Journal of Clinical Oncology, Vol 9, 432-437, Copyright © 1991 by American Society of Clinical Oncology
Second primary cancer following Hodgkin's disease: updated results of an Italian multicentric study
G Cimino, G Papa, S Tura, P Mazza, PL Rossi Ferrini, A Bosi, S Amadori, F Lo Coco, E D'Arcangelo and D Giannarelli
Department of Biopathology, University La Sapienza, Rome, Italy.
The risk of second primary cancer (SPC) was evaluated in 947 patients
treated for Hodgkin's disease (HD) during the period January 1969 to
December 1979. The median follow-up of this series was 10.5 years (range, 9
to 19). Treatment categories included radiotherapy (RT) alone (115
patients, 12%), chemotherapy (CHT) alone (161 patients, 17%), combined RT
plus CHT (381 patients, 40%), and salvage treatment for resistant or
relapsing HD (290 patients, 30.6%). Fifty-six SPCs were observed, occurring
between 1 and 17 years from initial treatment. Among these, secondary acute
nonlymphoid leukemia (s-ANLL) was the most frequent SPC (23 cases).
Secondary non-Hodgkin's lymphoma (s-NHL) occurred in 5 patients, whereas a
secondary solid tumor (s-ST) was observed in 28 patients. The calculated
actuarial risk (+/- SE) of developing SPC was 5.0% (+/- 0.9%) and 23.1%
(+/- 5.8%) at 10 and 19 years, respectively. Concerning treatment
modalities and s-ANLL risk, no cases were observed in the radiotherapy
group, whereas CHT plus RT and salvage groups showed the highest actuarial
risk. This was, in fact, at 10 and 19 years, 3.1% (+/- 0.9%) and 8.1% (+/-
4.0%) in the former group, and 1.8% (+/- 1.0%) and 16% (+/- 9.0%) in the
latter. A statistically significant difference was observed when the CHT
plus RT group was compared with CHT and RT groups (P = .04). Concerning the
relationships with chemotherapeutic regimens, 12 s-ANLL cases occurred in
the mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) plus
RT group, and only one case in the group receiving doxorubicin, bleomycin,
vinblastine, and dacarbazine (ABVD) plus RT. A statistically significant
difference of s-ANLL actuarial risk was found comparing patients receiving
MOPP plus RT to all other treatment groups (P = .04). With respect to s-ST,
the actuarial risk at 10 and 19 years was 2.0% (+/- 0.6%) and 13.0% (+/-
3.8%), respectively. No significant differences were found among groups
treated with different modalities. These data were confirmed by a
multivariate analysis, which indicated treatment modality and age as
independent variables for s-ANLL and s-ST development, respectively. Based
on the prolonged follow-up analysis, the actuarial SPC risk at 10 years
hereby reported should reflect the real SPC incidence in our series.
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