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Br J Cancer. 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.

Author information

1
Department of Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066 CX, The Netherlands.
2
Netherlands Comprehensive Cancer Organisation (IKNL), Hoog Catharijne, Godebaldkwartier 419, Utrecht 3511 DT, The Netherlands.
3
Department of Radiation Oncology, Erasmus MC Cancer Institute, 's-Gravendijkwal 230, Rotterdam 3015 CE, The Netherlands.
4
Department of Medical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066 CX, The Netherlands.
5
Division of Radiation Oncology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands.
6
Department of Hematology, VU University Medical Center, De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands.
7
Department of Radiation Oncology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen 6525 GA, The Netherlands.
8
Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Meibergdreef 9, Amsterdam-Zuidoost 1105 AZ, The Netherlands.
9
Department of Gastroenterology and Hepatology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
10
Department of Pharmacy, Faculty of Health and Medical Science (CORS), University of Copenhagen, Universitetsparken 2, Copenhagen 2100, Denmark.
11
Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam 1066 CX, The Netherlands.

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.

PMID:
28632726
PMCID:
PMC5537493
DOI:
10.1038/bjc.2017.177
[Indexed for MEDLINE]
Free PMC Article

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