Browse > Article
http://dx.doi.org/10.7314/APJCP.2016.17.2.749

Effects of Radiotherapy on the Risk of Developing Secondary Malignant Neoplasms in Hodgkin's Lymphoma Survivors  

Abou-Antoun, Tamara (Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese American University)
Mikhael, Rachelle (Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese American University)
Massoud, Marcel (Faculty of Medical Sciences, Holy Spirit University of Kaslik)
Chahine, Georges (Faculty of Medical Sciences, Holy Spirit University of Kaslik)
Saad, Aline (Department of Pharmacy Practice, School of Pharmacy, Lebanese American University)
Publication Information
Asian Pacific Journal of Cancer Prevention / v.17, no.2, 2016 , pp. 749-754 More about this Journal
Abstract
Extended follow-up of Hodgkin lymphoma (HL) survivors indicates that these patients are at high risk of secondary malignant neoplasms (SMNs) contributing to increased morbidity and mortality. This study examined the characteristics of HL survivors who developed SMNs with the aim to report any correlation with radiotherapy (RT) dose. In this retrospective multi-center cohort study of HL patients treated between 1990 and 2011 at three major teaching hospitals in Lebanon, classification was into two groups including those treated with combined modality (RT and chemotherapy-CHT) and those treated with CHT alone. Approval from the University Institutional Review Board (IRB) was obtained. Of the 112 patients evaluated, 52.7% (59) received the combined modality while 47.3% (53) received CHT alone. There were 6 cases of SMNs in the combined modality cohort and 5 cases in the CHT cohort. The mean RT dose in the combined modality cohort was 34.5 Gray (Gy) ($SD{\pm}5.3$). A statistically significant increase (1.5 fold) in the risk of developing SMNs was observed among patients who received a dose higher than 41 Gy compared to a dose between 20 to 30 Gy (OR= 1.5; 95% confidence interval= 0.674 to 3.339, p=0.012). The risk of SMNs was not significantly higher among patients who received extended field compared to involved field RT (p=0.964). This study showed that the risk of developing SMNs is higher among patients treated with RT dose greater than 31 Gy, independent of the RT type used.
Keywords
Secondary malignant neoplasms; Hodgkin's lymphoma; radiotherapy; extended field radiation therapy;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Lorigan P, Radford J, Howell A, Thatcher N (2005). Lung cancer after treatment for Hodgkin's lymphoma: a systematic review. Lancet Oncol, 6, 773-79.   DOI
2 Matasar MJ and Zelenetz AD (2008). Overview of lymphoma diagnosis and management. Radiol Clin North Am, 46, 175-98.   DOI
3 National Comprehensive Cancer Network (2015). Hodgkin Lymphoma. Clinical Practice Guidelines in Oncology. National Comprehensive Cancer Network (V 2.2015). http://www.nccn.org/professionals/physician_gls/pdf/hodgkins.pdf
4 National Cancer Registry (2004). Beirut: Ministry of Public Health. [Accessed 02/02/2014].
5 Ng AK, Bernardo MV, Weller E, et al (2002). Second malignancy after Hodgkin disease treated with radiation therapy with or without chemotherapy: long-term risks and risk factors. Blood, 100, 1989-96.   DOI
6 Noordijk EM, Carde P, Dupouy N, et al (2006). Combined modality therapy for clinical stage I or II Hodgkin's lymphoma: long-term results of the European Organisation for Research and Treatment of Cancer H7 randomized controlled trials. J Clin Oncol, 24, 3128-35.   DOI
7 O'Brien MM, Donaldson SS, Balise RR, Whittemore AS, and Link MP (2010). Second malignant neoplasms in survivors of pediatric Hodgkin's lymphoma treated with low-dose radiation and chemotherapy. J Clin Oncol, 28, 1232-9.   DOI
8 Oeffinger KC, Baxi SS, Friedman DN, Moskowitz CS (2013). Solid tumor second primary neoplasms: Who is at risk, what can we do? Semin Oncol, 40, 676-89.   DOI
9 Omer B, Kadan-Lottick NS, Roberts KB, et al (2012). Patterns of subsequent malignancies after Hodgkin lymphoma in children and adults. Br J Haematol, 5, 615-25.
10 Otrock ZK, Saab J, Aftimos G, et al (2013). A Collaborative nationwide Lymphoma study in Lebanon: Incidence of various subtypes and analysis of associations with viruses. Pathol Oncol Res, 19, 715-22.   DOI
11 Sader-Ghorra C, Rassy M, Naderi S, Kourie HR, Kattan J (2014). Type distribution of lymphomas in Lebanon: Five-year single institution experience. Asian Pac J Cancer Prev, 15, 5825-8.   DOI
12 Sasse S, Klimm B, Görgen H, et al (2012). Comparing longterm toxicity and efficacy of combined modality treatment including extended- or involved-field radiotherapy in earlystage Hodgkin's lymphoma. Ann Oncol, 23, 2953-9.   DOI
13 Schellong G, Riepenhausen M, Creutzig U, et al (1997). Low risk of secondary leukemias after chemotherapy without mechlorethamine in childhood Hodgkin's disease. J Clin Oncol, 25, 2241-53.
14 Schellong G, and Riepenhausen M, (2004). Late effects after therapy of Hodgkin's disease: Update 2003/04 on overwhelming postsplenectomy infections and secondary malignancies. Klin Padiatr, 216, 364-9.   DOI
15 Schellong G, Riepenhausen M, Ehlert K, et al (2014). Breast cancer in young women after treatment for Hodgkin's disease during childhood or adolescence. Dtsch Arztebl Int, 111, 3-9.
16 Swerdlow AJ, Higgins CD, Smith P, et al (2011). Second cancer risk after chemotherapy for Hodgkin's Lymphoma:a collaborative British cohort study. J Clin Oncol, 29, 4096-104.   DOI
17 Travis LB, Gospodarowicz M, Curtis RE, et al (2002). Lung cancer following chemotherapy and radiotherapy for Hodgkin's disease. J Natl Cancer Inst, 94, 182-92.   DOI
18 Travis LB, Hill DA, Dores GM, et al (2003). Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease. JAMA, 290, 465-75.   DOI
19 van Leeuwen FE, Klokman WJ, Stovall M, et al (2003). Roles of radiation dose, chemotherapy, and hormonal factors in breast cancer following Hodgkin's disease. J Natl Cancer Inst, 95, 971-80.   DOI
20 van Leeuwen FE, Klokman WJ, Veer MB, et al (2000). Long term risk of second malignancy in survivors of Hodgkin's disease treated during adolescence of young adulthood. J Clin Oncol, 18, 487-97.   DOI
21 Yahalom J (2009). Role of radiation therapy in Hodgkin's lymphoma. Cancer J, 15, 155-60.   DOI
22 Constine LS, Tarbell N, Hudson MM, et al (2008). Subsequent malignancies in children treated for Hodgkin's disease:associations with gender and radiation dose. Int J Radiat Oncol Biol Phys, 72, 24-33.   DOI
23 Aleman BM, van den Belt-Dusebout AW, Klokman WJ, et al (2003). Long-term cause-specific mortality of patients treated for Hodgkin's disease. J Clin Oncol, 21, 3431-9.   DOI
24 Aleman B, Schaapveld M, van Eggermond AM, et al (2012). Second cancer risk 40 years after hodgkin lymphoma treatment. Int J Radiat Oncol Biol Phys, 84, S70-1.
25 Choi DK, Helenowski I, Hijya N (2014). Secondary malignancies in pediatric cancer survivors: Perspectives and review of the literature. Int J Cancer, 135, 1764-73.   DOI
26 Dorffel W, Riepenhausen M, Luders H, Bramswig J, Schellong G (2015). Secondary malignancies following treatment for Hodgkin's Lymphoma in childhood and adolescence. Dtsch Arztebl Int, 112, 320-7.
27 Franklin J, Pluetschow A, Paus M, et al (2006). Second malignancy risk associated with treatment of Hodgkin's lymphoma: meta-analysis of the randomised trials. Ann Oncol, 17, 1749-60.   DOI
28 Gilbert ES, Stovall M, Gospodarowicz M, et al (2003). Lung cancer after treatment for Hodgkin's disease: focus on radiation effects. Radiat Res, 159, 161-73.   DOI
29 Hodgson DC, Koh ES, Tran TH, et al (2007) Individualized estimates of second cancer risks after contemporary radiation therapy for Hodgkin lymphoma. Cancer, 110, 2576-86.   DOI
30 Koh ES, Tran TH, Heydarian M, et al (2007). A comparison of mantle versus involved-field radiotherapy for Hodgkin's lymphoma: reduction in normal tissue dose and second cancer risk. Radiat Oncol, 2, 13.   DOI