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. 2014 Oct;25(10):2073-2079.
doi: 10.1093/annonc/mdu287. Epub 2014 Jul 25.

Pancreatic cancer risk after treatment of Hodgkin lymphoma

G M Dores  1 , R E Curtis  2 , F E van Leeuwen  3 , M Stovall  4 , P Hall  5 , C F Lynch  6 , S A Smith  4 , R E Weathers  4 , H H Storm  7 , D C Hodgson  8 , R A Kleinerman  2 , H Joensuu  9 , T B Johannesen  10 , M Andersson  11 , E J Holowaty  12 , M Kaijser  13 , E Pukkala  14 , L Vaalavirta  9 , S D Fossa  15 , F Langmark  10 , L B Travis  16 , J F Fraumeni Jr  2 , B M Aleman  17 , L M Morton  2 , E S Gilbert  2
Affiliations

Pancreatic cancer risk after treatment of Hodgkin lymphoma

G M Dores et al. Ann Oncol. 2014 Oct.

Abstract

Background: Although elevated risks of pancreatic cancer have been observed in long-term survivors of Hodgkin lymphoma (HL), no prior study has assessed the risk of second pancreatic cancer in relation to radiation dose and specific chemotherapeutic agents.

Patients and methods: We conducted an international case-control study within a cohort of 19 882 HL survivors diagnosed from 1953 to 2003 including 36 cases and 70 matched controls.

Results: Median ages at HL and pancreatic cancer diagnoses were 47 and 60.5 years, respectively; median time to pancreatic cancer was 19 years. Pancreatic cancer risk increased with increasing radiation dose to the pancreatic tumor location (Ptrend = 0.005) and increasing number of alkylating agent (AA)-containing cycles of chemotherapy (Ptrend = 0.008). The odds ratio (OR) for patients treated with both subdiaphragmatic radiation (≥10 Gy) and ≥6 AA-containing chemotherapy cycles (13 cases, 6 controls) compared with patients with neither treatment was 17.9 (95% confidence interval 3.5-158). The joint effect of these two treatments was significantly greater than additive (P = 0.041) and nonsignificantly greater than multiplicative (P = 0.29). Especially high risks were observed among patients receiving ≥8400 mg/m(2) of procarbazine with nitrogen mustard or ≥3900 mg/m(2) of cyclophosphamide.

Conclusion: Our study demonstrates for the first time that both radiotherapy and chemotherapy substantially increase pancreatic cancer risks among HL survivors treated in the past. These findings extend the range of nonhematologic cancers associated with chemotherapy and add to the evidence that the combination of radiotherapy and chemotherapy can lead to especially large risks.

Keywords: Hodgkin lymphoma; chemotherapy; pancreatic cancer; radiotherapy; second cancer.

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References

    1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63:11–30. - PubMed
    1. Birdwell SH, Hancock SL, Varghese A, et al. Gastrointestinal cancer after treatment of Hodgkin's disease. Int J Radiat Oncol Biol Phys. 1997;37:67–73. - PubMed
    1. Dores GM, Metayer C, Curtis RE, et al. Second malignant neoplasms among long-term survivors of Hodgkin's disease: a population-based evaluation over 25 years. J Clin Oncol. 2002;20:3484–3494. - PubMed
    1. Hodgson DC, Gilbert ES, Dores GM, et al. Long-term solid cancer risk among 5-year survivors of Hodgkin's lymphoma. J Clin Oncol. 2007;25:1489–1497. - PubMed
    1. Metayer C, Lynch CF, Clarke EA, et al. Second cancers among long-term survivors of Hodgkin's disease diagnosed in childhood and adolescence. J Clin Oncol. 2000;18:2435–2443. - PubMed

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