In a nutshell
This study determined whether targeted radiotherapy reduced the risk of secondary breast cancer in women with Hodgkin lymphoma compared to radiotherapy delivered to a larger area. The authors concluded that while larger field radiation was associated with an increased risk of breast cancer, targeted approaches did not increase the risk compared to chemotherapy alone.
Some background
Radiation is a main treatment option in Hodgkin lymphoma (HL). Female survivors who received chest-area radiotherapy have an increased risk of developing secondary breast cancer (SBC). This risk varies by age at diagnosis and by radiation dose.
Mantle-field radiotherapy (MRT) is radiotherapy to a large area of the neck, chest and armpits. Formerly, MRT was the standard HL treatment. MRT-treated patients generally have an increased SBC risk. More recently small-field radiotherapy (SFRT) combined with chemotherapy has been standard. It is not clear whether SFRT is associated with a lower risk of breast cancer compared to MRT.
Methods & findings
This study compared the risk of secondary breast cancer with MRT and SFRT. Information on 734 HL patients included in a cancer database was examined. All patients were treated for a first occurrence of HL. All were under 50 (and at least 4) years of age at diagnosis.
231 received MRT, 185 received SFRT and 318 received chemotherapy alone. Radiation was delivered above the diaphragm. The average follow-up time was 18 years (range 1-48 years). The average follow-up was more than 10 years for 75% of patients.
15 patients (2%) died of breast cancer. 54 patients (7%) developed SBC, 40 of whom were MRT-treated. MRT-treated patients had the highest 20-year estimated risk for SBC (7.5%). This was compared with 3.1% for the SFRT-treated and 2.2% for the chemotherapy-treated. MRT-treated patients were 2.9 times more likely to develop SBC than the chemotherapy-treated patients. MRT-treated patients were also 3.3 times more likely to develop SBC than the SFRT-treated. There was no significant difference in the risk of SBC between the SFRT and chemotherapy-treated patients.
The bottom line
The authors concluded that smaller-field radiotherapy did not increase the risk of secondary breast cancer compared to chemotherapy alone. Mantle-field radiotherapy was associated with an increased risk.
The fine print
This study did not include comparisons of radiation dose and breast cancer risk, or the location of the radiation delivery and the site of the breast cancer.
What’s next?
Consult your doctor about the potential need for breast cancer screening.
Published By :
International journal of radiation oncology, biology, physics
Date :
Jan 01, 2017
