Second malignancy risk associated with treatment of Hodgkin's lymphoma: Meta-analysis of the randomised trials Journal Article
| Authors: | Franklin, J.; Pluetschow, A.; Paus, M.; Specht, L.; Anselmo, A. P.; Aviles, A.; Biti, G.; Bogatyreva, T.; Bonadonna, G.; Brillant, C.; Cavalieri, E.; Diehl, V.; Eghbali, H.; Fermé, C.; Henry-Amar, M.; Hoppe, R.; Howard, S.; Meyer, R.; Niedzwiecki, D.; Pavlovsky, S.; Radford, J.; Raemaekers, J.; Ryder, D.; Schiller, P.; Shakhtarina, S.; Valagussa, P.; Wilimas, J.; Yahalom, J. |
| Article Title: | Second malignancy risk associated with treatment of Hodgkin's lymphoma: Meta-analysis of the randomised trials |
| Abstract: | Background: Despite several investigations, second malignancy risks (SMR) following radiotherapy alone (RT), chemotherapy alone (CT) and combined chemoradiotherapy (CRT) for Hodgkin's lymphoma (HL) remain controversial. Patients and Methods: We sought individual patient data from randomised trials comparing RT versus CRT, CT versus CRT, RT versus CT or involved-field (IF) versus extended-field (EF) RT for untreated HL. Overall SMR (including effects of salvage treatment) were compared using Peto's method. Results: Data for between 53% and 69% of patients were obtained for the four comparisons. (i) RT versus CRT (15 trials, 3343 patients): SMR were lower with CRT than with RT as initial treatment (odds ratio (OR) = 0.78, 95% confidence interval (CI) = 0.62-0.98 and P = 0.03). (ii) CT versus CRT (16 trials, 2861 patients): SMR were marginally higher with CRT than with CT as initial treatment (OR = 1.38, CI 1.00-1.89 and P = 0.05). (iii) IF-RT versus EF-RT (19 trials, 3221 patients): no significant difference in SMR (P = 0.28) although more breast cancers occurred with EF-RT (P = 0.04 and OR = 3.25). Conclusions: Administration of CT in addition to RT as initial therapy for HL decreases overall SMR by reducing relapse and need for salvage therapy. Administration of RT additional to CT marginally increases overall SMR in advanced stages. Breast cancer risk (but not SMR in general) was substantially higher after EF-RT. Caution is needed in applying these findings to current therapies. © 2006 Oxford University Press. |
| Keywords: | prednisone; clinical feature; clinical trial; salvage therapy; doxorubicin; cancer combination chemotherapy; cancer risk; solid tumor; cancer radiotherapy; combined modality therapy; chemotherapy; methotrexate; follow up; dacarbazine; melanoma; multiple cycle treatment; breast cancer; etoposide; radiotherapy; skin cancer; lung cancer; cyclophosphamide; vincristine; risk factor; chlormethine; procarbazine; vinblastine; hodgkin disease; risk assessment; acute leukemia; nonhodgkin lymphoma; hodgkin's lymphoma; randomized controlled trials; systematic review; colon cancer; bleomycin; stomach cancer; neoplasms, second primary; second cancer; rectum cancer; meta analysis; drug dose sequence; small intestine cancer; meta-analysis; second malignancies |
| Journal Title: | Annals of Oncology |
| Volume: | 17 |
| Issue: | 12 |
| ISSN: | 0923-7534 |
| Publisher: | Oxford University Press |
| Date Published: | 2006-12-01 |
| Start Page: | 1749 |
| End Page: | 1760 |
| Language: | English |
| DOI: | 10.1093/annonc/mdl302 |
| PUBMED: | 16984979 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 63" - "Export Date: 4 June 2012" - "CODEN: ANONE" - "Source: Scopus" |
