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Lung cancer and other second neoplasms after treatment of Hodgkin lymphoma

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Abstract

Purpose

To evaluate the risk factors associated with lung cancer (LC) and other second neoplasms (SN) in Hodgkin lymphoma (HL) survivors.

Methods

We retrospectively analyzed the clinical characteristics and outcomes of 604 patients treated in our institution between 1968 and 2012.

Results

90 out of 604 patients developed SN: 27 LC and 63 other SN. The median time elapsed until LC and other SN was 16.5 and 11.8 years, respectively (p = 0.003). In the LC group, 85.5 % of patients were male and 84.6 % smokers (HR 7, 95 % CI 2.4–20.7, p < 0.001). Radiotherapy (RT) doses applied were higher in the SN group with an increased risk of LC (HR: 4.0 95 % CI 1.1–11.6, p = 0.010) and other SN (HR: 3.3 95 % CI 1.6–6.7 p = 0.001) with doses higher than 42 Gy. No association was found between alkylating agents and development of SN. In LC, the most frequent histology was adenocarcinoma with an elapsed time after HL of 13.2 years in early stages and 21.3 in advanced (p = 0.02). Median OS after a diagnosis of LC was 12.6 months ranging from 5.9 (in cases presenting due to symptoms) to 49.1 (incidentally diagnosed cases) (p = 0.005).

Conclusions

RT treatment, especially with doses higher than 42 Gy, and smoking increase the risk of SN after HL. In this series, LC patients with early stages had a shorter elapsed time from HL diagnosis and longer OS, therefore the role of LC screening in HL survivors should be prospectively evaluated and smoking cessation counseling ought to be a key aspect during follow-up.

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References

  1. Santoro A, Bonadonna G, Valagussa P, Zucali R, Viviani S, Villani F, et al. Long term results of combined chemotherapy-radiotherapy approach in Hodgkin disease: superiority of ABVD plus radiotherapy versus MOPP plus radiotherapy. J Clin Oncol. 1987;5:27–37.

    PubMed  CAS  Google Scholar 

  2. Canellos GP, Anderson JR, Propert KJ, Nissen N, Cooper MR, Henderson ES, et al. Chemotherapy of advanced Hodgkin’s disease with MOPP, ABVD or MOPP alternating with ABVD. N England J Med. 1992;327:1498.

    Article  Google Scholar 

  3. Eich HT, Diehl V, Goergen H, Pabst T, Markova J, Debus J, et al. Intensified chemotherapy and dose-reduced involved-field radiotherapy in patients with early unfavorable Hodgkin’s lymphoma: final analysis of the German Hodgkin Study Group HD11 Trial. J Clin Oncol. 2010;28(27):4199–206.

    Article  PubMed  Google Scholar 

  4. Engert A, Plütschow A, Eich HT, Lohri A, Dörken B, Borchmann P, et al. Reduced treatment intensity in patients with early stage Hodgkin lymphoma. N Engl J Med. 2010;363(7):640–52.

    Article  PubMed  CAS  Google Scholar 

  5. Baxi SS, Matasar MJ. State-of-the-art issues in Hodgkin’s lymphoma survivorship. Curr Oncol Rep. 2010;12:366–73.

    Article  PubMed  Google Scholar 

  6. Aleman BM, van den Belt-Dusebout AW, Klokman WJ, Van’t Veer MB, Bartelink H, van Leeuwen FE. Long-term causes-specific mortality of patients treated for Hodgkin’s disease. J Clin Oncol. 2003;21:3431–9.

    Article  PubMed  Google Scholar 

  7. Henry-Amar M, Somers R. Survival outcome after Hodgkin’s disease: a report from the international data base on Hodgkin’s disease. Semin Oncol. 1990;17:758–68.

    PubMed  CAS  Google Scholar 

  8. Provencio M, García-López FJ, Bonilla F, España P. Comparison of the long-term mortality in Hodgkin’s disease patients with that of general population. Ann Oncol. 1999;10:1199–205.

    Article  PubMed  CAS  Google Scholar 

  9. Provencio M, Millán I, España P, Sánchez AC, Sánchez JJ, Cantos B, et al. Analysis of competing risks of causes of death and their variation over different time periods in Hodgkin’s disease. Clin Cancer Res. 2008;14(16):5300–5.

    Article  PubMed  Google Scholar 

  10. Lorenzo Y, Provencio M, Lombardía L, Díaz R, Silva J, Herrera M, et al. Differential Genetic and functional markers of second neoplasias in Hodgkin’s disease patients. Clin Cancer Res. 2009;15:4823–8.

    Article  PubMed  CAS  Google Scholar 

  11. Carbone PP, Kaplan HS, Musshoff K, Smithers DW, Tubiana M. Report of the Committee on Hodgkin’s disease staging classification. Cancer Res. 1971;31:1860–1.

    PubMed  CAS  Google Scholar 

  12. Lister TA, Crowther D, Sutcliffe SB, Glatstein E, Canellos GP, Young RC, et al. Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin’s disease: cotswolds meeting. J Clin Oncol. 1989;7:1630–6.

    PubMed  CAS  Google Scholar 

  13. Kaplan HS, Rosenberg SA. Extended field radical radiotherapy in advanced Hodgkin’s disease. Cancer Res. 1966;26:1268–76.

    PubMed  CAS  Google Scholar 

  14. Andrieu JM, Ifrah N, Payen C, Fermanian J, Coscas Y, Flandrin G. Increased risk of secondary acute non lymphocytic leukemia after extended-field radiation therapy combined with MOPP chemotherapy for Hodgkin’s disease. J Clin Oncol. 1990;8:1148–54.

    PubMed  CAS  Google Scholar 

  15. Edge SB, Compton CC. The American joint committee on cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.

    Article  PubMed  Google Scholar 

  16. Dores G, Metayer C, Curtis R, Lynch CF, Clarke EA, Glimelius B, et al. Second malignant neoplasms among long-term survivors of Hodgkin’s disease: a population based evaluation over 25 years. J Clin Oncol. 2002;16:3484–92.

    Article  Google Scholar 

  17. Gilbert ES, Stovall M, Gospodarowicz M, Van Leeuwen FE, Andersson M, Glimelius B,et al. Lung cancer after treatment for Hodgkin’s disease: focus on radiation effects. Radiat Res 2003;159:161–73.

  18. Travis LB, Gilbert E. Lung Cancer after Hodgkin lymphoma: the roles of chemotherapy, radiotherapy and tobacco use. Radiat Res. 2005;163:695–6.

    PubMed  CAS  Google Scholar 

  19. Cutuli B, Kanoun S, Tunon De Lara C, Baron M, Livi L, Levy C, et al. Breast cancer occurred after Hodgkin’s disease: clinico-pathological features, treatments and outcome: Analysis of 214 cases. Crit Rev Oncol Hematol. 2012;81:29–37.

    Article  PubMed  Google Scholar 

  20. Swerdlow AJ, Schoemaker MJ, Allerton R, Horwich A, Barber JA, Cunningham D, et al. Lung cancer after Hodgkin’s disease: a nested case-controlled study of the relation to treatment. J Clin Oncol. 2001;19:1610–8.

    PubMed  CAS  Google Scholar 

  21. Purdy JA. Advances in the planning and delivery of radiotherapy: new expectations, new standards of care. Front Radiat Ther Oncol. 2011;43:1–28.

    Article  PubMed  Google Scholar 

  22. Specht L, Yahalom J, Illidge T, Berthelsen AK, Constine LS, Eich HT, et al. Modern radiation therapy for Hodgkin lymphoma: field and dose guidelines from the international lymphoma radiation oncology group (ILROG). Int J Radiat Oncol Biol Phys. 2014;89(4):854–62. doi:10.1016/j.ijrobp.2013.05.005 (Epub 2013 Jun 18).

    Article  PubMed  Google Scholar 

  23. Hodgson DC, Koh E-S, Tran TH, Heydarian M, Tsang R, Pintilie M, et al. Individualized estimates of second cancer risks after contemporary radiation therapy for Hodgkin lymphoma. Cancer. 2007;110:2576–86.

    Article  PubMed  Google Scholar 

  24. Ezzeldin MI, Ghieth AK, Khaled MA, Al-Mansour MM, Al-Fayea TM, Al-Foheidi M, et al. Risk of second lung cancer in Hodgkin’s lymphoma survivors: a meta-analysis. Lung. 2013;191:117–34.

    Article  Google Scholar 

  25. Milano MT, Huilin Li, Constine LS, Travis LB. Variables affecting survival after second primary lung cancer: A population-based study of 187 Hodgkin’s lymphoma patients. J Thorac Dis 2011;4:22–29.

  26. Behrens C, Travis LB, Wistuba II, Davis S, Maitra A, Clarke EA, et al. Molecular changes in second primary lung and breast cancers after therapy for Hodgkin’s disease. Cancer Epidemiol Biomarkers Prev. 2000;9:1027–35.

    PubMed  CAS  Google Scholar 

  27. Hayat MJ, Howlader N, Reichman ME, Edwards BK. Cancer statistics, trends, and multiple primary cancer analyses from the surveillance, epidemiology, and end results (SEER) Program. Oncologist. 2007;12(1):20–37.

    Article  PubMed  Google Scholar 

  28. Kaldor JM, Day NE, Bell J, Langmark F, Karjalainen S, Band P, et al. Lung cancer following Hodgkin’s disease: a case-control study. Int J Cancer. 1992;52:677–81.

    Article  PubMed  CAS  Google Scholar 

  29. Laurie SA, Kris MG, Portlock CS, Rosenzweig KE, Miller VA, Krug LM, et al. The clinical course of non small cell lung carcinoma in survivors of Hodgkin disease. Cancer. 2002;95:119–26.

    Article  PubMed  Google Scholar 

  30. Schoenfeld JD, Mauch PM, Das P, Silver B, Marcus KJ, Stevenson MA, et al. Lung malignancies after Hodgkin lymphoma: disease characteristics, detection methods and clinical outcome. Annals of Oncology 2012;23(7):1813–8.

    Article  PubMed  CAS  Google Scholar 

  31. Team National Lung Screening Trial Research, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395–409.

    Article  Google Scholar 

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Acknowledgments

Authors would like to acknowledge Isabel Millán for her support reviewing the article statistics. The authors also wish to thank Martin Hadley-Adams for assisting with the English language and preparation of the manuscript.

Conflict of interest

Authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Manuel de Falla 1, 28220, Majadahonda, Spain

    E. Almagro-Casado, A. Sánchez, B. Cantos, D. Pérez-Callejo & M. Provencio

  2. Department of Pathology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain

    C. Salas

Authors
  1. E. Almagro-Casado
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  2. A. Sánchez
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  3. B. Cantos
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  6. M. Provencio
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Correspondence to E. Almagro-Casado.

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Almagro-Casado, E., Sánchez, A., Cantos, B. et al. Lung cancer and other second neoplasms after treatment of Hodgkin lymphoma. Clin Transl Oncol 18, 99–106 (2016). https://doi.org/10.1007/s12094-015-1342-7

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  • DOI: https://doi.org/10.1007/s12094-015-1342-7

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