Stomach Cancer Risk After Treatment for Hodgkin Lymphoma
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Published:2013-09-20
Issue:27
Volume:31
Page:3369-3377
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ISSN:0732-183X
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Container-title:Journal of Clinical Oncology
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language:en
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Short-container-title:JCO
Author:
Morton Lindsay M.1, Dores Graça M.1, Curtis Rochelle E.1, Lynch Charles F.1, Stovall Marilyn1, Hall Per1, Gilbert Ethel S.1, Hodgson David C.1, Storm Hans H.1, Johannesen Tom Børge1, Smith Susan A.1, Weathers Rita E.1, Andersson Michael1, Fossa Sophie D.1, Hauptmann Michael1, Holowaty Eric J.1, Joensuu Heikki1, Kaijser Magnus1, Kleinerman Ruth A.1, Langmark Frøydis1, Pukkala Eero1, Vaalavirta Leila1, van den Belt-Dusebout Alexandra W.1, Fraumeni Joseph F.1, Travis Lois B.1, Aleman Berthe M.1, van Leeuwen Flora E.1
Affiliation:
1. Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J....
Abstract
Purpose Treatment-related stomach cancer is an important cause of morbidity and mortality among the growing number of Hodgkin lymphoma (HL) survivors, but risks associated with specific HL treatments are unclear. Patients and Methods We conducted an international case-control study of stomach cancer nested in a cohort of 19,882 HL survivors diagnosed from 1953 to 2003, including 89 cases and 190 matched controls. For each patient, we quantified cumulative doses of specific alkylating agents (AAs) and reconstructed radiation dose to the stomach tumor location. Results Stomach cancer risk increased with increasing radiation dose to the stomach (Ptrend < .001) and with increasing number of AA-containing chemotherapy cycles (Ptrend = .02). Patients who received both radiation to the stomach ≥ 25 Gy and high-dose procarbazine (≥ 5,600 mg/m2) had strikingly elevated stomach cancer risk (25 cases, two controls; odds ratio [OR], 77.5; 95% CI, 14.7 to 1452) compared with those who received radiation < 25 Gy and procarbazine < 5,600 mg/m2 (Pinteraction < .001). Risk was also elevated (OR, 2.8; 95% CI, 1.3 to 6.4) among patients who received radiation to the stomach ≥ 25 Gy but procarbazine < 5,600 mg/m2; however, no procarbazine-related risk was evident with radiation < 25 Gy. Treatment with dacarbazine also increased stomach cancer risk (12 cases, nine controls; OR, 8.8; 95% CI, 2.1 to 46.6), after adjustment for radiation and procarbazine doses. Conclusion Patients with HL who received subdiaphragmatic radiotherapy had dose-dependent increased risk of stomach cancer, with marked risks for patients who also received chemotherapy containing high-dose procarbazine. For current patients, risks and benefits of exposure to both procarbazine and subdiaphragmatic radiotherapy should be weighed carefully. For patients treated previously, GI symptoms should be evaluated promptly.
Publisher
American Society of Clinical Oncology (ASCO)
Subject
Cancer Research,Oncology
Cited by
90 articles.
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