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Title: Pancreatic cancer risk after treatment of Hodgkin lymphoma.
Authors: Dores GM,  Curtis RE,  van Leeuwen FE,  Stovall M,  Hall P,  Lynch CF,  Smith SA,  Weathers RE,  Storm HH,  Hodgson DC,  Kleinerman RA,  Joensuu H,  Johannesen TB,  Andersson M,  Holowaty EJ,  Kaijser M,  Pukkala E,  Vaalavirta L,  Fossa SD,  Langmark F,  Travis LB,  Fraumeni JF Jr,  Aleman BM,  Morton LM,  Gilbert ES
Journal: Ann Oncol
Date: 2014 Oct
Branches: OD, REB
PubMed ID: 25185241
PMC ID: PMC4176454
Abstract: BACKGROUND: Although elevated risks of pancreatic cancer have been observed in long-term survivors of Hodgkin lymphoma (HL), no prior study has assessed the risk of second pancreatic cancer in relation to radiation dose and specific chemotherapeutic agents. PATIENTS AND METHODS: We conducted an international case-control study within a cohort of 19 882 HL survivors diagnosed from 1953 to 2003 including 36 cases and 70 matched controls. RESULTS: Median ages at HL and pancreatic cancer diagnoses were 47 and 60.5 years, respectively; median time to pancreatic cancer was 19 years. Pancreatic cancer risk increased with increasing radiation dose to the pancreatic tumor location (Ptrend = 0.005) and increasing number of alkylating agent (AA)-containing cycles of chemotherapy (Ptrend = 0.008). The odds ratio (OR) for patients treated with both subdiaphragmatic radiation (≥10 Gy) and ≥6 AA-containing chemotherapy cycles (13 cases, 6 controls) compared with patients with neither treatment was 17.9 (95% confidence interval 3.5-158). The joint effect of these two treatments was significantly greater than additive (P = 0.041) and nonsignificantly greater than multiplicative (P = 0.29). Especially high risks were observed among patients receiving ≥8400 mg/m(2) of procarbazine with nitrogen mustard or ≥3900 mg/m(2) of cyclophosphamide. CONCLUSION: Our study demonstrates for the first time that both radiotherapy and chemotherapy substantially increase pancreatic cancer risks among HL survivors treated in the past. These findings extend the range of nonhematologic cancers associated with chemotherapy and add to the evidence that the combination of radiotherapy and chemotherapy can lead to especially large risks.