High prevalence of advanced colorectal neoplasia and serrated polyposis syndrome in Hodgkin lymphoma survivors

Rigter, Lisanne S.; Spaander, Manon C.W.; Aleman, Berthe M.P.; Bisseling, Tanya M.; Moons, Leon M.G.; Cats, Annemieke; Lugtenburg, Pieternella J.; Janus, Cécile P.M.; Petersen, Eefke; Roesink, Judith M.; Maazen, R.W.M. van der; Snæbjörnsson, Pétur; Kuipers, Ernst J.; Bruno, Marco J.; Dekker, Evelien; Meijer, Gerrit A.; Boer, Jan Paul de; Leeuwen, Flora E. van; Leerdam, Monique E. van

doi:10.1002/cncr.31903

Cited by 25 publications

(60 citation statements)

References 31 publications

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“…The cecum was reached during colonoscopy in all FIT and mt-sDNA participants. The median inspection time during withdrawal was 20 min (range 8-70), Boston Bowel Preparation score > 6 was reported in all participants [7]. Table 1 shows the colonoscopy findings of FIT and/or mt-sDNA cohorts.…”

Section: Colonoscopy Resultsmentioning

confidence: 99%

“…Individuals were included in a prospective multicenter cohort study evaluating yield of colonoscopy in HL survivors. The study design and the diagnostic yield of colonoscopy in the study population were described previously [7,29]. Inclusion criteria for colonoscopy were infradiaphragmatic radiotherapy consisting of at least para-aortic and iliac fields, chemotherapy containing a cumulative procarbazine dosage of ≥2.8 g/m 2 or infradiaphragmatic radiotherapy (any field(s) and chemotherapy (any regimen)).…”

Section: Study Populationmentioning

confidence: 99%

“…Between February 2015 and February 2017, 101 HL survivors underwent a colonoscopy [7]. Figure 1 shows the flow of participants eligible for this study.…”

Section: Study Populationmentioning

confidence: 99%

“…A recent prospective colonoscopy study showed a high yield of advanced adenoma (AA) and advanced serrated lesions (ASL) in HL survivors at a younger age compared with the general population. Therefore, colonoscopy surveillance is recommended from the age of 35 or eight years after HL treatment [7,8]. Yet, colonoscopy is burdensome and has a small risk of serious complications [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…HL survivors might benefit from a more personalized approach for CRC surveillance due to the young age of developing AN, more right-sided lesions, other histology (high frequency of serrated polyps), and psychological burden of colonoscopy [7]. Stool tests could be an alternative for colonoscopy surveillance and could increase the participation rate of CRC surveillance in HL survivors.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Accuracy of Stool Tests for Colorectal Cancer Surveillance in Hodgkin Lymphoma Survivors

Ykema

Rigter

Spaander

et al. 2020

JCM

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Background: Hodgkin lymphoma (HL) survivors have an increased colorectal cancer (CRC) risk. Diagnostic accuracy of quantitative fecal immunochemical testing (FIT, OC Sensor) and/or a multi-target stool DNA test (mt-sDNA, Cologuard®) for advanced neoplasia (AN) was evaluated. Methods: 101 HL survivors underwent a surveillance colonoscopy and were asked to perform two stool tests (FIT and mt-sDNA). Advanced adenoma (AA), advanced serrated lesion (ASL), and AN (AA, ASL, CRC) were evaluated. Sensitivity, specificity, and area under the curve (AUC) for AN were calculated for different FIT cut-offs and mt-sDNA with colonoscopy as reference. Results: FIT and mt-sDNA were analyzed in 73 (72%) and 82 (81%) participants, respectively. AN was detected in 19 (26%) and 22 (27%), respectively. AN sensitivities for FIT cut-off of 10 ug Hb/g feces (FIT10) and mt-sDNA were 37% (95% confidence interval (CI): 16–62) and 68% (95% CI: 45–86), with corresponding specificities of 91% (95% CI: 80–97) and 70% (95% CI: 57–86), respectively. AUC for FIT was 0.68 (95% CI: 0.54–0.82) and for mt-sDNA 0.76 (95% CI: 0.63–0.89). Conclusions: In HL survivors, mt-sDNA showed highest sensitivity but with relatively low specificity for AN. Cost-effectiveness analyses is necessary to determine the optimal surveillance strategy.

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Section: Colonoscopy Resultsmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

“…Between February 2015 and February 2017, 101 HL survivors underwent a colonoscopy [7]. Figure 1 shows the flow of participants eligible for this study.…”

Section: Study Populationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Diagnostic Accuracy of Stool Tests for Colorectal Cancer Surveillance in Hodgkin Lymphoma Survivors

Ykema

Rigter

Spaander

et al. 2020

JCM

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Association of Changes in Cancer Therapy Over 3 Decades With Risk of Subsequent Breast Cancer Among Female Childhood Cancer Survivors

et al. 2022

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ImportanceBreast cancer is the most common invasive subsequent malignant disease in childhood cancer survivors, though limited data exist on changes in breast cancer rates as primary cancer treatments have evolved.ObjectiveTo quantify the association between temporal changes in cancer treatment over 3 decades and subsequent breast cancer risk.Design, Setting, and ParticipantsRetrospective cohort study of 5-year cancer survivors diagnosed when younger than 21 years between 1970 and 1999, with follow-up through December 5, 2020.ExposuresRadiation and chemotherapy dose changes over time.Main Outcomes and MeasuresBreast cancer cumulative incidence rates and age-specific standardized incidence ratios (SIRs) compared across treatment decades (1970-1999). Piecewise exponential models estimated invasive breast cancer and ductal carcinoma in situ (DCIS) risk and associations with treatment exposures, adjusted for age at childhood cancer diagnosis and attained age.ResultsAmong 11 550 female survivors (median age, 34.2 years; range 5.6-66.8 years), 489 developed 583 breast cancers: 427 invasive, 156 DCIS. Cumulative incidence was 8.1% (95% CI, 7.3%-9.0%) by age 45 years. An increased breast cancer risk (SIR, 6.6; 95% CI, 6.1-7.2) was observed for survivors compared with the age-sex-calendar-year-matched general population. Changes in therapy by decade included reduced rates of chest (34% in the 1970s, 22% in the 1980s, and 17% in the 1990s) and pelvic radiotherapy (26%, 17%, and 13% respectively) and increased rates of anthracycline chemotherapy exposures (30%, 51%, and 64%, respectively). Adjusting for age and age at diagnosis, the invasive breast cancer rate decreased 18% every 5 years of primary cancer diagnosis era (rate ratio [RR], 0.82; 95% CI, 0.74-0.90). When accounting for chest radiotherapy exposure, the decline attenuated to an 11% decrease every 5 years (RR, 0.89; 95% CI, 0.81-0.99). When additionally adjusted for anthracycline dose and pelvic radiotherapy, the decline every 5 years increased to 14% (RR, 0.86; 95% CI, 0.77-0.96). Although SIRs of DCIS generally increased over time, there were no statistically significant changes in incidence.Conclusions and RelevanceInvasive breast cancer rates in childhood cancer survivors have declined with time, especially in those younger than 40 years. This appears largely associated with the reduced use of chest radiation therapy, but was tempered by concurrent changes in other therapies.

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Association of Radiation and Procarbazine Dose With Risk of Colorectal Cancer Among Survivors of Hodgkin Lymphoma

et al. 2023

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ImportanceHodgkin 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.ObjectiveTo quantify the rate of colorectal cancer according to radiation dose to the large bowel and procarbazine dose among HL survivors.Design, Setting, and ParticipantsA 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.ExposuresMean radiation doses to the large bowel were estimated by reconstructing individual radiation therapy treatments on representative computed tomography data sets.Main Outcomes and MeasuresExcess 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.ResultsThe 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 RelevanceThis 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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High prevalence of advanced colorectal neoplasia and serrated polyposis syndrome in Hodgkin lymphoma survivors

Cited by 25 publications

References 31 publications

Diagnostic Accuracy of Stool Tests for Colorectal Cancer Surveillance in Hodgkin Lymphoma Survivors

Diagnostic Accuracy of Stool Tests for Colorectal Cancer Surveillance in Hodgkin Lymphoma Survivors

Association of Changes in Cancer Therapy Over 3 Decades With Risk of Subsequent Breast Cancer Among Female Childhood Cancer Survivors

Association of Radiation and Procarbazine Dose With Risk of Colorectal Cancer Among Survivors of Hodgkin Lymphoma

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