MIAMI BEACH--Patients treated for Hodgkin's disease are at moderately
increased risk of developing secondary gastrointestinal (GI) cancer,
Sandra H. Birdwell, MD, said at the American Society for Therapeutic
Radiology and Oncol-ogy (ASTRO) meeting.
Dr. Birdwell and her colleagues at Stanford University School
of Medicine, where she is a resident in radiation oncol-ogy, identified
cases of GI cancer from the records of 2,441 patients treated
for Hodgkin's disease between 1961 and 1994. Patients were followed
for a mean of 11 years after treatment ended.
The study was undertaken because of concern about the increased
rate of subsequent illness in Hodgkin's survivors. "While
roughly 85% of Hodgkin's patients can be expected to be cured
of this neoplasm, survivors are at increased risk of developing
several health problems as a result of Hodgkin's disease or its
treatment," Dr. Birdwell said.
In fact, the development of other cancers has been the major factor
contributing to excess mortality in this population, she said.
An increased risk of breast cancer, lung cancer, and leukemia
has been shown in previous studies, but no study had focused exclusively
on the incidence of subsequent GI cancer in Hodgkin's survivors.
Overall, 25 patients in the Stanford series were found to have
developed invasive GI cancer, Dr. Birdwell said, indicating that
Hodgkin's patients were 2.5 times as likely to develop GI cancer
as persons without Hodgkin's disease.
The risk of a second cancer was significantly increased for cancers
of the stomach, small intestine, and pancreas. By contrast, there
was no appreciable increase in the risk of a subsequent cancer
in the esophagus or colorectum.
The data also showed that exposure to combined modality therapy
resulted in a significant increase in GI cancer risk, while no
increased risk was observed after treatment with radiotherapy
alone or chemotherapy alone. However, few patients in this series
received chemotherapy alone.