Nyandoto P, Muhonen T, Joensuu H
Department of Oncology, Helsinki University Central Hospital, Finland.
Int J Radiat Oncol Biol Phys. 1998 Sep 1;42(2):373-8. doi: 10.1016/s0360-3016(98)00217-x.
There are limited data on the frequency of second cancer among long-term survivors from Hodgkin's disease. The aim of this study was to determine the frequencies of second cancers, and their locations with respect to radiotherapy portals.
Medical records of 202 consecutive patients who survived at least for 5 years after treatment for Hodgkin's disease, and who were treated with radiotherapy in Helsinki University Central Hospital between 1970 and 1979, were reviewed. Survival data were collected also from the Finnish Cancer Registry and records of other hospitals. The median follow-up time of the patients still alive was 22 years (range, from 13 to 26). All patients received radiotherapy; in addition, 65 patients received MOPP and 3 received MOPP and ABVD.
During the follow-up consisting of 4020 person-years, 27 patients developed a second cancer. The cumulative risk for a second cancer was 17% (95% CI, from 10.4 to 23.1 %) at 20 years after the diagnosis of Hodgkin's disease. Of the 26, 20 (77%) solid second cancers were found within or adjoining the irradiated fields, and the 20-year cumulative risk for a second cancer within the irradiated fields was 12% (6.3-17.5%). The most common second cancers were lung (n = 7) and breast (n = 4) cancer. In a multivariate analysis, predictive factors for a second cancer were: age at diagnosis greater than the median (30 years, relative risk, 3.97, 1.6-12.5), treatment for recurrent lymphoma (RR, 2.75, 1.3-6.7) and primary treatment without splenectomy (RR 4.31, 1.7-11.0). However, portal size and inclusion of chemotherapy as part of the primary treatment were not significantly associated with second cancer in a univariate analysis.
Patients treated with radiotherapy for Hodgkin's disease have a considerable risk for a second cancer in long-term follow-up. The majority of second cancers arise within or next to the irradiated portals, and particular attention should be paid to the irradiated sites in posttreatment follow-up.
关于霍奇金淋巴瘤长期幸存者中第二原发癌的发生频率，相关数据有限。本研究旨在确定第二原发癌的发生频率及其相对于放疗野的位置。
回顾了1970年至1979年间在赫尔辛基大学中心医院接受放疗且治疗后至少存活5年的202例连续患者的病历。生存数据还从芬兰癌症登记处和其他医院的记录中收集。仍存活患者的中位随访时间为22年（范围为13至26年）。所有患者均接受了放疗；此外，65例患者接受了MOPP方案，3例患者接受了MOPP和ABVD方案。
在为期4020人年的随访期间，27例患者发生了第二原发癌。霍奇金淋巴瘤诊断后20年时，第二原发癌的累积风险为17%（95%置信区间为10.4%至23.1%）。在这27例患者中，20例（77%）实体性第二原发癌位于照射野内或其毗邻区域，照射野内第二原发癌的20年累积风险为12%（6.3%至17.5%）。最常见的第二原发癌是肺癌（n = 7）和乳腺癌（n = 4）。在多因素分析中，第二原发癌的预测因素为：诊断时年龄大于中位数（30岁，相对风险为3.97，1.6至12.5）、复发性淋巴瘤的治疗（RR为2.75，1.3至6.7）以及初次治疗未行脾切除术（RR为4.31，1.7至11.0）。然而，在单因素分析中，照射野大小以及化疗作为初次治疗的一部分与第二原发癌无显著相关性。
接受放疗的霍奇金淋巴瘤患者在长期随访中有发生第二原发癌的相当大风险。大多数第二原发癌发生在照射野内或其附近，在治疗后随访中应特别关注照射部位。
