title: [Bilateral breast cancer after Hodgkin disease. Clinical and pathological characteristics and therapeutic possibilities: an analysis of 13 cases].
abstract: OBJECTIVE
  Though Hodgkin's disease (HD) is one of the malignancies in which considerable progress has been made, long-term side effects have been observed, second primary cancer being the most significant. Several recent reports have indicated an increased risk of breast cancer (BC) in girls and young women among HD patients.
  
  
  METHODS
  In a retrospective multicenter analysis, 63 women treated for HD subsequently developed BC. Results that were obtained in 13 women (21%) who developed either synchronous (five cases) or metachronous (eight cases) BC were analyzed. The median age at diagnosis of HD was 19 years. Seven patients underwent exclusive radiotherapy (RT) (including "mantle" supradiaphragmatic irradiation) and six received concomittant radiation therapy and chemotherapy.
  
  
  RESULTS
  The first breast tumor occurred after a median delay of 16 years. According to the TNM classification, we showed nine stage T0 (non palpable lesions), four stage T1, five stage T2, one stage T3, two stage T4 and five stage Tx BC. Seventeen infiltrating carcinomas, two fibrosarcomas and seven ductal carcinomas in situ were observed. Among 15 axillary dissections performed for invasive carcinomas, histological involvement was found in 10 cases. Seventeen tumors were treated by mastectomy and nine patients underwent conservative surgical treatment. With a 70-month median follow-up (range: 15-125), three patients developed locoregional recurrence and four other metastases. At present, eight are alive with no evidence of disease and one died of intercurrent disease.
  
  
  CONCLUSIONS
  According to previous works, BC represents 6.3 to 9% of all second cancers occurring after HD treatment. The risk is higher in young women treated before 20 years of age, especially before 15 years of age. Factors that favour the development of secondary BC are: supradiaphragmatic irradiation, very young age at treatment, chemotherapy with alkylating agents, and probably genetic factors. We conclude that young women and girls treated for HD should be carefully monitored at least 10 years after the end of the treatment for HD, using clinical examination, mammography and ultrasonography. The optimal rythm of this follow-up is not yet clearly defined. Moreover, after multidisciplinary concertation, we suggest that secondary BC be sometimes treated by conservative radiosurgical approach.
authors.affiliation: Département de radiothérapie, centre Paul-Strauss, Strasbourg, France.
authors.forename: B
authors.initials: B
authors.lastname: Cutuli
authors.forename: A
authors.initials: A
authors.lastname: de La Rochefordière
authors.forename: F
authors.initials: F
authors.lastname: Dhermain
authors.forename: C
authors.initials: C
authors.lastname: Borel
authors.forename: Y
authors.initials: Y
authors.lastname: Graic
authors.forename: B
authors.initials: B
authors.lastname: de Lafontan
authors.forename: J M
authors.initials: JM
authors.lastname: Dilhyudy
authors.forename: H
authors.initials: H
authors.lastname: Mignotte
authors.forename: E
authors.initials: E
authors.lastname: Tessier
authors.forename: J
authors.initials: J
authors.lastname: Tortochaux
authors.forename: T
authors.initials: T
authors.lastname: N'Guyen
authors.forename: P
authors.initials: P
authors.lastname: Bey
authors.forename: A
authors.initials: A
authors.lastname: Le Mevel-Le Pourhier
authors.forename: R
authors.initials: R
authors.lastname: Arriagada
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000209:etiology / Q000473:pathology / Q000628:therapy; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006689:Hodgkin Disease / Q000532:radiotherapy*; D006801:Humans; D009367:Neoplasm Staging; D009381:Neoplasms, Radiation-Induced; D016609:Neoplasms, Second Primary; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors