2ND MALIGNANCY IN PATIENTS WITH HODGKINS-DISEASE TREATED AT THE ROYAL-MARSDEN-HOSPITAL

Risk of second primary malignancy was assessed in follow-up to June 19 91 of 1039 patients first treated for Hodgkin's disease at the Royal M arsden Hospital during 1963-91. A total of 77 second malignancies occu rred. There were significantly raised risks of stomach [standardized i ncidence ratio (SIR) = 4.0], lung (SIR = 3.8), bone (SIR = 26.5), soft tissue (SIR = 16.9) and non-melanoma skin (SIR = 3.9) cancers, non-Ho dgkin's lymphoma (SIR = 4.6), and acute and non-lymphocytic leukaemia (SIR = 31.3), with a relative risk of 3.3 for all second cancers other than non-melanoma skin cancer, Solid cancer risk was raised to a simi lar extent in patients treated only with radiotherapy (SIR = 2.6, P < 0.001), only with chemotherapy (SIR = 3.1, P = 0.08) and with both (SI R = 3.1, P < 0.001). Leukaemia risk was raised only in those receiving chemotherapy, whether alone or with radiotherapy. The relative risk f or solid cancers was much greater in patients who were younger at firs t treatment (trend P < 0.001), whereas leukaemia risk was greatest for those first treated at ages 25-44. For solid cancers (P < 0.001) but not leukaemia (P = 0.05) there was a strong gradient of greater relati ve risks at younger attained ages. The relative risk of second cancers overall was 27.5 at ages under 25 and 2.0 at ages 55 and above. Leuka emia and solid cancer risks in patients treated with chlorambucil, vin blastine, procarbazine and prednisone (ChIVPP) were not significantly greater than those in patients treated with mustine, vincristine, proc arbazine and prednisone (MOPP). Number of cycles of chemotherapy was s ignificantly related to risk of leukaemia (P < 0.001), and there was a trend in the same direction for solid cancers (P = 0.07). The study a dds to evidence that alkylating chemotherapy may increase the risk of solid cancers, and that ChIVPP does not provide a less carcinogenic al ternative to MOPP chemotherapy. The very targe relative risks found fo r solid cancers at young attained ages and in patients treated when yo ung may have important implications as, in the long term, the majority of second malignancies after Hodgkin's disease are solid cancers. The risks of solid malignancies need clarification by larger collaborativ e epidemiological studies.