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. 2017 Jul 25;117(3):306-314.
doi: 10.1038/bjc.2017.177. Epub 2017 Jun 20.

Infradiaphragmatic irradiation and high procarbazine doses increase colorectal cancer risk in Hodgkin lymphoma survivors

Anna M van Eggermond  1 , Michael Schaapveld  1   2 , Cécile Pm Janus  3 , Jan Paul de Boer  4 , Augustinus Dg Krol  5 , Josée M Zijlstra  6 , Richard Wm van der Maazen  7 , Leontien C Kremer  8 , Monique E van Leerdam  9 , Marieke Wj Louwman  2 , Otto Visser  2 , Marie L De Bruin  10 , Berthe Mp Aleman  11 , Flora E van Leeuwen  1
Affiliations

Infradiaphragmatic irradiation and high procarbazine doses increase colorectal cancer risk in Hodgkin lymphoma survivors

Anna M van Eggermond et al. Br J Cancer. .

Abstract

Background: Hodgkin lymphoma (HL) survivors are at increased risk of second malignancies, but few studies have assessed colorectal cancer (CRC) risk after HL treatment. We assessed long-term, subsite-specific CRC risk associated with specific radiation fields and chemotherapy regimens.

Methods: In a Dutch cohort of 3121 5-year HL survivors treated between 1965 and 1995, subsite-specific CRC incidence was compared with general population rates. Treatment effects were quantified by Cox regression analyses.

Results: After a median follow-up of 22.9 years, 55 patients developed CRC. The standardized incidence ratios (SIR) was 2.4-fold increased (95% confidence interval (95%CI) 1.8-3.2), leading to 5.7 excess cases per 10 000 patient-years. Risk was still increased 30 years after HL treatment (SIR: 2.8; 95%CI: 1.6-4.6). The highest (SIR: 6.5, 95%CI: 3.3-11.3) was seen for transverse colon cancer (15.0 (95%CI: 4.3-40.8) after inverted-Y irradiation). A prescribed cumulative procarbazine dose >4.2 g m-2 was associated with a 3.3-fold higher CRC risk (95%CI: 1.8-6.1) compared to treatment without procarbazine. Patients receiving >4.2 g m-2 procarbazine and infradiaphragmatic radiotherapy had a hazard ratio of 6.8 (95%CI: 3.0-15.6) compared with patients receiving neither treatment, which is significantly higher than an additive joint effect (Padditivity=0.004).

Conclusions: Colorectal cancer surveillance should be considered for HL survivors who received Infradiaphragmatic radiotherapy and a high cumulative procarbazine dose.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(A) Cumulative incidence of CRC by attained age according to age at first Hodgkin lymphoma treatment. Solid lines represent the observed incidence, dashed lines the expected incidence. (B) Cumulative incidence of CRC by attained age according to radiation therapy and procarbazine dose for HL patients treated before the age of 35. Solid lines represent the observed incidence, dashed lines the expected incidence. Infra RT=infradiaphragmatic radiotherapy.
See this image and copyright information in PMC

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