Secondary Breast Cancer Risk by Radiation Volume in Women With Hodgkin Lymphoma

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• 作者：Jessica L. Conway ; MD^&lowast ; ; ^&dagger ; ; Joseph M. Connors ; MD^&lowast ; ; Scott Tyldesley ; MD^&lowast ; ; ^&dagger ; ; Kerry J. Savage ; MD^&lowast ; ; Belinda A. Campbell ; MD^&Dagger ; ; Yvonne Y. Zheng ; MEng ; MSc^§ ; ; Jeremy Hamm ; MSc^§ ; ; Tom Pickles ; MD^&lowast ; ; ^&dagger ; ; ^{TPickles@bccancer.bc.ca}
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2017
• 出版时间：1 January 2017
• 年：2017
• 卷：97
• 期：1
• 页码：35-41
• 全文大小：348 K
• 卷排序：97

文摘

To determine whether the risk of secondary breast cancer (SBC) is reduced in women with Hodgkin lymphoma (HL) treated with smaller field radiation therapy (SFRT) versus mantle field radiation therapy (MRT).Methods and MaterialsWe used the BC Cancer Agency (BCCA) Lymphoid Cancer Database to identify female patients treated for HL between January 1961 and December 2009. Radiation therapy volumes were categorized as MRT or SFRT, which included involved field, involved site, or involved nodal radiation therapy. SBC risk estimates were compared using competing risk analysis and Fine and Gray multivariable model: MRT ± chemotherapy, SFRT ± chemotherapy, or chemotherapy-only.ResultsOf 734 eligible patients, 75% of the living patients have been followed up for more than 10 years, SBC has developed in 54, and 15 have died of breast cancer. The 20-year estimated risks (competing risk cumulative incidence) for SBC differed significantly: MRT 7.5% (95% confidence interval [CI] 4.4%-11.5%), SFRT 3.1% (95% CI 1.0%-7.7%), and chemotherapy-only 2.2% (95% CI 1.0%-4.8%) (P=.01). Using a Fine and Gray model to control for death and patients lost to follow-up, MRT was associated with a higher risk of SBC (hazard ratio [HR] = 2.9; 95% CI 1.4%-6.0%; P=.004) compared with chemotherapy-only and with SFRT (HR = 3.3; 95% CI 1.3%-8.4%; P=.01). SFRT was not associated with a greater risk of SBC compared with chemotherapy-only (HR = 0.87; 95% CI 0.28%-2.66%; P=.80).ConclusionThis study confirms that large-volume MRT is associated with a markedly increased risk of SBC; however, more modern small-volume RT is not associated with a greater risk of SBC than chemotherapy alone.