Journal article
Risk of Treatment-Related Stomach Cancer Among Hodgkin Lymphoma Survivors
Blood, Vol.116(21), pp.2679-2679
11/19/2010
DOI: 10.1182/blood.V116.21.2679.2679
Abstract
Abstract Abstract 2679 Introduction. Subsequent malignancies are a leading cause of morbidity and mortality among Hodgkin lymphoma (HL) survivors. Stomach cancer is one of the more common second malignancies occurring after HL, yet few studies have quantified stomach cancer risk in relation to radiation dose, and only one investigation has evaluated potential risks associated with chemotherapy. Methods. We conducted a nested case-control study of stomach cancer among 17,447 ≥5-year survivors of HL from six European and North American population-based cancer registries during 1953–2005. Patients included 71 cases diagnosed with HL and subsequent stomach cancer, and 142 individually-matched controls diagnosed with HL only. Data were pooled with a previous hospital-based case-control study from The Netherlands (18 cases, 48 controls), resulting in a total of 89 cases and 190 controls. For all patients, detailed data were abstracted from medical records on HL diagnosis and treatment and, for cases, stomach cancer diagnosis. Based on detailed radiotherapy information, the radiation dose was estimated to the area of the stomach where the case patient's tumor developed and to the comparable location in matched control patients. Chemotherapy data included specific drugs, doses, and number of cycles. The relative risk of stomach cancer was estimated using odds ratios (ORs) derived from conditional logistic regression analyses. Results. Median ages of case patients at HL and stomach cancer diagnosis were 32 years (range, 11–83 years) and 50 years (range, 26–89 years), respectively, with a median interval between HL and stomach cancer of 16 years (range, 5–36 years). Most patients received combined modality treatment (chemotherapy + radiotherapy, 56% cases, 44% controls) or radiotherapy alone (36% cases, 43% controls), whereas few patients received chemotherapy alone (8% cases, 13% controls). Stomach cancer risk increased with increasing radiation dose to the stomach tumor location (Ptrend<0.001). Compared with patients receiving <0.5 Gy, radiation doses of 30–39 Gy were associated with 5.3-fold increased risk [95% confidence interval (CI) 2.1–13], whereas radiation doses ≥40 Gy were associated with 2.1-fold increased risk (95%CI 0.8–5.9). Stomach cancer risk also increased with increasing number of cycles of alkylating agent chemotherapy (≥11 cycles versus no chemotherapy, OR=2.8, 95%CI 1.2–7.0; Ptrend=0.042), and was most strongly associated with increasing dose of procarbazine (Ptrend=0.004). Conclusions. Past treatment with radiotherapy and alkylating agent-based chemotherapy is associated with dose-dependent increased risk for stomach cancer among HL survivors. Current treatment practices with involved field radiotherapy, lower radiation doses, and alternate chemotherapy regimens may be associated with lower risk, however, patients receiving abdominal radiation and/or alkylating agents may still be at increased risk. Our results highlight the importance of increased awareness among clinicians and patients during long-term follow-up and prompt evaluation of signs and symptoms referable to the upper gastrointestinal tract. Disclosures: No relevant conflicts of interest to declare.
Details
- Title: Subtitle
- Risk of Treatment-Related Stomach Cancer Among Hodgkin Lymphoma Survivors
- Creators
- Lindsay M Morton - Reb/Dceg, National Cancer Institute, NIH, DHHS, Rockville, MD, USAEthel S Gilbert - Reb/Dceg, National Cancer Institute, NIH, DHHS, Rockville, MD, USACharles F Lynch - Department of Epidemiology, University of Iowa, Iowa City, IA, USAPer Hall - Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, SwedenGraca M Dores - Medical Service, Department of Veterans Affairs Medical Center, Oklahoma City, OK, USARochelle E Curtis - Reb/Dceg, National Cancer Institute, NIH, DHHS, Rockville, MD, USAHans H Storm - Cancer Prevention and Documentation, Danish Cancer Society, Copenhagen, DenmarkTom Borge Johannesen - Cancer Registry of Norway, Oslo, NorwayMarilyn Stovall - Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TXSusan A Smith - Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TXRita E Weathers - Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USABerthe M Aleman - Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, TX, NetherlandsRuth A Kleinerman - Reb/Dceg, National Cancer Institute, NIH, DHHS, Rockville, MD, USAJoseph F Fraumeni - Dceg, National Cancer Institute, NIH, DHHS, Rockville, MD, USAEric J Holowaty - Population Studies and Surveillance, Cancer Care Ontario, Toronto, ON, CanadaEero Pukkala - Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry, Helsinki, FinlandMagnus Kaijser - Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, SwedenMichael Hauptmann - Department of Bioinformatics and Statistics, The Netherlands Cancer Institute, Amsterdam, NetherlandsSophie D Fossa - Department of Oncology, Oslo University Hospital and University of Oslo, Oslo, NorwayHeikki Joensuu - Department of Oncology, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandMichael Andersson - Department of Oncology, Copenhagen University Hospital, Copenhagen, DenmarkAlexandra W. van den Belt-Dusebout - Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, NetherlandsLeila Vaalavirta - Department of Oncology, Helsinki University Central Hospital and University of Helsinki, Helsinki, FinlandFroydis Langmark - Cancer Registry of Norway, Oslo, NorwayLois B Travis - Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USAFlora E van Leeuwen - Department of Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
- Resource Type
- Journal article
- Publication Details
- Blood, Vol.116(21), pp.2679-2679
- DOI
- 10.1182/blood.V116.21.2679.2679
- ISSN
- 0006-4971
- eISSN
- 1528-0020
- Language
- English
- Date published
- 11/19/2010
- Academic Unit
- Epidemiology
- Record Identifier
- 9984214708902771
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