standard of care. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. By combining the most recent medical literature and expert opinion, this revised guideline can aid clinicians in the appropriate use of combined modality therapy for favorable prognosis stage I and II Hodgkin lymphoma. Increasing information about the late effects of treatment has led to attempts to decrease toxicity by using less chemotherapy (decreased duration and/or intensity or different agents) and less radiation therapy (reduced volume and/or dose) while maintaining excellent efficacy.
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Infradiaphragmatic irradiation and high procarbazine doses increase colorectal cancer risk in Hodgkin lymphoma survivors. Br J Cancer 2017. [PMID: 28632726 PMCID: PMC5537493 DOI: 10.1038/bjc.2017.177] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hodgkin lymphoma (HL) survivors are at increased risk of second malignancies, but few studies have assessed colorectal cancer (CRC) risk after HL treatment. We assessed long-term, subsite-specific CRC risk associated with specific radiation fields and chemotherapy regimens. METHODS In a Dutch cohort of 3121 5-year HL survivors treated between 1965 and 1995, subsite-specific CRC incidence was compared with general population rates. Treatment effects were quantified by Cox regression analyses. RESULTS After a median follow-up of 22.9 years, 55 patients developed CRC. The standardized incidence ratios (SIR) was 2.4-fold increased (95% confidence interval (95%CI) 1.8-3.2), leading to 5.7 excess cases per 10 000 patient-years. Risk was still increased 30 years after HL treatment (SIR: 2.8; 95%CI: 1.6-4.6). The highest (SIR: 6.5, 95%CI: 3.3-11.3) was seen for transverse colon cancer (15.0 (95%CI: 4.3-40.8) after inverted-Y irradiation). A prescribed cumulative procarbazine dose >4.2 g m-2 was associated with a 3.3-fold higher CRC risk (95%CI: 1.8-6.1) compared to treatment without procarbazine. Patients receiving >4.2 g m-2 procarbazine and infradiaphragmatic radiotherapy had a hazard ratio of 6.8 (95%CI: 3.0-15.6) compared with patients receiving neither treatment, which is significantly higher than an additive joint effect (Padditivity=0.004). CONCLUSIONS Colorectal cancer surveillance should be considered for HL survivors who received Infradiaphragmatic radiotherapy and a high cumulative procarbazine dose.
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Sud A, Thomsen H, Sundquist K, Houlston RS, Hemminki K. Risk of Second Cancer in Hodgkin Lymphoma Survivors and Influence of Family History. J Clin Oncol 2017; 35:1584-1590. [PMID: 28384078 PMCID: PMC5455705 DOI: 10.1200/jco.2016.70.9709] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Purpose Although advances in Hodgkin lymphoma (HL) treatment have led to improved disease-free survival, this has been accompanied by an increased risk of second cancers. We sought to quantify the second cancer risks and to investigate the impact of family history. Patients and Methods Using the Swedish Family-Cancer Project Database, we identified 9,522 individuals with primary HL diagnosed between 1965 and 2012. We calculated standardized incidence ratios and cumulative incidence of second cancer in HL survivors and compared the standardized incidence ratios of lung, breast, colorectal, and all second cancers in HL survivors with and without a site-specific family history of cancer. Interactions between family history of cancer and HL treatment were evaluated under additive and multiplicative models. Results Overall, the risk of a second cancer in HL survivors was increased 2.39-fold (95% CI, 2.29 to 2.53). The 30-year cumulative incidence of breast cancer in women diagnosed with HL at younger than 35 years of age was 13.8%. We observed no significant difference in cancer risk over successive time periods. The risk of all second cancers was 1.3-fold higher for HL survivors with a first-degree relative with cancer ( P < .001), with 3.3-fold, 2.1-fold, and 1.8-fold differences shown for lung, colorectal, and breast cancers, respectively. Moreover, a greater than additive interaction between family history of lung cancer and HL treatment was shown ( P = .03). Conclusion HL survivorship is associated with a substantive risk of a second cancer. Notably, the risk is higher in individuals with a family history of cancer. This information should be used to inform risk-adapted therapy and to assist in screening to reduce long-term morbidity and mortality in patients with HL.
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Affiliation(s)
- Amit Sud
- Amit Sud and Richard S. Houlston, The Institute of Cancer Research, London, United Kingdom; Hauke Thomsen and Kari Hemminki, German Cancer Research Centre, Heidelberg, Germany; and Kristina Sundquist and Kari Hemminki, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
- Corresponding author: Amit Sud, MBChB, MRes, Division of Genetics and Epidemiology, The Institute of Cancer Research, 15 Cotswold Rd, London, SM2 5NG, United Kingdom; e-mail:
| | - Hauke Thomsen
- Amit Sud and Richard S. Houlston, The Institute of Cancer Research, London, United Kingdom; Hauke Thomsen and Kari Hemminki, German Cancer Research Centre, Heidelberg, Germany; and Kristina Sundquist and Kari Hemminki, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Kristina Sundquist
- Amit Sud and Richard S. Houlston, The Institute of Cancer Research, London, United Kingdom; Hauke Thomsen and Kari Hemminki, German Cancer Research Centre, Heidelberg, Germany; and Kristina Sundquist and Kari Hemminki, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Richard S. Houlston
- Amit Sud and Richard S. Houlston, The Institute of Cancer Research, London, United Kingdom; Hauke Thomsen and Kari Hemminki, German Cancer Research Centre, Heidelberg, Germany; and Kristina Sundquist and Kari Hemminki, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Kari Hemminki
- Amit Sud and Richard S. Houlston, The Institute of Cancer Research, London, United Kingdom; Hauke Thomsen and Kari Hemminki, German Cancer Research Centre, Heidelberg, Germany; and Kristina Sundquist and Kari Hemminki, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
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Blank O, von Tresckow B, Monsef I, Specht L, Engert A, Skoetz N. Chemotherapy alone versus chemotherapy plus radiotherapy for adults with early stage Hodgkin lymphoma. Cochrane Database Syst Rev 2017; 4:CD007110. [PMID: 28447341 PMCID: PMC6478261 DOI: 10.1002/14651858.cd007110.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Combined modality treatment consisting of chemotherapy followed by localised radiotherapy is the standard treatment for patients with early stage Hodgkin lymphoma (HL). However, due to long- term adverse effects such as secondary malignancies the role of radiotherapy has been questioned recently and some clinical study groups advocate chemotherapy only for this indication. OBJECTIVES To assess the effects of chemotherapy alone compared to chemotherapy plus radiotherapy in adults with early stage HL . SEARCH METHODS For the or i ginal version of this review, we searched MEDLINE, Embase and CENTRAL as well as conference proceedings (American Society of Hematology, American Society of Clinical Oncology and International Symposium of Hodgkin Lymphoma) from January 1980 to November 2010 for randomised controlled trials (RCTs) comparing chemotherapy alone versus chemotherapy regimens plus radiotherapy. For the updated review we searched MEDLINE, CENTRAL and conference proceedings to December 2016. SELECTION CRITERIA We included RCTs comparing chemotherapy alone with chemotherapy plus radiotherapy in patients with early stage HL. We excluded trials with more than 20% of patients in advanced stage. As the value of radiotherapy in addition to chemotherapy is still not clear, we also compared to more cycles of chemotherapy in the control arm. In this updated review, we also included a second comparison evaluating trials with varying numbers of cycles of chemotherapy between intervention and control arms, same chemotherapy regimen in both arms assumed. We excluded trials evaluating children only, therefore only trials involving adults are included in this updated review. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the quality of trials. We contacted study authors to obtain missing information. As effect measures we used hazard ratios (HR) for overall survival (OS) and progression-free survival (PFS) and risk ratios (RR) for response rates. Since not all trials reported PFS according to our definitions, we evaluated all similar outcomes (e.g. event-free survival) as PFS/tumour control. MAIN RESULTS Our search led to 5518 potentially relevant references. From these, we included seven RCTs in the analyses involving 2564 patients. In contrast to the first version of this review including five trials, we excluded trials randomising children. As a result, we excluded one trial from the former analyses and we identified three new trials.Five trials with 1388 patients compared the combination of chemotherapy alone and chemotherapy plus radiotherapy, with the same number of chemotherapy cycles in both arms. The addition of radiotherapy to chemotherapy has probably little or no difference on OS (HR 0.48; 95% confidence interval (CI) 0.22 to 1.06; P = 0.07, moderate- quality evidence), however two included trials had potential other high risk of bias due to a high number of patients not receiving planned radiotherapy. After excluding these trials in a sensitivity analysis, the results showed that the combination of chemotherapy and radiotherapy improved OS compared to chemotherapy alone (HR 0.31; 95% CI 0.19 to 0.52; P <0.00001, moderate- quality evidence). In contrast to chemotherapy alone the use of chemotherapy and radiotherapy improved PFS (HR 0.42; 95% CI 0.25 to 0.72; P = 0.001; moderate- quality evidence). Regarding infection- related mortality (RR 0.33; 95% CI 0.01 to 8.06; P = 0.5; low- quality evidence), second cancer- related mortality (RR 0.53; 95% CI 0.07 to 4.29; P = 0.55; low- quality evidence) and cardiac disease- related mortality (RR 2.94; 95% CI 0.31 to 27.55; P = 0.35;low- quality evidence), there is no evidence for a difference between the use of chemotherapy alone and chemotherapy plus radiotherapy. For complete response rate (CRR) (RR 1.08; 95% CI 0.93 to 1.25; P = 0.33; low- quality evidence), there is also no evidence for a difference between treatment groups.Two trials with 1176 patients compared the combination of chemotherapy alone and chemotherapy plus radiotherapy, with different numbers of chemotherapy cycles in both arms. OS is reported in one trial only, the use of chemotherapy alone (more chemotherapy cycles) may improve OS compared to chemotherapy plus radiotherapy (HR 2.12; 95% CI 1.03 to 4.37; P = 0.04; low- quality evidence). This trial also had a potential other high risk of bias due to a high number of patients not receiving planned therapy. There is no evidence for a difference between chemotherapy alone and chemotherapy plus radiotherapy regarding PFS (HR 0.42; 95% CI 0.14 to 1.24; P = 0.12; low- quality evidence). After excluding the trial with patients not receiving the planned therapy in a sensitivity analysis, the results showed that the combination of chemotherapy and radiotherapy improved PFS compared to chemotherapy alone (HR 0.24; 95% CI 0.070 to 0.88; P = 0.03, based on one trial). For infection- related mortality (RR 6.90; 95% CI 0.36 to 132.34; P = 0.2; low- quality evidence), second cancer- related mortality (RR 2.22; 95% CI 0.7 to 7.03; P = 0.18; low- quality evidence) and cardiac disease-related mortality (RR 0.99; 95% CI 0.14 to 6.90; P = 0.99; low-quality evidence), there is no evidence for a difference between the use of chemotherapy alone and chemotherapy plus radiotherapy. CRR rate was not reported. AUTHORS' CONCLUSIONS This systematic review compared the effects of chemotherapy alone and chemotherapy plus radiotherapy in adults with early stage HL .For the comparison with same numbers of chemotherapy cycles in both arms, we found moderate- quality evidence that PFS is superior in patients receiving chemotherapy plus radiotherapy than in those receiving chemotherapy alone. The addition of radiotherapy to chemotherapy has probably little or no difference on OS . The sensitivity analysis without the trials with potential other high risk of bias showed that chemotherapy plus radiotherapy improves OS compared to chemotherapy alone.For the comparison with different numbers of chemotherapy cycles between the arms there are no implications for OS and PFS possible, because of the low quality of evidence of the results.
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Affiliation(s)
- Oliver Blank
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50937
| | - Bastian von Tresckow
- University Hospital of CologneDepartment I of Internal MedicineCologneGermany50931
| | - Ina Monsef
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50937
| | - Lena Specht
- Rigshospitalet, University of CopenhagenDepts. of Oncology and HaematologyThe Finsen Centre9 BlegdamsvejCopenhagenDenmarkDK‐2100
| | - Andreas Engert
- University Hospital of CologneDepartment I of Internal MedicineCologneGermany50931
| | - Nicole Skoetz
- University Hospital of CologneCochrane Haematological Malignancies Group, Department I of Internal MedicineKerpener Str. 62CologneGermany50937
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Senatore FJ, Murali S, Dasanu CA. Accelerated Premalignant Polyposis and Second Colon Cancers: Incriminating Immunosuppression, Radiotherapy, and Systemic Chemotherapy Agents. J Gastrointest Cancer 2017; 47:152-6. [PMID: 26957095 DOI: 10.1007/s12029-016-9813-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cancer survivors are known to be at increased risk for second primary cancers. In addition, immunosuppression and previous cancer treatments such as radiotherapy and systemic chemotherapy are linked with increased risk of both colonic adenomas and adenocarcinomas. AIM We performed a systematic review searching for manuscripts discussing second colon cancers, accelerated polyposis, immunosuppression, radiation, and chemotherapy. We sought to identify a link between immunosuppression and increased risks specific to premalignant polyposis and second colon cancers. FINDINGS We identified multiple studies demonstrating associations between radiotherapy, systemic chemotherapy, and immunosuppression with a higher propensity for second colon adenomas and adenocarcinomas. When compared to the general population, these risks were more profound and the rate at which these second malignancies developed was significantly increased. CONCLUSIONS We believe that timing for colonoscopic surveillance in these patients should be different from the general population in order to identify promptly these rapidly progressive neoplasms. Screening for second malignancies should be considered early after remission of the primary cancer is documented, especially when a prolonged survival or a cure is anticipated. We also recommend consideration be given to increasing the frequency of colonoscopy in these cohorts. Future studies are required in order to establish the optimal time interval for surveillance colonoscopy in these high-risk individuals.
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Affiliation(s)
- Frank J Senatore
- Department of Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA.
| | - Shruti Murali
- Department of Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA
| | - Constantin A Dasanu
- Lucy Curci Cancer Center, Eisenhower Medical Center/University of Southern California, Rancho Mirage, CA, USA
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Hodgson D, van Leeuwen F, Ng A, Morton L, Henderson TO. Breast Cancer After Childhood, Adolescent, and Young Adult Cancer: It's Not Just About Chest Radiation. Am Soc Clin Oncol Educ Book 2017; 37:736-745. [PMID: 28561716 DOI: 10.1200/edbk_175668] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Women who have been treated for a childhood, adolescent, or young adult cancer are at an increased risk for developing breast cancer at a young age, and breast cancer accounts for the most common subsequent malignant neoplasm among female childhood and adolescent cancer survivors. Risk of breast cancer in these survivors appears to be a multifaceted relationship between constitutional factors, exposures to radiation therapy (RT) and chemotherapy, and genetic predisposition. Given the significant morbidities and mortality associated with a breast cancer diagnosis, it is imperative that health care providers understand the risks, biology and genetics, recommended surveillance guidelines for early detection, and potential prevention strategies for women who have survived pediatric and young adult cancer.
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Affiliation(s)
- David Hodgson
- From the University of Toronto, Toronto, Ontario; Netherlands Cancer Institute, Amsterdam, Netherlands; Dana-Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; University of Chicago, Chicago, IL
| | - Flora van Leeuwen
- From the University of Toronto, Toronto, Ontario; Netherlands Cancer Institute, Amsterdam, Netherlands; Dana-Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; University of Chicago, Chicago, IL
| | - Andrea Ng
- From the University of Toronto, Toronto, Ontario; Netherlands Cancer Institute, Amsterdam, Netherlands; Dana-Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; University of Chicago, Chicago, IL
| | - Lindsay Morton
- From the University of Toronto, Toronto, Ontario; Netherlands Cancer Institute, Amsterdam, Netherlands; Dana-Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; University of Chicago, Chicago, IL
| | - Tara O Henderson
- From the University of Toronto, Toronto, Ontario; Netherlands Cancer Institute, Amsterdam, Netherlands; Dana-Farber Cancer Institute, Boston, MA; National Cancer Institute, Bethesda, MD; University of Chicago, Chicago, IL
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Breast Cancer in Lymphoma Survivors. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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van Leeuwen FE, Ng AK. Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:323-330. [PMID: 27913498 PMCID: PMC6142518 DOI: 10.1182/asheducation-2016.1.323] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Long-term survivors of Hodgkin lymphoma (HL) experience several late adverse effects of treatment, with second malignant neoplasms (SMNs) and cardiovascular diseases (CVDs) being the leading causes of death in these patients. Other late effects have also been identified, such as pulmonary dysfunction, endocrinopathies (thyroid dysfunction, infertility), neck muscle atrophy, and persistent fatigue. HL survivors have two- to fourfold increased risks to develop SMNs and CVD compared with the general population. With respect to SMNs, radiotherapy is associated with 1.5- to 15-fold increased risk of solid malignancies. The relative risk (RR) of solid tumors increases steadily with increasing follow-up time from 5 to 15 years since radiotherapy, and remains elevated for at least 40 years. The RR of solid SMNs increases strongly with younger age at first treatment. Risks of lung, breast, and gastrointestinal (GI) cancers increase with higher radiation dose. Alkylating agent chemotherapy, especially procarbazine, does not only increase risk of leukemia but also of solid malignancies, in particular, cancers of the lung and GI tract. In contrast, gonadotoxic chemotherapy decreases the risk of radiation-associated breast cancer, through induction of premature menopause. Smoking appears to multiply the radiation- and chemotherapy-associated risks of lung cancer. Both radiotherapy and chemotherapy for HL may cause cardiovascular toxicity. Radiotherapy increases the risk of coronary heart disease, valvular heart disease, congestive heart failure (HF), and pericarditis, whereas anthracycline-containing chemotherapy increases the risks of HF and valvular heart disease. Cardiovascular toxicity following radiotherapy is usually observed from 5 to at least 35 years after therapy, whereas anthracycline-related toxicity is already observed during treatment, up to at least 25 years. The joint effects of anthracyclines, radiotherapy, and conventional cardiovascular risk factors (eg, hypertension, smoking, and physical inactivity) appear to be additive rather than multiplicative. HL survivors need lifelong risk-based screening for selected SMNs and CVDs. Furthermore, preventive strategies should include lifestyle and drug-based interventions to minimize exposure to conventional risk factors for cancer and CVD.
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Affiliation(s)
- Flora E. van Leeuwen
- Division of Psychosocial Research and Epidemiology, Department of Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; and
| | - Andrea K. Ng
- Department of Radiation Oncology, Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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Athiyaman H, m A, Chougule A, Hs K. Estimated Risk of Radiation Induced Contra Lateral Breast Cancer Following Chest Wall Irradiation by Conformal Wedge Field and Forward Intensity Modulated Radiotherapy Technique for Post-Mastectomy Breast Cancer Patients. Asian Pac J Cancer Prev 2016; 17:5107-5111. [PMID: 28122442 PMCID: PMC5454644 DOI: 10.22034/apjcp.2016.17.12.5107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Epidemiological studies have indicated an increasing incidence of radiation induced secondary cancer (SC) in breast cancer patients after radiotherapy (RT), most commonly in the contra-lateral breast (CLB). The present study was conducted to estimate the SC risk in the CLB following 3D conformal radiotherapy techniques (3DCRT) including wedge field and forward intensity modulated radiotherapy (fIMRT) based on the organ equivalent dose (OED). Material and Methods: RT plans treating the chest wall with conformal wedge field and fIMRT plans were created for 30 breast cancer patients. The risks of radiation induced cancer were estimated for the CLB using dose-response models: a linear model, a linear-plateau model and a bell-shaped model with full dose response accounting for fractionated RT on the basis of OED. Results: The plans were found to be ranked quite differently according to the choice of model; calculations based on a linear dose response model fIMRT predict statistically significant lower risk compared to the enhanced dynamic wedge (EDW) technique (p-0.0089) and a non-significant difference between fIMRT and physical wedge (PW) techniques (p-0.054). The widely used plateau dose response model based estimation showed significantly lower SC risk associated with fIMRT technique compared to both wedge field techniques (fIMRT vs EDW p-0.013, fIMRT vs PW p-0.04). The full dose response model showed a non-significant difference between all three techniques in the view of second CLB cancer. Finally the bell shaped model predicted interestingly that PW is associated with significantly higher risk compared to both fIMRT and EDW techniques (fIMRT vs PW p-0.0003, EDW vs PW p-0.0032). Conclusion: In conclusion, the SC risk estimations of the CLB revealed that there is a clear relation between risk associated with wedge field and fIMRT technique depending on the choice of model selected for risk comparison.
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Lifetime grain consumption and breast cancer risk. Breast Cancer Res Treat 2016; 159:335-45. [PMID: 27510186 DOI: 10.1007/s10549-016-3910-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
We evaluated individual grain-containing foods and whole and refined grain intake during adolescence, early adulthood, and premenopausal years in relation to breast cancer risk in the Nurses' Health Study II. Grain-containing food intakes were reported on a baseline dietary questionnaire (1991) and every 4 years thereafter. Among 90,516 premenopausal women aged 27-44 years, we prospectively identified 3235 invasive breast cancer cases during follow-up to 2013. 44,263 women reported their diet during high school, and from 1998 to 2013, 1347 breast cancer cases were identified among these women. Cox proportional hazards regression was used to estimate relative risks (RR) and 95 % confidence intervals (95 % CI) of breast cancer for individual, whole and refined grain foods. After adjusting for known breast cancer risk factors, adult intake of whole grain foods was associated with lower premenopausal breast cancer risk (highest vs. lowest quintile: RR 0.82; 95 % CI 0.70-0.97; P trend = 0.03), but not postmenopausal breast cancer. This association was no longer significant after further adjustment for fiber intake. The average of adolescent and early adulthood whole grain food intake was suggestively associated with lower premenopausal breast cancer risk (highest vs lowest quintile: RR 0.74; 95 % CI 0.56-0.99; P trend = 0.09). Total refined grain food intake was not associated with risk of breast cancer. Most individual grain-containing foods were not associated with breast cancer risk. The exceptions were adult brown rice which was associated with lower risk of overall and premenopausal breast cancer (for each 2 servings/week: RR 0.94; 95 % CI 0.89-0.99 and RR 0.91; 95 % CI 0.85-0.99, respectively) and adult white bread intake which was associated with increased overall breast cancer risk (for each 2 servings/week: RR 1.02; 95 % CI 1.01-1.04), as well as breast cancer before and after menopause. Further, pasta intake was inversely associated with overall breast cancer risk. Our results suggest that high whole grain food intake may be associated with lower breast cancer risk before menopause. Fiber in whole grain foods may mediate the association with whole grains.
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