title: [Secondary breast cancer after treatment for Hodgkin's disease. About seven cases].
abstract: OBJECTIVE
  Therapeutic results of Hodgkin disease (HD) have improved by the use of combined radio-chemotherapy. However, this association can increase the risk of on-term effects including secondary cancers. In a retrospective study, we collected secondary breast cancer (BC) in patients previously treated with chemoradiotherapy for Hodgkin disease at Salah-Azaïz institute of Tunis.
  
  
  METHODS
  Between 1975 and 2003, seven patients (six women and one man) treated for HD subsequently developed BC. Mean age at diagnosis of HD was 21 years (12-29). The first treatment was combined chemotherapy (MOPP-ABVD) and radiotherapy for all patients. Radiotherapy was delivered with cobalt 60 with large fields. The median dose was 41.3 Gy (2 Gy/fraction in 6 patients and 3.3 Gy in one).
  
  
  RESULTS
  The breast tumours occurred after a median delay of 204 months (132-276). According to the TNM classification, we showed two stage T2, one stage T3, two stage T4b and two stage T4d. The mean clinical size was 47 mm (25-80 mm). All patients had infiltrating carcinoma. Axillary node histological involvement was found in 6 cases. All patients were treated by mastectomy and chemotherapy. Only one patient had a locoregional irradiation. Median survival was 26.5 months (12-48). Four patients died and three are still alive at respectively 24, 31 and 144 months.
  
  
  CONCLUSIONS
  According to the previous data, breast cancer represents 6.3 to 9% of all second cancers occurring after HD treatment. We conclude that especially young women and girls treated for HD should be carefully monitored. We suggest that secondary BC be sometimes treated by conservative radiosurgical approach.
authors.affiliation: Service de Chirurgie Carcinologique, Institut Salah-Azaïz, Tunis, Tunisie.
authors.forename: J
authors.initials: J
authors.lastname: Ben Hassouna
authors.forename: M
authors.initials: M
authors.lastname: Slimène
authors.forename: H
authors.initials: H
authors.lastname: Boussen
authors.forename: H
authors.initials: H
authors.lastname: Bouzaiene
authors.forename: F
authors.initials: F
authors.lastname: Khomsi
authors.forename: R
authors.initials: R
authors.lastname: Chargui
authors.forename: L
authors.initials: L
authors.lastname: Kochbati
authors.forename: M H
authors.initials: MH
authors.lastname: Mtaallah
authors.forename: A
authors.initials: A
authors.lastname: Gamoudi
authors.forename: F
authors.initials: F
authors.lastname: Benna
authors.forename: M
authors.initials: M
authors.lastname: Hechiche
authors.forename: K
authors.initials: K
authors.lastname: Rahal
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology / Q000532:radiotherapy; D018270:Carcinoma, Ductal, Breast / Q000139:chemically induced* / Q000453:epidemiology; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D009381:Neoplasms, Radiation-Induced; D016609:Neoplasms, Second Primary; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014416:Tunisia / Q000453:epidemiology