Treatment history predicts lung cancer risk in patients with Hodgkin's disease

NEW YORK (Reuters Health) – Hodgkin's disease patients who have been treated with alkylating agents and/or radiotherapy are more than four times as likely to develop lung cancer as patients without this treatment history, according to a report published in the February 6th issue of the Journal of the National Cancer Institute. However, as in the general population, the greatest single risk factor is tobacco use.

While lung cancer is known to be a frequent cause of death in patients cured of Hodgkin's disease, the extent to which past treatment regimens influence the lung cancer risk is unclear.

Dr. Lois B. Travis, from the National Institutes of Health in Bethesda, Maryland, and colleagues compared the treatment and tobacco use histories of 222 Hodgkin's disease patients who developed lung cancer with those of 444 matched control patients.

The researchers found that patients who received alkylating agents were 4.2 times more likely to develop lung cancer than were patients who did not. Similarly, treatment with radiation at a dose of 5 Gy or more was associated with a nearly six-fold increase in lung cancer risk. A dose-dependent effect was noted for both treatment modalities (p for trend < 0.001) and combined treatment was associated with relative risk of 8.0.

The elevated lung cancer risk associated with treatment with alkylating agents began within 1 to 4 years of treatment, the authors note. In contrast, radiotherapy was not associated with an excess risk until 5 years or more after treatment. However, the radiotherapy-related risk lasted for more than 20 years.

Patients who used tobacco currently or at the time of diagnosis had a more than 20-fold increase in the lung cancer risk. Furthermore, a history of moderate to heavy smoking appeared to multiply the treatment-related risks.

"To our knowledge this is the first study of lung cancer following Hodgkin's disease to include quantitative measures of radiation dose to the precise location where the lung tumor was diagnosed, cumulative amounts of chemotherapeutic agents, and data on tobacco use," the investigators note.

The magnitude of the treatment-related lung cancer risks should be interpreted with caution, as it is possible that tobacco use had residual and enhancing effects. Furthermore, "it is clear that the tremendous improvement in the treatment of Hodgkin's disease far outweighs any therapy-related risks of lung cancers," Dr. Travis said in a statement.

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