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Annals of Oncology Advance Access published online on March 31, 2005
Annals of Oncology, doi:10.1093/annonc/mdi155
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© 2005 European Society for Medical Oncology
Received October 20, 2004
Revised January 3, 2005
Accepted January 5, 2005

Original article

Clinical course of thoracic cancers in Hodgkin's disease survivors

P. Das 1*, A. K. Ng 2, M. A. Stevenson 3, and P. M. Mauch 2

1 Department of Radiation Oncology, U.T. M.D. Anderson Cancer Center, Houston, TX, USA
2 Departments of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
3 Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

* To whom correspondence should be addressed.
P. Das, E-mail: PrajDas{at}mdanderson.org


  Abstract

Background: Hodgkin's disease survivors have a high risk of subsequently developing thoracic cancers. Our goal was to evaluate the prognosis and treatment outcomes of thoracic cancers after Hodgkin's disease.

Patients and methods: Thirty-three patients treated for Hodgkin's disease at Harvard-affiliated hospitals subsequently developed small-cell lung carcinoma, non-small-cell lung carcinoma (NSCLC) or mesothelioma. Information was obtained from medical records about the initial treatment for Hodgkin's disease, any salvage therapy, smoking history, and the stage, histology, treatment and survival for thoracic cancers.

Results: Of the 33 patients, 29 (88%) had a history of radiotherapy to the thorax, 17 (52%) had received alkylating chemotherapy, and 24 (73%) had a known history of smoking. The median time between diagnosis of Hodgkin's disease and diagnosis of thoracic cancer was 17.3 years (range 1.2-27.9 years). Among patients with NSCLC and a known stage, 85% presented with stage III or stage IV disease. Among patients whose treatment details were available, 40% underwent surgery, 40% received radiotherapy and 65% received chemotherapy. The median survival was 9 months (range 1-47 months).

Conclusions: Most patients with thoracic cancers after Hodgkin's disease have a history of exposure to risk factors and present at an advanced stage. Patients with thoracic cancers after Hodgkin's disease have a poor survival.

Keywords: Hodgkin's disease; lung cancer; risk factors; second malignancy; survival; thoracic neoplasm.
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