Breast Cancer Risk in Female Survivors of Hodgkin's Lymphoma: Lower Risk After Smaller Radiation Volumes

Bruin, Marie L. De; Sparidans, Judith; Veer, M. B. Van't; Noordijk, Evert M.; Louwman, Marieke W. J.; Zijlstra, Josée M.; Berg, Hendrik Van den; Russell, Nicola S.; Broeks, Annegien; Baaijens, Margreet H.A.; Aleman, Berthe M.P.; Leeuwen, Flora E. van

doi:10.1200/jco.2008.19.9174

Cited by 321 publications

(256 citation statements)

References 31 publications

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“…A debate on the real influence of high or low RT doses, as well as large or "involved" fields used for HD cure, is still ongoing [25,26]. However, a retrospective analysis of the doses delivered to different parts of the breasts is almost impossible and the doses are often wrongly estimated due to difficulties of precise measurement [18,27].…”

Section: Specific Survival According To Surgerymentioning

confidence: 99%

Breast cancer occurred after Hodgkin's disease: Clinico-pathological features, treatments and outcome: Analysis of 214 cases

Cutuli

Kanoun

Lara

et al. 2012

Critical Reviews in Oncology/Hematology

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Section: Specific Survival According To Surgerymentioning

confidence: 99%

Breast cancer occurred after Hodgkin's disease: Clinico-pathological features, treatments and outcome: Analysis of 214 cases

Cutuli

Kanoun

Lara

et al. 2012

Critical Reviews in Oncology/Hematology

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“…13 For patients treated at age 25 years with a chest radiation dose of at least 40 Gy without alkylating agents, the estimated cumulative absolute risks of breast cancer by age 35, 45, and 55 years were 1.4%, 11.1%, and 29.0%, respectively. Several studies have demonstrated a direct correlation between breast cancer risk and radiation field size [14][15][16][17] and also showed that smaller fields and treatment volume are associated with a significantly lower risk of breast cancer. In a population-based study comparing outcome of de novo breast cancer versus breast cancer after HL, women with localized breast cancer after HL had a significantly increased 2-fold risk of death from breast cancer compared with patients with de novo breast cancer.…”

Section: Second Malignancymentioning

confidence: 99%

Current survivorship recommendations for patients with Hodgkin lymphoma: focus on late effects

2014

Blood

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Long-term survivors of Hodgkin lymphoma (HL) are at an increased risk for a range of late complications, with subsequent malignant neoplasm and cardiovascular disease representing the 2 leading causes of death in these patients. Raising awareness, close follow-up, and adoption of selected earlydetection and risk-reduction strategies may help to reduce the adverse impact of these late effects on patients. This chapter reviews known long-term complications of HL therapy, risk factors, and the timing of their occurrence. Where available, data on the efficacy of screening for selected late effects of HL are presented. Current evidence-based and consensus-based recommendations on follow-up of longterm HL survivors are also reviewed. As HL therapy evolves over time, late effects and implications on follow-up of patients treated in the contemporary era should be considered and opportunities for future research should be explored. (Blood. 2014; 124(23):3373-3379)

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“…Likewise, retardation of bone growth which seems to be more prominent above 25 Gy should also be reduced with this approach. Studies from the Netherlands Cancer Institute and Stanford University have conflicting results regarding the reduction of secondary breast cancer following involved field RT [23,24]. A study from St. Jude Children's Research Hospital has shown that even with a dose of 15 Gy, growth of the clavicle can still be impaired after asymmetric mantle RT, more prominent in younger children [25].…”

Section: Use Of Chemotherapy To Lower Rt Dose and Volumementioning

confidence: 99%

Treatment strategies to reduce radiotherapy late effects in children

Paulino

2012

J Radiat Oncol

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Late effects of treatment are an important cause of morbidity and mortality in childhood cancer survivors. The use of radiotherapy has been implicated as a risk factor for the development of many late complications. Several strategies have been employed in pediatric oncology to minimize the late effects of radiotherapy. These have included (1) omitting or delaying radiotherapy until the child is older, (2) decreasing radiotherapy doses and volumes by incorporating chemotherapy in the treatment regimen, (3) alteration of radiotherapy fractionation, (4) use of novel techniques to spare or minimize radiation dose to surrounding normal tissues, and (5) elimination of radiotherapy in favorable subsets of patients. In infants with brain tumors, delaying radiotherapy and giving chemotherapy until the child is 3 years old was a popular approach three to four decades ago with limited success with respect to tumor control. With the advent of modern radiotherapy technology, younger patients are now able to be treated with conformal techniques and reasonable neurotoxicity. Using chemotherapy to reduce doses of radiation therapy has been employed in standard-risk medulloblastoma, intracranial germinoma, Hodgkin lymphoma, and Wilms' tumor. Likewise, the use of chemotherapy to reduce radiotherapy volumes has been employed in intracranial germinoma, Hodgkin lymphoma, and neuroblastoma and for the boost portion of treatments for rhabdomyosarcoma and Ewing sarcoma. There are a few phase III trials comparing conventional and hyperfractionated radiotherapy, but none of them have shown superiority of one over the other in terms of tumor control and late effects. Current protocols are testing the omission of radiotherapy in the most favorable subset of patients with Hodgkin lymphoma and Wilms' tumor. Intensity-modulated radiation therapy is currently used in many children in developed nations. Proton therapy is available in a few centers; clinical results of treatment are accumulating regarding the effectiveness and longterm toxicity of this radiation modality.

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Breast Cancer Risk in Female Survivors of Hodgkin's Lymphoma: Lower Risk After Smaller Radiation Volumes

Abstract: Reduction of radiation volume appears to decrease the risk for BC after HL. In addition, shorter duration of intact ovarian function after irradiation is associated with a significant reduction of the risk for BC.

Cited by 321 publications

References 31 publications

Breast cancer occurred after Hodgkin's disease: Clinico-pathological features, treatments and outcome: Analysis of 214 cases

Breast cancer occurred after Hodgkin's disease: Clinico-pathological features, treatments and outcome: Analysis of 214 cases

Current survivorship recommendations for patients with Hodgkin lymphoma: focus on late effects

Treatment strategies to reduce radiotherapy late effects in children

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