Subsequent malignancies in children treated for Hodgkin's disease: associations with gender and radiation dose. Int J Radiat Oncol Biol Phys 2008 Sep 01;72(1):24-33
Date
08/30/2008Pubmed ID
18722263Pubmed Central ID
PMC3531236DOI
10.1016/j.ijrobp.2008.04.067Scopus ID
2-s2.0-49549115762 (requires institutional sign-in at Scopus site) 121 CitationsAbstract
PURPOSE: Subsequent malignant neoplasms (SMNs) are a dominant cause of morbidity and mortality in children treated for Hodgkin's disease (HD). We evaluated select demographic and therapeutic factors associated with SMNs, specifically gender and radiation dose.
METHODS AND MATERIALS: A total of 930 children treated for HD at five institutions between 1960 and 1990 were studied. Mean age at diagnosis was 13.6 years, and mean follow-up was 16.8 years (maximum, 39.4 years). Treatment included radiation alone (43%), chemotherapy alone (9%), or both (48%).
RESULTS: We found that SMNs occurred in 102 (11%) patients, with a 25-year actuarial rate of 19%. With 15,154 patient years of follow-up, only 7.18 cancers were expected (standardized incidence ratio [SIR] = 14.2; absolute excess risk [AER] = 63 cases/10,000 years). The SIR for female subjects, 19.93, was significantly greater than for males, 8.41 (p < 0.0001). After excluding breast cancer, the SIR for female patients was 15.4, still significantly greater than for male patients (p = 0.0012). Increasing radiation dose was associated with an increasing SIR (p = 0.0085). On univariate analysis, an increased risk was associated with female gender, increasing radiation dose, and age at treatment (12-16 years). Using logistic regression, mantle radiation dose increased risk, and this was 2.5-fold for female patients treated with more than 35 Gy primarily because of breast cancer.
CONCLUSIONS: Survivors of childhood HD are at risk for SMNs, and this risk is greater for female individuals even after accounting for breast cancer. Although SMNs occur in the absence of radiation therapy, the risk increases with RT dose.
Author List
Constine LS, Tarbell N, Hudson MM, Schwartz C, Fisher SG, Muhs AG, Basu SK, Kun LE, Ng A, Mauch P, Sandhu A, Culakova E, Lyman G, Mendenhall NAuthor
Cindy L. Schwartz MD, MPH Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAntineoplastic Combined Chemotherapy Protocols
Breast Neoplasms
Child
Child, Preschool
Combined Modality Therapy
Female
Follow-Up Studies
Hodgkin Disease
Humans
Incidence
Infant
Male
Neoplasms, Radiation-Induced
Neoplasms, Second Primary
Radiotherapy Dosage
Recurrence
Sex Factors
Statistics as Topic
Survivors
Thyroid Neoplasms
