J. Slanina et al., Second malignancies following treatment of Hodgkin's disease: the Freiburgpatients 1940 to 1991, STRAH ONKOL, 175(4), 1999, pp. 154-161
Aim: To quantify the risk of second malignancies in patients with Hodgkin's
disease treated at the department of radiotherapy University Clinic Freibu
rg, with the object of comparing this risk xith the international experienc
e and as a contribution to the discussion about future treatment.
Patients and,Methods: Second malignancies were reviewed in I 588 patients t
reated for Hodgkin's disease between 1940 and 1991. Treatment consisted of
involved or extended field radiotherapy as a single modality or in combinat
ion with chemotherapy, Before the early 1970's, chemotherapy used (sequenti
al) monodrug regimens. The mean follow-up was 8.3 years, The cumulative ris
k was calculated using the Kaplan-Meier method and related to the risk of a
normal population taken from epidemiological data of the National Cancer I
nstitute, An estimate of radiation dose at the site of origin of the second
malignancy was obtained from representative measurements employing an Alde
rson phantom.
Results: After 5. 10, 15 and 20 years the cumulative risk for all malignanc
ies was 1.5%, 4.2%, 9.4% and 21%, respectively; for solid tumors it came to
1.2%, 3.1%, 7.9% and 19%; for non-Hodgkin lymphoma (NHL) the risk amounted
to 0.1%, 0.9%, 1.4% and 1.9%; and for leukemia it Has 0.1%, 0.3%, 0.6% and
0.6%, For the same time points the relative risk for all malignancies was
calculated to be 1.1, 1.4, 1.8 and 2.5; for solid tumors it came to 1.0, 1.
1, 1.6 and 2.5; for NHL it amounted to 3.31 11.8, 9.3 and 8.0; and for leuk
emia it was 3.3, 3.1, 3.4 and 2.1. For combinations of radiotherapy and che
motherapy the risk for second malignancies was highest in patients receivin
g ABVD any time during their treatment. 51% of the second malignancies were
located infield, 22% at the field border and 27% outfield. In those cases
for which the cause of death was known, Hodgkin's disease accounted for 79%
followed by second malignancies accounting for 8%. The results obtained in
Freiburg fell within the range reported in international publications.
Conclusion: The increased incidence of second malignancies in cured Hodgkin
's patients is a long-term risk making regular follow-up mandatory. Althoug
h part of the second malignancies are unrelated to therapy, there is a need
to carefully collect the data from patients treated according to new proto
cols in order to detect any changes in the number or kind of second maligna
ncies in due time. This may well lead to a reassessment of therapeutic conc
epts.