Second malignancy risk associated with treatment of Hodgkin's lymphoma: meta-analysis of the randomised trials

J Franklin; A Pluetschow; M Paus; L Specht; A-P Anselmo; A Aviles; G Biti; T Bogatyreva; G Bonadonna; C Brillant; E Cavalieri; V Diehl; H Eghbali; C Fermé; M Henry-Amar; R Hoppe; S Howard; R Meyer; D Niedzwiecki; S Pavlovsky; J Radford; J Raemaekers; D Ryder; P Schiller; S Shakhtarina; P Valagussa; J Wilimas; J Yahalom

doi:10.1093/annonc/mdl302

Second malignancy risk associated with treatment of Hodgkin's lymphoma: meta-analysis of the randomised trials

J Franklin, A Pluetschow, M Paus, L Specht, A-P Anselmo, A Aviles, G Biti, T Bogatyreva, G Bonadonna, C Brillant, E Cavalieri, V Diehl, H Eghbali, C Fermé, M Henry-Amar, R Hoppe, S Howard, R Meyer, D Niedzwiecki, S PavlovskyJ Radford, J Raemaekers, D Ryder, P Schiller, S Shakhtarina, P Valagussa, J Wilimas, J Yahalom

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Abstract

BACKGROUND: Despite several investigations, second malignancy risks (SMR) following radiotherapy alone (RT), chemotherapy alone (CT) and combined chemoradiotherapy (CRT) for Hodgkin's lymphoma (HL) remain controversial. PATIENTS AND METHODS: We sought individual patient data from randomised trials comparing RT versus CRT, CT versus CRT, RT versus CT or involved-field (IF) versus extended-field (EF) RT for untreated HL. Overall SMR (including effects of salvage treatment) were compared using Peto's method. RESULTS: Data for between 53% and 69% of patients were obtained for the four comparisons. (i) RT versus CRT (15 trials, 3343 patients): SMR were lower with CRT than with RT as initial treatment (odds ratio (OR) = 0.78, 95% confidence interval (CI) = 0.62-0.98 and P = 0.03). (ii) CT versus CRT (16 trials, 2861 patients): SMR were marginally higher with CRT than with CT as initial treatment (OR = 1.38, CI 1.00-1.89 and P = 0.05). (iii) IF-RT versus EF-RT (19 trials, 3221 patients): no significant difference in SMR (P = 0.28) although more breast cancers occurred with EF-RT (P = 0.04 and OR = 3.25). CONCLUSIONS: Administration of CT in addition to RT as initial therapy for HL decreases overall SMR by reducing relapse and need for salvage therapy. Administration of RT additional to CT marginally increases overall SMR in advanced stages. Breast cancer risk (but not SMR in general) was substantially higher after EF-RT. Caution is needed in applying these findings to current therapies
Udgivelsesdato: 2006/12

Original language	English
Journal	Annals of Oncology
Volume	17
Issue number	12
Pages (from-to)	1749-60
Number of pages	12
ISSN	0923-7534
DOIs	https://doi.org/10.1093/annonc/mdl302
Publication status	Published - 2006

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10.1093/annonc/mdl302

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Franklin, J., Pluetschow, A., Paus, M., Specht, L., Anselmo, A-P., Aviles, A., Biti, G., Bogatyreva, T., Bonadonna, G., Brillant, C., Cavalieri, E., Diehl, V., Eghbali, H., Fermé, C., Henry-Amar, M., Hoppe, R., Howard, S., Meyer, R., Niedzwiecki, D., ... Yahalom, J. (2006). Second malignancy risk associated with treatment of Hodgkin's lymphoma: meta-analysis of the randomised trials. Annals of Oncology, 17(12), 1749-60. https://doi.org/10.1093/annonc/mdl302

Franklin, J, Pluetschow, A, Paus, M, Specht, L, Anselmo, A-P, Aviles, A, Biti, G, Bogatyreva, T, Bonadonna, G, Brillant, C, Cavalieri, E, Diehl, V, Eghbali, H, Fermé, C, Henry-Amar, M, Hoppe, R, Howard, S, Meyer, R, Niedzwiecki, D, Pavlovsky, S, Radford, J, Raemaekers, J, Ryder, D, Schiller, P, Shakhtarina, S, Valagussa, P, Wilimas, J & Yahalom, J 2006, 'Second malignancy risk associated with treatment of Hodgkin's lymphoma: meta-analysis of the randomised trials', Annals of Oncology, vol. 17, no. 12, pp. 1749-60. https://doi.org/10.1093/annonc/mdl302

@article{ea6635404e1911df928f000ea68e967b,

title = "Second malignancy risk associated with treatment of Hodgkin's lymphoma: meta-analysis of the randomised trials",

abstract = "BACKGROUND: Despite several investigations, second malignancy risks (SMR) following radiotherapy alone (RT), chemotherapy alone (CT) and combined chemoradiotherapy (CRT) for Hodgkin's lymphoma (HL) remain controversial. PATIENTS AND METHODS: We sought individual patient data from randomised trials comparing RT versus CRT, CT versus CRT, RT versus CT or involved-field (IF) versus extended-field (EF) RT for untreated HL. Overall SMR (including effects of salvage treatment) were compared using Peto's method. RESULTS: Data for between 53% and 69% of patients were obtained for the four comparisons. (i) RT versus CRT (15 trials, 3343 patients): SMR were lower with CRT than with RT as initial treatment (odds ratio (OR) = 0.78, 95% confidence interval (CI) = 0.62-0.98 and P = 0.03). (ii) CT versus CRT (16 trials, 2861 patients): SMR were marginally higher with CRT than with CT as initial treatment (OR = 1.38, CI 1.00-1.89 and P = 0.05). (iii) IF-RT versus EF-RT (19 trials, 3221 patients): no significant difference in SMR (P = 0.28) although more breast cancers occurred with EF-RT (P = 0.04 and OR = 3.25). CONCLUSIONS: Administration of CT in addition to RT as initial therapy for HL decreases overall SMR by reducing relapse and need for salvage therapy. Administration of RT additional to CT marginally increases overall SMR in advanced stages. Breast cancer risk (but not SMR in general) was substantially higher after EF-RT. Caution is needed in applying these findings to current therapies Udgivelsesdato: 2006/12",

author = "J Franklin and A Pluetschow and M Paus and L Specht and A-P Anselmo and A Aviles and G Biti and T Bogatyreva and G Bonadonna and C Brillant and E Cavalieri and V Diehl and H Eghbali and C Ferm{\'e} and M Henry-Amar and R Hoppe and S Howard and R Meyer and D Niedzwiecki and S Pavlovsky and J Radford and J Raemaekers and D Ryder and P Schiller and S Shakhtarina and P Valagussa and J Wilimas and J Yahalom",

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T1 - Second malignancy risk associated with treatment of Hodgkin's lymphoma: meta-analysis of the randomised trials

AU - Franklin, J

AU - Pluetschow, A

AU - Paus, M

AU - Specht, L

AU - Anselmo, A-P

AU - Aviles, A

AU - Biti, G

AU - Bogatyreva, T

AU - Bonadonna, G

AU - Brillant, C

AU - Cavalieri, E

AU - Diehl, V

AU - Eghbali, H

AU - Fermé, C

AU - Henry-Amar, M

AU - Hoppe, R

AU - Howard, S

AU - Meyer, R

AU - Niedzwiecki, D

AU - Pavlovsky, S

AU - Radford, J

AU - Raemaekers, J

AU - Ryder, D

AU - Schiller, P

AU - Shakhtarina, S

AU - Valagussa, P

AU - Wilimas, J

AU - Yahalom, J

N1 - DA - 20061207IS - 0923-7534 (Print)LA - engPT - Journal ArticlePT - Meta-AnalysisSB - IM

PY - 2006

Y1 - 2006

N2 - BACKGROUND: Despite several investigations, second malignancy risks (SMR) following radiotherapy alone (RT), chemotherapy alone (CT) and combined chemoradiotherapy (CRT) for Hodgkin's lymphoma (HL) remain controversial. PATIENTS AND METHODS: We sought individual patient data from randomised trials comparing RT versus CRT, CT versus CRT, RT versus CT or involved-field (IF) versus extended-field (EF) RT for untreated HL. Overall SMR (including effects of salvage treatment) were compared using Peto's method. RESULTS: Data for between 53% and 69% of patients were obtained for the four comparisons. (i) RT versus CRT (15 trials, 3343 patients): SMR were lower with CRT than with RT as initial treatment (odds ratio (OR) = 0.78, 95% confidence interval (CI) = 0.62-0.98 and P = 0.03). (ii) CT versus CRT (16 trials, 2861 patients): SMR were marginally higher with CRT than with CT as initial treatment (OR = 1.38, CI 1.00-1.89 and P = 0.05). (iii) IF-RT versus EF-RT (19 trials, 3221 patients): no significant difference in SMR (P = 0.28) although more breast cancers occurred with EF-RT (P = 0.04 and OR = 3.25). CONCLUSIONS: Administration of CT in addition to RT as initial therapy for HL decreases overall SMR by reducing relapse and need for salvage therapy. Administration of RT additional to CT marginally increases overall SMR in advanced stages. Breast cancer risk (but not SMR in general) was substantially higher after EF-RT. Caution is needed in applying these findings to current therapies Udgivelsesdato: 2006/12

AB - BACKGROUND: Despite several investigations, second malignancy risks (SMR) following radiotherapy alone (RT), chemotherapy alone (CT) and combined chemoradiotherapy (CRT) for Hodgkin's lymphoma (HL) remain controversial. PATIENTS AND METHODS: We sought individual patient data from randomised trials comparing RT versus CRT, CT versus CRT, RT versus CT or involved-field (IF) versus extended-field (EF) RT for untreated HL. Overall SMR (including effects of salvage treatment) were compared using Peto's method. RESULTS: Data for between 53% and 69% of patients were obtained for the four comparisons. (i) RT versus CRT (15 trials, 3343 patients): SMR were lower with CRT than with RT as initial treatment (odds ratio (OR) = 0.78, 95% confidence interval (CI) = 0.62-0.98 and P = 0.03). (ii) CT versus CRT (16 trials, 2861 patients): SMR were marginally higher with CRT than with CT as initial treatment (OR = 1.38, CI 1.00-1.89 and P = 0.05). (iii) IF-RT versus EF-RT (19 trials, 3221 patients): no significant difference in SMR (P = 0.28) although more breast cancers occurred with EF-RT (P = 0.04 and OR = 3.25). CONCLUSIONS: Administration of CT in addition to RT as initial therapy for HL decreases overall SMR by reducing relapse and need for salvage therapy. Administration of RT additional to CT marginally increases overall SMR in advanced stages. Breast cancer risk (but not SMR in general) was substantially higher after EF-RT. Caution is needed in applying these findings to current therapies Udgivelsesdato: 2006/12

U2 - 10.1093/annonc/mdl302

DO - 10.1093/annonc/mdl302

M3 - Journal article

C2 - 16984979

SN - 0923-7534

VL - 17

SP - 1749

EP - 1760

JO - Annals of Oncology

JF - Annals of Oncology

IS - 12

ER -