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Increased Risk For Secondary Malignant Neoplasms After Treatment for Pediatric Hodgkin's Disease
BUFFALO, NY - Childhood survivors of Hodgkin's disease have a substantial risk for second malignant neoplasms (SMN) according to research published in today's Journal of Clinical Oncology. The most common SMNs are cancers of the skin (non-melanoma), thyroid and breast, non-Hodgkin's lymphoma and acute leukemia.
Daniel M. Green, MD, a pediatric oncologist who directs the Long-Term Follow-Up Clinic at Roswell Park Cancer Institute (RPCI), and colleagues examined the medical records of 182 consecutive, previously untreated patients with Hodgkin's disease, who were less than 20 years of age at diagnosis and were admitted to RPCI for treatment between January 1, 1960 and January 31, 1989. Twenty-eight members of this cohort developed 36 SMNs within 30 years of their initial diagnosis for Hodgkin's disease. Nine patients who developed SMNs died, seven as a result of the SMN, one due to respiratory failure and one due to progressive Hodgkin's disease.
Hodgkin's disease is a type of lymphoma in which the cancer cells generally collect in the lymph nodes of the neck, underarm or groin. The progression of the disease is usually from one node to another, and cells may migrate to the spleen or liver. Hodgkin's disease was one of the first cancers cured with chemotherapy and is currently treated with the combination of radiotherapy and chemotherapy. The five-year survival exceeds 90 percent.
"This prolonged survival has led to an unforeseen complication. There is a greater risk of second and subsequent cancers in these patients after they are treated for their initial disease. We believe the solid tumors that arise in this group are a caused by their radiation therapy, although some of the chemotherapeutic agents used may increase this risk; the acute leukemias and lymphomas seen are almost always due to chemotherapy," said Dr. Green. "The cancers most often seen as SMNs are conducive to cancer screening techniques, which should be a regular part of the cancer follow-up for former Hodgkin's disease patients."
In a study, published last November in the Journal of Clinical Oncology, Dr. Green evaluated the impact of cardiac disease and SMNs on late mortality and attempted to identify risk factors for late mortality among 15-year survivors of childhood and adolescent cancer. Dr. Green concluded that survivors who relapsed during the 15-year period had excess mortality.
This research was supported by a 1997 Developmental Funds award from the Roswell Park Alliance Foundation.
The Long-Term Follow-Up Clinic at RPCI, one of the first in the United States, was established in 1986 to monitor the health of survivors of childhood and adolescent cancer, counsel them about other issues that affect them, and conduct research on the possible effects of their therapy for cancer on their health and that of their offspring.
Roswell Park Cancer Institute, founded in 1898, is the nation's first and one of its largest cancer research, treatment and education centers and is the only National Cancer Institute-designated comprehensive cancer center in Western New York.
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