Journal article
Stomach cancer risk after treatment for hodgkin lymphoma
Journal of clinical oncology, Vol.31(27), pp.3369-3377
09/20/2013
DOI: 10.1200/JCO.2013.50.6832
PMCID: PMC3770865
PMID: 23980092
Abstract
Treatment-related stomach cancer is an important cause of morbidity and mortality among the growing number of Hodgkin lymphoma (HL) survivors, but risks associated with specific HL treatments are unclear.
We conducted an international case-control study of stomach cancer nested in a cohort of 19,882 HL survivors diagnosed from 1953 to 2003, including 89 cases and 190 matched controls. For each patient, we quantified cumulative doses of specific alkylating agents (AAs) and reconstructed radiation dose to the stomach tumor location.
Stomach cancer risk increased with increasing radiation dose to the stomach (Ptrend < .001) and with increasing number of AA-containing chemotherapy cycles (Ptrend = .02). Patients who received both radiation to the stomach ≥ 25 Gy and high-dose procarbazine (≥ 5,600 mg/m(2)) had strikingly elevated stomach cancer risk (25 cases, two controls; odds ratio [OR], 77.5; 95% CI, 14.7 to 1452) compared with those who received radiation < 25 Gy and procarbazine < 5,600 mg/m(2) (Pinteraction < .001). Risk was also elevated (OR, 2.8; 95% CI, 1.3 to 6.4) among patients who received radiation to the stomach ≥ 25 Gy but procarbazine < 5,600 mg/m(2); however, no procarbazine-related risk was evident with radiation < 25 Gy. Treatment with dacarbazine also increased stomach cancer risk (12 cases, nine controls; OR, 8.8; 95% CI, 2.1 to 46.6), after adjustment for radiation and procarbazine doses.
Patients with HL who received subdiaphragmatic radiotherapy had dose-dependent increased risk of stomach cancer, with marked risks for patients who also received chemotherapy containing high-dose procarbazine. For current patients, risks and benefits of exposure to both procarbazine and subdiaphragmatic radiotherapy should be weighed carefully. For patients treated previously, GI symptoms should be evaluated promptly.
Details
- Title: Subtitle
- Stomach cancer risk after treatment for hodgkin lymphoma
- Creators
- Lindsay M MortonGraça M DoresRochelle E CurtisCharles F LynchMarilyn StovallPer HallEthel S GilbertDavid C HodgsonHans H StormTom Børge JohannesenSusan A SmithRita E WeathersMichael AnderssonSophie D FossaMichael HauptmannEric J HolowatyHeikki JoensuuMagnus KaijserRuth A KleinermanFrøydis LangmarkEero PukkalaLeila VaalavirtaAlexandra W van den Belt-DuseboutJoseph F Fraumeni JrLois B TravisBerthe M AlemanFlora E van Leeuwen
- Resource Type
- Journal article
- Publication Details
- Journal of clinical oncology, Vol.31(27), pp.3369-3377
- Publisher
- United States
- DOI
- 10.1200/JCO.2013.50.6832
- PMID
- 23980092
- PMCID
- PMC3770865
- ISSN
- 0732-183X
- eISSN
- 1527-7755
- Grant note
- N02CP31003 / NCI NIH HHS N02CP31136 / NCI NIH HHS Intramural NIH HHS N01CP31154 / NCI NIH HHS N01-CP-31155 / NCI NIH HHS N01-CP-31156 / NCI NIH HHS N01-CP-31157 / NCI NIH HHS N01CP31156 / NIAID NIH HHS N01CP31019 / NCI NIH HHS N02CP55503 / NCI NIH HHS N01-CP-31003 / NCI NIH HHS
- Language
- English
- Date published
- 09/20/2013
- Academic Unit
- Epidemiology
- Record Identifier
- 9983995012502771
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