Second malignant neoplasms after treatment for Hodgkin's disease in childhood or adolescence

Purpose: To determine the frequency of and risk factors for second malignan t neoplasms (SMNs) after treatment for Hodgkin's disease diagnosed in child ren and adolescents. Patients and Methods: One hundred eighty-two consecutive, previously untrea ted patients with Hodgkin's disease who were younger than 20 years of age a t diagnosis and who were referred to Roswell Park Cancer Institute (Buffalo , NY) for treatment between January 1, 1960, and December 31, 1989, were st udied, Sex-specific standardized incidence ratios (SIRs) were calculated. K aplan-Meier survival estimates and Cox regression analyses were performed t o determine the relationship of several demographic and treatment variables to SMN incidence. Results: Twenty-eight patients developed an SMN at a mean of 14.93 +/- 8.09 years (range, 2.65 to 29.88 years) after diagnosis of Hodgkin's disease. T he cumulative percentage of patients who developed an SMN was 26.27 +/- 6.7 5% at 30 years after diagnosis, The SIR was 9.39 (95% confidence interval [ Cl], 4.05 to 18.49) for male patients and 10.16 (95% Cl, 5.56 to 17.05) for female patients, The most frequent SMNs were thyroid cancer, breast cancer , nonmelanoma skin cancer, non-Hodgkin's lymphoma, and acute leukemia. Mult ivariate analysis of sex, treatment with any alkylating agent, treatment wi th doxorubicin, splenectomy, and relapse (as a time-dependent covariate) wi th time to SMN onset gave nonsignificant results. Conclusion: Successfully treated children and adolescents with Hodgkin's di sease have a substantial risk for the occurrence of subsequent neoplasms, T he most frequent SMNs (skint thyroid, and breast) ore readily detected by p hysical examination and available screening procedures. (C) 2000 by America n Society of Clinical Oncology.