BREAST-CANCER IN PATIENTS TREATED FOR HODGKINS-DISEASE - CLINICAL ANDPATHOLOGICAL ANALYSIS OF 76 CASES IN 63 PATIENTS

In a retrospective multicentric analysis, 63 women treated between 194 1 to 1988 for Hodgkin's disease (HD) subsequently developed 76 breast cancers (BC). The median age at diagnosis of HD was 26 years (range 7- 67), and 22 women (35%) were 20 years old or less. Exclusive radiother apy (RT) was used in 36 women (57%) and combined modalities with chemo therapy (CT) in 25 (39%). Breast cancer occurred after a median interv al of 16 years (range 2-40) and the median age at diagnosis of the fir st BC was 42 years (range 25-73). TNM classification (UICC, 1978) show ed 10 T0 <non-palpable lesions) (13%), 20 T1 (26%), 22 T2 (29%), 8 T3 (11%), 7 T4 (9%) and 9 Tx (12%), giving altogether a total of 76 tumou rs, including, respectively, 5 and 8 bilateral synchronous and metachr onous lesions. Among the 68 tumours initially discovered, 53 ductal in filtrating, one lobular infiltrating and two medullary carcinomas were found. Moreover, two fibrosarcomas and 10 ductal carcinoma in situ (D CIS) were also found. Among 50 axillary dissections for invasive carci nomas, histological involvement was found in 31 cases (62%). 45 tumour s were treated by mastectomy, without (n = 35) or with (n = 10) RT. 27 tumours had lumpectomy, without (n = 7) or with RT (n = 20). 2 others received RT only, and one only CT. 7 patients (11%) developed isolate d local recurrence. 20 patients (32%) developed metastases and all die d; 38 are in complete remission, whereas 5 died of intercurrent diseas e. The 5-year disease-specific survival rate by the Kaplan-Meier metho d was 61%. The 5-year disease-specific survival rate for pN0, pN1-3 an d pN greater than or equal to 3 groups were 91%, 66% and 0%, respectiv ely (P < 0.0001) and 100%, 88%, 64% and 23% for the T0, T1, T2 and T3T 4 groups, respectively. These secondary BCs seem to be of two types: a large number of aggressive tumours with a very unfavourable prognosis (especially in the case of pN > 3 and/or T3T4); and many tumours with a 'slow development' such as DCIS and microinvasive lesions, especial ly in patients treated exclusively by RT. Moreover, a very unusual rat e of bilateral tumours (21%) was observed. These secondary BC could be 'in field', in 'border of field' or 'out of field'. However, a comple te analysis of doses delivered by supradiaphragmatic irradiation was o ften very difficult, due to large variations in several parameters. We conclude that young women and girls treated for HD should be carefull y monitored by clinical examination, mammography and ultrasonography. (C) 1997 Elsevier Science Ltd.