2ND SOLID TUMORS IN PATIENTS WITH HODGKINS-DISEASE CURED AFTER RADIATION OR CHEMOTHERAPY PLUS ADJUVANT LOW-DOSE RADIATION

Purpose: Late solid tumors (STs) are a significant cause of morbidity and mortality in long-term survivors of Hodgkin's disease. To investig ate the carcinogenic potential of two different therapeutic approaches , we measured the relative risk (RR) of STs in patients with early-sta ge disease cured after primary full-dose (similar to- 40 Gy) radiation therapy (RT) and in patients with advanced disease who were treated w ith chemotherapy followed by low-dose(l5 to 30 Gy) involved-field radi ation (CMT). Patients and Methods: because therapy-induced STs general ly begin after a latency period of 5 to 10 years, we restricted our an alysis to patients treated before 1986 who achieved durable remissions . Patients who required salvage chemotherapy or who died of Hodgkin's disease were excluded from analysis. The RR of STs was calculated by d ividing the observed number of cases by the expected number in a march ed population from the Connecticut Tumor Registry. The actuarial incid ence of STs was also measured. Results: A total of 197 patients formed the Ri group and 116 the CMT group. The median follow-up period in th e RT group was 12.8 years, versus 13.5 years in the CMT group. The ove rall RR of STs in the CMT group was 1.5 (95% confidence interval [CI], 0.6 to 3.5; P = .122). There were no cases of lung or breast cancer. In the RT group, the overall RR of STs was 3.3 (95% CI, 2.0 to 5.3; P < .001). There were seven cases of lung cancer (RR = 10.8; 95% CI, 5.3 to 22.2; P < .001) and two cases of breast cancer (RR = 2; 95% ICI, 0 .6 to 7.4; P = .07). All six benign tumors occurred ill the RT group. Conclusion: In patients cured by initial treatment for Hodgkin's disea se, RT was associated with a statistically significant increase in STs , particularly lung cancer. CMT was not associated with a significant increase in STs. These data may have important implications for the de sign of newer therapies for early-stage Hodgkin's disease. (C) 1996 by American Society of Clinical Oncology.