Second cancers among long-term survivors of Hodgkin's disease diagnosed inchildhood and adolescence

Purpose: To quantify the risk of second cancers among long-term survivors o f Hodgkin's disease (HD) diagnosed before 21 years of age and to explore se x-, age-, and site-related differences. Patients and Methods: We analyzed data from 5,925 pediatric HD patients, in cluding 2,646 10-year and 755 20-year survivors, who were reported to 16 po pulation-based cancer registries in North America and Europe between 1935 a nd 1994. Results: A total of 157 solid tumors (observed/expected ratio [O/E] = 7.0; 95% confidence interval [CI], 5.9 to 8.2.) and 26 acute leukemias (O/E = 27 .4; 95% CI, 17.9 to 40.2) were reported. Risk of solid tumors remained sign ificantly increased among 20-year survivors (O/E = 6.6, observed [O] = 40, cumulative risk = 6.5%) and persisted for 25 years (O/E = 4.6, O = 15, cumu lative risk = 11.7%). Temporal trends for cancers of thyroid, female breast , bone/connective tissue, stomach, and esophagus were consistent with the l ate effects of radiotherapy. Greater than 50-fold increased risks were obse rved for tumors of the thyroid and respiratory tract tone lung and one pleu ral among children treated before age 10. At older ages (10 to 16 years), t he largest number of second cancers occurred in the digestive tract (O/E = 19.3) and breast (O/E = 22.9). Risk of solid tumors increased with decreasi ng age at HD on a relative but not absolute scale, Conclusion: Children and adolescents treated for HD experience significantl y increased risks of second cancers at various sites for 2 to 3 decades. Al though our results reflect the late effects of past therapeutic modalities, they underscore the importance of lifelong fallow-up of pediatric HD patie nts given early more aggressive treatments. J Clin Oncol 18:2435-2443. (C) 2000 by American Society of Clinical Oncology.