Infradiaphragmatic irradiation and high procarbazine doses increase colorectal cancer risk in Hodgkin lymphoma survivors
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Infradiaphragmatic irradiation and high procarbazine doses increase colorectal cancer risk in Hodgkin lymphoma survivors. / van Eggermond, Anna M; Schaapveld, Michael; Janus, Cécile Pm; de Boer, Jan Paul; Krol, Augustinus Dg; Zijlstra, Josée M; van der Maazen, Richard Wm; Kremer, Leontien C; van Leerdam, Monique E; Louwman, Marieke Wj; Visser, Otto; De Bruin, Marie L; Aleman, Berthe Mp; van Leeuwen, Flora E.
In: B J C, Vol. 117, No. 3, 25.07.2017, p. 306-314.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Infradiaphragmatic irradiation and high procarbazine doses increase colorectal cancer risk in Hodgkin lymphoma survivors
AU - van Eggermond, Anna M
AU - Schaapveld, Michael
AU - Janus, Cécile Pm
AU - de Boer, Jan Paul
AU - Krol, Augustinus Dg
AU - Zijlstra, Josée M
AU - van der Maazen, Richard Wm
AU - Kremer, Leontien C
AU - van Leerdam, Monique E
AU - Louwman, Marieke Wj
AU - Visser, Otto
AU - De Bruin, Marie L
AU - Aleman, Berthe Mp
AU - van Leeuwen, Flora E
PY - 2017/7/25
Y1 - 2017/7/25
N2 - 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.
AB - 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.
KW - Adult
KW - Antineoplastic Agents
KW - Antineoplastic Combined Chemotherapy Protocols
KW - Bleomycin
KW - Colon
KW - Colorectal Neoplasms
KW - Diaphragm
KW - Doxorubicin
KW - Female
KW - Follow-Up Studies
KW - Hodgkin Disease
KW - Humans
KW - Male
KW - Mechlorethamine
KW - Middle Aged
KW - Neoplasms, Radiation-Induced
KW - Neoplasms, Second Primary
KW - Netherlands
KW - Prednisone
KW - Procarbazine
KW - Rectum
KW - Risk Factors
KW - Survivors
KW - Vinblastine
KW - Vincristine
KW - Young Adult
KW - Journal Article
U2 - 10.1038/bjc.2017.177
DO - 10.1038/bjc.2017.177
M3 - Journal article
C2 - 28632726
VL - 117
SP - 306
EP - 314
JO - The British journal of cancer. Supplement
JF - The British journal of cancer. Supplement
SN - 0007-0920
IS - 3
ER -
ID: 185405029