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Multicenter Study
. 2019 Mar 15;125(6):990-999.
doi: 10.1002/cncr.31903. Epub 2018 Dec 18.

High prevalence of advanced colorectal neoplasia and serrated polyposis syndrome in Hodgkin lymphoma survivors

Lisanne S Rigter  1 , Manon C W Spaander  2 , Berthe M P Aleman  3 , Tanya M Bisseling  4 , Leon M Moons  5 , Annemieke Cats  1 , Pieternella J Lugtenburg  6 , Cecile P M Janus  7 , Eefke J Petersen  8 , Judith M Roesink  9 , Richard W M van der Maazen  10 , Petur Snaebjornsson  11 , Ernst J Kuipers  2 , Marco J Bruno  2 , Evelien Dekker  12 , Gerrit A Meijer  11 , Jan Paul de Boer  13 , Flora E van Leeuwen  14 , Monique E van Leerdam  1
Affiliations
Multicenter Study

High prevalence of advanced colorectal neoplasia and serrated polyposis syndrome in Hodgkin lymphoma survivors

Lisanne S Rigter et al. Cancer. .

Abstract

Background: Hodgkin lymphoma (HL) survivors treated with abdominal radiotherapy and/or alkylating chemotherapy have an increased risk of colorectal cancer (CRC). This study was aimed at evaluating the prevalence of colorectal neoplasia in HL survivors.

Methods: This multicenter cohort study assessed the diagnostic yield of advanced colorectal neoplasia detected by a first surveillance colonoscopy among HL survivors treated with abdominal radiotherapy and/or procarbazine. Advanced colorectal neoplasia included advanced adenomas (high-grade dysplasia, ≥25% villous component, or ≥10-mm diameter), advanced serrated lesions (dysplasia or ≥10-mm diameter), and CRC. The results were compared with those for a Dutch general population cohort that underwent a primary screening colonoscopy (1426 asymptomatic individuals 50-75 years old). This study demonstrated the results of a predefined interim analysis.

Results: A colonoscopy was performed in 101 HL survivors, who were significantly younger (median, 51 years; interquartile range [IQR], 45-57 years) than the general population controls (median, 60 years; IQR, 55-65 years; P < .001). The prevalence of advanced neoplasia was higher in HL survivors than controls (25 of 101 [25%] vs 171 of 1426 [12%]; P < .001). Advanced adenomas were detected in 14 of 101 HL survivors (14%) and in 124 of 1426 controls (9%; P = .08). The prevalence of advanced serrated lesions was higher in HL survivors than controls (12 of 101 [12%] vs 55 of 1426 [4%]; P < .001). Serrated polyposis syndrome was present in 6% of HL survivors and absent in controls (P < .001).

Conclusions: HL survivors treated with abdominal radiotherapy and/or procarbazine have a high prevalence of advanced colorectal neoplasia. The implementation of a colonoscopy surveillance program should be considered.

Keywords: colorectal cancer (CRC) screening; epidemiology; polyps/adenomas.

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Conflict of interest statement

The authors made no disclosures.

Figures

Figure 1
Figure 1
Flow diagram of the study invitations and participants. *Invitations were accompanied by an information leaflet, which included information about CRC in general and the advantages and possible risks of colonoscopy. ABVD indicates doxorubicin, bleomycin, vinblastine, and dacarbazine; CRC, colorectal cancer; HL, Hodgkin lymphoma.
Figure 2
Figure 2
Frequencies of neoplasia detection in subgroups of HL survivors and general population controls. An advanced adenoma is defined as an adenoma with a ≥10‐mm diameter, a ≥25% villous component, or high‐grade dysplasia; an advanced serrated lesion is defined as a serrated lesion with a ≥10‐mm diameter or dysplasia; and advanced neoplasia is defined as an advanced adenoma, an advanced serrated lesion, or colorectal cancer. *There was a significant difference between groups (P < .05). HL indicates Hodgkin lymphoma; RT, radiotherapy; SPS, serrated polyposis syndrome.
See this image and copyright information in PMC

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