Second malignancies after chemotherapy and radiotherapy for Hodgkin disease

被引:18
作者
Chronowski, GM
Wilder, RB
Levy, LB
Atkinson, EN
Ha, CS
Hagemeister, FB
Barista, I
Rodriguez, MA
Sarris, AH
Hess, MA
Cabanillas, F
Cox, JD
机构
[1] Univ Texas, MD Anderson Canc Ctr, Dept Radiat Oncol, Houston, TX 77030 USA
[2] Univ Texas, MD Anderson Canc Ctr, Dept Biomath, Houston, TX 77030 USA
[3] Univ Texas, MD Anderson Canc Ctr, Dept Lymphoma, Houston, TX 77030 USA
来源
AMERICAN JOURNAL OF CLINICAL ONCOLOGY-CANCER CLINICAL TRIALS | 2004年 / 27卷 / 01期
关键词
chemotherapy; NOVP; radiotherapy; Hodgkin disease; second primary neoplasms;
D O I
10.1097/01.coc.0000045853.73233.42
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
The purpose of this preliminary study was to determine the incidence of second malignancies after combined-modality therapy for adults with Hodgkin disease and relate it to the details of initial treatment. We retrospectively studied 286 patients ranging in age from 16 to 88 years with stage I or II Hodgkin disease who were treated between 1980 and 1995 with chemotherapy followed 3 to 4 weeks later by radiotherapy. Patients received a median of three cycles of induction chemotherapy. Mitoxantrone, vincristine, vinblastine, and prednisone was used in 161 cases, mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) in 67 cases, Adriamycin, bleomycin, vinblastine, and dacarbazine in 19 cases, lomustine, vinblastine, procarbazine, and prednisone/doxorubicin, bleomycin, dacarbazine, and lomustine in 18 cases, and other chemotherapeutic regimens in the remaining 21 cases. The median radiotherapy dose was 40 Gy given in 20 daily 2-Gy fractions. Median follow-up of surviving patients was 7.4 years. There were 2,230 person-years of observation. Significantly increased relative risks (RR) were observed for acute myeloid leukemia (RR, 69.3; 95% CI, 14.3-202.6) and melanoma (RR, 7.3; 95% CI, 1.5-21.3). The 5-, 10-, and 15-year actuarial risks of acute myeloid leukemia were 0.8%, 1.3%, and 1.3%, respectively. Patients treated with MOPP had the highest 15-year actuarial risk of leukemia (1.6%). The 5-, 10-, and 15-year actuarial risks of solid tumors were 1.9%, 9.3%, and 16.8%, respectively. Consolidative radiotherapy to both sides of the diaphragm resulted in a trend toward an increased risk of solid tumors relative to radiotherapy to only one side of the diaphragm (p = 0.08). In an effort to reduce the risk of second malignancies, we have stopped using the alkylating agents nitrogen mustard and procarbazine and elective paraaortic and splenic radiotherapy after chemotherapy.
引用
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页码:73 / 80
页数:8
相关论文
共 52 条
[1]  
Aisenberg AC, 1997, CANCER, V79, P1203, DOI 10.1002/(SICI)1097-0142(19970315)79:6<1203::AID-CNCR20>3.0.CO
[2]  
2-2
[3]  
ANDRIEU J, 2001, J CLIN ONCOL, V20, pA283
[4]   NONLYMPHOMATOUS MALIGNANT TUMORS COMPLICATING HODGKINS-DISEASE - POSSIBLE ASSOCIATION WITH INTENSIVE THERAPY [J].
ARSENEAU, JC ;
CANELLOS, GP ;
BONNER, H ;
SCHNIPPER, LE ;
SPONZO, RW ;
YOUNG, RC ;
JOHNSON, RE ;
DEVITA, VT ;
LEVIN, DL .
NEW ENGLAND JOURNAL OF MEDICINE, 1972, 287 (22) :1119-+
[5]   Breast cancer and other second neoplasms after childhood Hodgkin's disease [J].
Bhatia, S ;
Robison, LL ;
Oberlin, O ;
Greenberg, M ;
Bunin, G ;
FossatiBellani, F ;
Meadows, AT .
NEW ENGLAND JOURNAL OF MEDICINE, 1996, 334 (12) :745-751
[6]  
BOIVIN JF, 1988, CANCER, V61, P2541, DOI 10.1002/1097-0142(19880615)61:12<2541::AID-CNCR2820611225>3.0.CO
[7]  
2-G
[8]  
BONFANTE V, 2001, J CLIN ONCOL, V20, pA281
[9]  
Brusamolino E, 1998, HAEMATOLOGICA, V83, P812
[10]  
Brusamolino E, 2000, HAEMATOLOGICA, V85, P1032