title: Bone and soft tissue sarcomas in the follow-up of Hodgkin's disease.
abstract: Prolonged follow-up of large series of patients treated for Hodgkin's disease with an intensive therapeutic approach has demonstrated an incidence of second tumors of around 5-10%. Acute leukemia is the most frequent second neoplasia, and treatments including alkylating agents and radiotherapy seem to be correlated with a higher risk of this fatal complication. Bone and soft tissue sarcomas have rarely been observed after treatment of Hodgkin's disease, and only a few cases are described in the literature. Four cases observed at the Istituto Nazionale Tumori of Milano in a large series of nearly 800 patients treated over the last two decades with different modalities are presented. One case of chondrosarcoma and 3 cases of soft tissue sarcomas were diagnosed after a median and mean interval of 50 and 70 months, respectively (range 49-96). Three patients had been treated with radiotherapy plus chemotherapy (MOPP, 2 cases; ABVD, 1 case), and one with radiotherapy alone. The site of the second tumor was always within an irradiated area, which had received a dose ranging from 10 to 43 Gy. Prognosis of secondary bone and soft tissue sarcomas is very poor. Three of our cases died 14, 15 and 19 months after diagnosis; only one patient is alive, 3 months after diagnosis of a chondrosarcoma. The problem of second tumors in patients treated for Hodgkin's disease requires a careful evaluation of aggressive treatment modalities to minimize the risks of this severe complication.
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D001761:Bleomycin / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000556:secondary*; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006689:Hodgkin Disease / Q000628:therapy*; D006801:Humans; D008297:Male; D008466:Mechlorethamine / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D011344:Procarbazine / Q000627:therapeutic use; D011878:Radiotherapy / Q000009:adverse effects; D012509:Sarcoma / Q000556:secondary*; D012983:Soft Tissue Neoplasms / Q000556:secondary*; D014747:Vinblastine; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D001761:Bleomycin; D011344:Procarbazine; D008466:Mechlorethamine; D014750:Vincristine; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin; D011241:Prednisone