ANALYSIS OF THE RISK OF SOLID TUMOR FOLLOWING HODGKINS-DISEASE

Background and Objective. This study examines the occurrence of solid tumor (ST) in relation to the different types of therapy (radiotherapy , chemotherapy and radiochemotherapy; splenectomy or splenic irradiati on vs no splenectomy - no splenic irradiation) received by patients tr eated for Hodgkin's disease (HD). Methods. The study included 1,045 HD patients treated at the Department of Radiation Oncology, the Institu te of Radiology and the Department of Human Biopathology, Hematology S ection, University of Rome, ''La Sapienza'', from 1972 to 1992. For 23 % of the patients the follow-up period was longer than 10 years. The a verage follow-up period was 72 months. For a more accurate calculation of the risk of ST occurrence, the patients were first divided into 3 subgroups according to initial treatment and then according to the tot al treatment they had received. Moreover, to establish a probable conn ection between solid tumor and splenic treatment the patients were als o divided into 3 subgroups (splenectomy, splenic irradiation and no sp lenectomy/no splenic irradiation). Results. We recorded twenty-four ca ses of ST after initial treatment. Secondary solid tumor showed a cumu lative risk of 0.2% and 13.4% at 5 and 20 years, respectively. After i nitial treatment with radiotherapy (RT) alone, the cumulative risk was 1.7% and 5.2% at 10 and 20 years, respectively; in the chemotherapy ( CT) group, it was 2.4% and 18.1%; in the CT+RT group, it was 1.7% and 9%. No statistically significant differences were observed among the d ifferent types of treatment (splenectomy, splenic irradiation or no sp lenectomy/no splenic irradiation) as regards the occurrence of ST. Acc ording to multivariate analysis, the most important factor in the risk of ST was age (>40). Relative risk was 5.2, p = 0.0001. Interpretatio n and Conclusions. We conclude that an age of over 40 at diagnosis and treatment with CT alone greatly increase the risk of solid tumor occu rrence. (C) 1997, Ferrata Storti Foundation.