Subsequent Malignancies in Children Treated for Hodgkin's Disease: Associations With Gender and Radiation Dose

Journal Article · Mon Sep 01 04:00:00 EDT 2008 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2008.04.067· OSTI ID:21124420

Constine, Louis S ^[1]; Tarbell, Nancy ^[2]; Hudson, Melissa M ^[3]; Schwartz, Cindy ^[4]; Fisher, Susan G ^[5]; Muhs, Ann G. B.A. ^[1]; Basu, Swati K ^[5]; Kun, Larry E ^[6]; Ng, Andrea; Mauch, Peter ^[7]; Sandhu, Ajay ^[8]; Culakova, Eva ^[5]; Lyman, Gary ^[9]; Mendenhall, Nancy ^[10]

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1. Department of Radiation Oncology, James P. Wilmot Cancer Center at University of Rochester, Rochester, NY (United States)
2. Department of Pediatric Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)
3. Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, TN (United States)
4. Department of Hematology-Oncology, Johns Hopkins Hospital, Baltimore, MD (United States)
5. Department of Community and Preventative Medicine, James P. Wilmot Cancer Center at University of Rochester, Rochester, NY (United States)
6. Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN (United States)
7. Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA (United States)
8. Department of Radiation Oncology, University of California Medical Center-San Diego, San Diego, CA (United States)
9. Department of Medicine, Duke University Medical Center, Durham, NC (United States)
10. Department of Radiation Oncology, University of Florida Medical Center, Gainesville, FL (United States)

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.

• OSTI ID: 21124420
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 1 Vol. 72; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CARCINOMAS
CHEMOTHERAPY
CHILDREN
DIAGNOSIS
MAMMARY GLANDS
MORTALITY
PEDIATRICS
RADIATION DOSES
RADIOTHERAPY