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Subsequent malignancies in children treated for Hodgkin's disease: associations with gender and radiation dose.

Publication ,  Journal Article
Constine, LS; Tarbell, N; Hudson, MM; Schwartz, C; Fisher, SG; Muhs, AG; Basu, SK; Kun, LE; Ng, A; Mauch, P; Sandhu, A; Culakova, E; Lyman, G ...
Published in: Int J Radiat Oncol Biol Phys
September 1, 2008

PURPOSE: Subsequent malignant neoplasms (SMNs) are a dominant cause of morbidity and mortality in children treated for Hodgkin's disease (HD). We evaluated select demographic and therapeutic factors associated with SMNs, specifically gender and radiation dose. METHODS AND MATERIALS: A total of 930 children treated for HD at five institutions between 1960 and 1990 were studied. Mean age at diagnosis was 13.6 years, and mean follow-up was 16.8 years (maximum, 39.4 years). Treatment included radiation alone (43%), chemotherapy alone (9%), or both (48%). RESULTS: We found that SMNs occurred in 102 (11%) patients, with a 25-year actuarial rate of 19%. With 15,154 patient years of follow-up, only 7.18 cancers were expected (standardized incidence ratio [SIR] = 14.2; absolute excess risk [AER] = 63 cases/10,000 years). The SIR for female subjects, 19.93, was significantly greater than for males, 8.41 (p < 0.0001). After excluding breast cancer, the SIR for female patients was 15.4, still significantly greater than for male patients (p = 0.0012). Increasing radiation dose was associated with an increasing SIR (p = 0.0085). On univariate analysis, an increased risk was associated with female gender, increasing radiation dose, and age at treatment (12-16 years). Using logistic regression, mantle radiation dose increased risk, and this was 2.5-fold for female patients treated with more than 35 Gy primarily because of breast cancer. CONCLUSIONS: Survivors of childhood HD are at risk for SMNs, and this risk is greater for female individuals even after accounting for breast cancer. Although SMNs occur in the absence of radiation therapy, the risk increases with RT dose.

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Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

September 1, 2008

Volume

72

Issue

1

Start / End Page

24 / 33

Location

United States

Related Subject Headings

  • Thyroid Neoplasms
  • Survivors
  • Statistics as Topic
  • Sex Factors
  • Recurrence
  • Radiotherapy Dosage
  • Oncology & Carcinogenesis
  • Neoplasms, Second Primary
  • Neoplasms, Radiation-Induced
  • Male
 

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Constine, L. S., Tarbell, N., Hudson, M. M., Schwartz, C., Fisher, S. G., Muhs, A. G., … Mendenhall, N. (2008). Subsequent malignancies in children treated for Hodgkin's disease: associations with gender and radiation dose. Int J Radiat Oncol Biol Phys, 72(1), 24–33. https://doi.org/10.1016/j.ijrobp.2008.04.067
Constine, Louis S., Nancy Tarbell, Melissa M. Hudson, Cindy Schwartz, Susan G. Fisher, Ann G. Muhs, Swati K. Basu, et al. “Subsequent malignancies in children treated for Hodgkin's disease: associations with gender and radiation dose.Int J Radiat Oncol Biol Phys 72, no. 1 (September 1, 2008): 24–33. https://doi.org/10.1016/j.ijrobp.2008.04.067.
Constine LS, Tarbell N, Hudson MM, Schwartz C, Fisher SG, Muhs AG, et al. Subsequent malignancies in children treated for Hodgkin's disease: associations with gender and radiation dose. Int J Radiat Oncol Biol Phys. 2008 Sep 1;72(1):24–33.
Constine, Louis S., et al. “Subsequent malignancies in children treated for Hodgkin's disease: associations with gender and radiation dose.Int J Radiat Oncol Biol Phys, vol. 72, no. 1, Sept. 2008, pp. 24–33. Pubmed, doi:10.1016/j.ijrobp.2008.04.067.
Constine LS, Tarbell N, Hudson MM, Schwartz C, Fisher SG, Muhs AG, Basu SK, Kun LE, Ng A, Mauch P, Sandhu A, Culakova E, Lyman G, Mendenhall N. Subsequent malignancies in children treated for Hodgkin's disease: associations with gender and radiation dose. Int J Radiat Oncol Biol Phys. 2008 Sep 1;72(1):24–33.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

September 1, 2008

Volume

72

Issue

1

Start / End Page

24 / 33

Location

United States

Related Subject Headings

  • Thyroid Neoplasms
  • Survivors
  • Statistics as Topic
  • Sex Factors
  • Recurrence
  • Radiotherapy Dosage
  • Oncology & Carcinogenesis
  • Neoplasms, Second Primary
  • Neoplasms, Radiation-Induced
  • Male