Sarcoma of bone and soft tissue following treatment of Hodgkin's disease

Halperin, Edward C.; Greenberg, Mortimer S.; Suit, Herman D.

doi:10.1002/1097-0142(19840115)53:2<232::aid-cncr2820530208>3.0.co;2-f

Cited by 62 publications

(13 citation statements)

References 20 publications

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“…29 Thus, intensive chemotherapy is suspect in reported bone and brain tumors that developed beyond radiation fields. 12,14 In contrast, chance or nonspecific host factors are implicated in a proportion of solid SM in adult HD patients, including SM outside radiation fields in patients not exposed to chemotherapy3 and SM in untreated or recently diagnosed Furthermore, the spectrum of solid SM in survivors of childhood HD does not match that in adult HD series.24 Carcinomas predominate in the but except for those of thyroid and skin, they are distinctly unusual in the childhood HD group. Lung and urinary tract cancers, for example, have not yet been reported in survivors of childhood HD.…”

Section: Discussionmentioning

confidence: 99%

Second malignancies after childhood Hodgkin's disease: The memorial sloan-kettering cancer center experience

Kushner

Zauber

Tan

1988

Cancer

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A review of the Memorial Sloan-Kettering Cancer Center experience with second malignancies (SM) after childhood Hodgkin's Disease (HD) identified 17 SM in 320 patients who survived more than 1 year from, and were 15 years old or younger at the time of, HD diagnosis (1949 to 1983). Of 254 previously untreated patients, 12 SM were noticed as compared with 0.606 expected on the basis of rates in the general pediatric population (relative risk, 19.8; 95% confidence interval, 10.2 to 34.6). For patients who received multi-agent chemotherapy, the cumulative probability of developing acute nonlymphocytic leukemia (ANLL) or bone sarcoma was 6.2% and 5.5%, respectively, at 10 years from the initiation of therapy; the cumulative risk of all SM in this group reached 18.7% at 15 years. For patients who received radiation alone or with single-agent chemotherapy, the cumulative risk of SM rose from 0% at 10 years and 2% at 15 years, to 10.7% at 25 years from the initiation of treatment. The risk of ANLL after childhood HD was highest in the first 5 to 10 years after combined modality treatment, and aggressive forms of NHL were associated with excessive immunosuppression. Bone sarcomas predominated in solid SM in the first decade after HD treatment, whereas "adult-type" cancers, for example, breast and colon carcinomas, were more delayed. Our findings, supported by a literature review, point to a therapy-related enhanced risk of approximately age-appropriate solid SM. This possibility mandates careful surveillance of long-term survivors of childhood HD.

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Section: Discussionmentioning

confidence: 99%

Second malignancies after childhood Hodgkin's disease: The memorial sloan-kettering cancer center experience

Kushner

Zauber

Tan

1988

Cancer

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“…The reported incidence was thought to range between 0.1-0.2% of breast cancer survivors, but may actually be higher due to longer survival of these patients [69,70]. The reported risk at 5 years in patients following treatment for Hodgkin's disease is 0.9% [71]. One estimate of the overall incidence ranges between 0.03% (of patients who receive radiation) to 0.2% (of patients who received radiation and survived 5 years) [66].…”

Section: Malignant Tumoursmentioning

confidence: 99%

The effect of X-rays on bone: a pictorial review

2005

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The deleterious effects of X-rays on bone have been recognised for almost a century and continue to be seen today because of improved survival in patients treated for malignancy with radiotherapy with or without other treatments. In this pictorial review we present the imaging features of radiation damage to bone highlighting the differences seen in the immature skeleton and post-skeletal fusion. In the former, damage is greatest to the physis resulting in growth disturbances. In the mature skeleton there is a spectrum of changes from mild osteopenia, through disordered attempts at healing with varying degrees of sclerosis, radionecrosis which may lead to acute fractures following minimal trauma and insufficiency fractures both with refractory healing to the dreaded complication of sarcomatous transformation. The imaging appearances are illustrated and the features that help distinguish malignant change from other complications stressed.

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“…The use of chemotherapeutic agents, especially alkylating agents, is associated with an increased incidence of hematologic malignancies [23], whereas radiotherapy has been associated with an increased incidence of solid tumors [4]. The cumulative risk for an iatrogenous secondary malignancy because of the combination of polychemotherapy and radiation is 10-15% [1,5,7,18,22,28,36,37,38]. Because of the known side effects, the intensity of multimodal treatment has to take into account that osseous HD is not a systemic disease, and might only require local radiation therapy without a treatment of the lymphatic system and the splenic pedicle.…”

Section: Discussionmentioning

confidence: 99%