2ND SOLID MALIGNANCIES AFTER COMBINED-MODALITY THERAPY FOR HODGKINS-DISEASE

Purpose: To determine the actuarial incidence (Al) and relative risk ( RR) of second solid malignancies (SSM; solid tumors and non-Hodgkin's lymphoma) in patients with Hodgkin's disease who were treated with che motherapy and adjuvant, low-dose radiation (combined modality therapy; CMT). Patients and Methods: From 1969 to 1983, 102 patients with prev iously untreated advanced Hodgkin's disease (group A) and 81 patients with recurrent disease after radiation (group B) were treated with CMT . Patients were observed far the development of solid tumors (ST) and non-Hodgkin's lymphoma (NHL), and the Al and RR were calculated. Resul ts: Nearly half of the patients entering remission were reserved for g reater than 15 years. At 20 years, the Al for SSM wets 12% in group A versus 41% in group B (P = .009). The overall RR for developing a ST i n group A was 1.88 (not significant) versus 8.84 in group B (95% confi dence interval, 5.3 to 15.4), The difference in the RR between groups A and B was significant (P < .001). The RR for developing NHL was sign ificantly increased in both groups, but the difference between groups was not significant. Conclusion: Previously untreated patients with ad vanced disease who were treated with CMT (group A) had a modest but no t significant increase in the RR of ST; however, patients treated with CMT for recurrent disease (group B) had a highly significant increase in the RR of Si, Possible explanations for the increase in ST in grou p B include more cumulative radiation or a greater carcinogenic effect of chemotherapy in previously irradiated patients, but it also is pos sible that the increase is due to a longer follow-up time. (C) 1995 by American society of Clinical Oncology.