Long-Term Survival and Competing Causes of Death in Patients With Early-Stage Hodgkin’s Disease Treated at Age 50 or Younger

Ng, Andrea K.; Bernardo, M.P; Weller, Edie; Backstrand, Kendall; Silver, Barbara; Marcus, Karen; Tarbell, Nancy J.; Friedberg, Jonathan W.; Canellos, George P.; Mauch, Peter

doi:10.1200/jco.2002.08.021

Cited by 386 publications

(224 citation statements)

References 22 publications

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“…One other study has done so18 but, as it was based on only 281 individuals, it was unable to provide risk estimates with any precision. Several studies of cause‐specific mortality in survivors of Hodgkin lymphoma diagnosed in childhood or early adult life have been carried out,19, 20, 21 and the risk of hospitalisation among survivors of all types of cancer diagnosed in adolescence and young adulthood has been studied in other populations 22, 23, 24, 25. Other studies specifically of survivors of Hodgkin lymphoma diagnosed in young adulthood have usually reported on specific risks of second cancers11, 26, 27, 28, 29, 30, 31, 32, 33 or cardiovascular diseases 12, 34, 35, 36.…”

Section: Discussionmentioning

confidence: 99%

Long-term hospitalisation rates among 5-year survivors of Hodgkin lymphoma in adolescence or young adulthood: A nationwide cohort study

et al. 2017

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In the present study, we report on the full range of physical diseases acquired by survivors of Hodgkin lymphoma diagnosed in adolescence or young adulthood. In a Danish nationwide population‐based cohort study, 1,768 five‐year survivors of Hodgkin lymphoma diagnosed at ages 15–39 years during 1943–2004 and 228,447 comparison subjects matched to survivors on age and year of birth were included. Hospital discharge diagnoses and bed‐days during 1977–2010 were obtained from the Danish Patient Register for 145 specific disease categories gathered in 14 main diagnostic groups. The analysis was conducted separately on three subcohorts of survivors, that is, survivors diagnosed 1943–1976 for whom we had no information on rehospitalisation for Hodgkin lymphoma and survivors diagnosed 1977–2004, split into a subcohort with no expected relapses and a subcohort for whom a rehospitalisation for Hodgkin lymphoma indicated a relapse. The overall standardised hospitalisation rate ratios (RRs) were 2.0 [95% confidence interval (CI), 1.9–2.1], 1.5 (1.4–1.6) and 2.9 (2.6–3.1) respectively, and the corresponding RRs for bed‐days were 3.5 (3.4–3.5), 1.8 (1.8–1.9) and 10.4 (10.3–10.6). Highest RRs were seen for nonmalignant haematological conditions (RR: 2.6; 3.1 and 9.7), malignant neoplasms (RR: 3.2; 2.5 and 4.7) and all infections combined (RR: 2.5; 2.2 and 5.3). Survivors of Hodgkin lymphoma in adolescence or young adulthood are at increased risk for a wide range of diseases that require hospitalisation. The risk depends on calendar period of treatment and on whether the survivors were rehospitalised for Hodgkin lymphoma, and thus likely had a relapse.

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Section: Discussionmentioning

confidence: 99%

Long-term hospitalisation rates among 5-year survivors of Hodgkin lymphoma in adolescence or young adulthood: A nationwide cohort study

et al. 2017

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“…Similarly, estimates of cumulative risk of breast cancer after treatment at young ages have at the extreme been estimated at 42% at 30 years of follow-up for women treated under age 16 years in a study with incomplete follow-up (Bhatia et al, 1996a), but studies with highquality follow-up have found cumulative risks of 12% at 30 years after treatment in the Nordic countries (Sankila et al, 1996) and 16% at 25 years in the Netherlands for patients treated under age 21 years. In median 18-year follow-up of over 500 women treated at ages under 41 years in the Dutch cohort, only five deaths occurred from breast cancer , and among 161 deaths in long-term follow-up of 494 women treated under age 51 years in the US, four were from breast cancer (Ng et al, 2002a) Risks of second primary breast cancer are also raised after treatment for Hodgkin's disease in young adulthood, although relative risks are lower than those for childhood and adolescent treatment (Hancock et al, 1993;van Leeuwen et al, 2000;Ng et al, 2002b), reflecting the greater background rates at older ages. However, a lesser relative risk does not necessarily imply a lesser absolute excess, and indeed van in the Netherlands and Hancock et al (1993)and Ng et al (2002b) in the US found absolute excess risks fairly similar for patients treated at ages 20 -29 years to those for patients treated under age 20 years.…”

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confidence: 96%

Second primary breast cancer after Hodgkin's disease

Horwich

Swerdlow

2004

Br J Cancer

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Although the potential carcinogenic risk of radiotherapy is well known, it has become clear that there is a particularly high risk of radiation-induced breast cancer in women treated for Hodgkin's disease at young ages. Thankfully, death from breast cancer in this population is uncommon, but it is important to understand factors contributing to the risk, including treatment parameters, and to develop a logical and efficient method for medical management of those at risk. In this minireview, we examine the evidence which should inform such a management policy. The prognosis of patients with Hodgkin's disease has been improved dramatically over the last 40 years by the development of extended field radiotherapy techniques and then by combination chemotherapy (DeVita et al, 1980;Rosenberg and Kaplan, 1985). However, long-term follow-up of survivors has demonstrated that a price of this success has been an increased risk of second cancers. Acute leukaemia frequently occurs in the first decade after treatment, mainly as a consequence of chemotherapy regimens that included an alkylating agent (Tucker et al, 1988;Kaldor et al, 1990;Swerdlow et al, 2000). In the long term, however, the absolute excess risks of a second solid cancer are higher (Swerdlow et al, 2000;Ng et al, 2002b; and are linked mainly with radiotherapy, although for some sites, such as lung cancer, there may be a substantial risk also from chemotherapy (Swerdlow et al, 2000;Travis et al, 2002). Recent reports from The Netherlands and from an international consortium of cancer registries have refined our understanding of how therapy may affect breast cancer risk.The relative risks of many cancers are higher if patients have been treated for Hodgkin's disease at a younger age (Swerdlow et al, 2000;van Leeuwen et al, 2000;Dores et al, 2002). Thus, although the risk of breast cancer is only about 50% increased in most all-age studies of women with Hodgkin's disease (van Leeuwen et al, 1999), relative risks are far larger than this in patients treated at young ages, especially those treated in childhood and adolescence (Hancock et al, 1993;Bhatia et al, 1996b); for them this is one of the main long-term sequelae of radiotherapy. This effect of age is unsurprising, as similar gradients are seen in other cohorts of radiation-exposed women (United Nations Scientific Committee on the Effects of Atomic Radiation, 1994).The size of risk of breast cancer found in Hodgkin's disease patients has varied between studies. For patients treated under age 21 years relative risks have generally been around 15 -25 (Hancock et al, 1993;Sankila et al, 1996;Wolden et al, 1998;Metayer et al, 2000;van Leeuwen et al, 2000;Dores et al, 2002), although they have been less raised (Neglia et al, 2001) or more raised (Mauch et al, 1996;Bhatia et al, 1996b;Aisenberg et al, 1997;Ng et al, 2002b) than this in a few studies; absolute excess risks have generally been of the order of 20 -40 per 10 000 per annum. Relative risks have been greater for patients treated at ages 10 -16 than at...

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“…Heart mean dose and V30 were significantly reduced for all Nonco_IMRT plans compared with conventional AP–PA plans, which has been blamed for inducing late cardiac complications 18 , 19 . Nonco_IMRT was obviously superior for spinal cord sparing, and the mean dose of radiation delivered to normal tissue outside the PTV was 4% lower than in the AP–PA treatment.…”

Section: Discussionmentioning

confidence: 95%

“…High cure rates in mediastinal lymphoma result in long life expectancy; thus, reducing late complications, such as second cancers and cardiac toxicity, are important 18 , 19 …”

Section: Discussionmentioning

confidence: 99%

Noncoplanar intensity‐modulated radiation therapy for young female patients with mediastinal lymphoma

Chen

Jin

Wang

et al. 2012

J Applied Clin Med Phys

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The purpose of this study is to apply noncoplanar intensity‐modulated radiation therapy (Nonco_IMRT) to young female patients with mediastinal lymphoma. Nonco_IMRT was evaluated through a planning comparison study with coplanar IMRT (Co_IMRT) and conventional anteroposterior and posteroanterior fields (AP–PA) plans. Co_IMRT was performed with five equally spaced beams starting from a gantry angle of 216°. Nonco_IMRT used two noncoplanar beams in the sagittal plane to replace the Co_IMRT beams that directly irradiated the breasts. Nineteen young female patients were enrolled in the retrospective study. Dose coverage of the planning target volume (PTV) and the dose delivered to organs at risk (OARs) were analyzed. For all patients, PTV coverage and heart V30 were similar between the two IMRT techniques (p < 0.05). Compared to Co_IMRT, the mean dose delivered and regions receiving a low radiation dose were significantly reduced for bilateral breasts and lungs in Nonco_IMRT (p < 0.05). Breast V5 and lung V5 were relatively reduced by 21% and 12%, respectively. Compared with the conventional AP–PA plan, Nonco_IMRT had better PTV coverage and OARs sparing, except for being larger in V5 to breast and lung. In IMRT for young female patients with mediastinal lymphoma, using of Nonco_IMRT significantly reduces the radiation dose to the breasts and lungs compared with Co_IMRT, and consequently reduces the risk of breast second cancer and pulmonary toxicity. Besides young female patients, Nonco_IMRT can also benefit other mediastinal lymphoma patients.PACS number: 87.55.D‐

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Long-Term Survival and Competing Causes of Death in Patients With Early-Stage Hodgkin’s Disease Treated at Age 50 or Younger

Cited by 386 publications

References 22 publications

Long-term hospitalisation rates among 5-year survivors of Hodgkin lymphoma in adolescence or young adulthood: A nationwide cohort study

Long-term hospitalisation rates among 5-year survivors of Hodgkin lymphoma in adolescence or young adulthood: A nationwide cohort study

Second primary breast cancer after Hodgkin's disease

Noncoplanar intensity‐modulated radiation therapy for young female patients with mediastinal lymphoma

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