Long-term risk of secondary skin cancers after radiation therapy for Hodgkin's lymphoma.
OBJECTIVE
Survivors of Hodgkin's lymphoma (HL) are at risk of secondary tumors. We investigated the risk of secondary skin cancers after radiotherapy compared to treatment without radiation and to an age-matched population.


METHODS
We conducted a retrospective cohort study of 889 HL patients treated between 1965 and 2005. Data on secondary skin cancers and treatment fields were retrieved. Incidence rates were compared to observed rates in the Dutch population.


RESULTS
318 skin cancers were diagnosed in 86 patients, showing significantly higher risks of skin cancers, the majority being BCC. The standardized incidence ratio (SIR) of BCC in HL survivors was significantly increased (SIR 5.2, 95% CI 4.0-6.6), especially in those aged <35 years at diagnosis (SIR 8.0, 95% CI 5.8-10.7). SIR increased with longer follow-up to 15.9 (95% CI 9.1-25.9) after 35 years, with 626 excess cases per 10,000 patients per year. Most (57%) skin cancers developed within the radiation fields, with significantly increased risk in patients treated with radiotherapy compared to chemotherapy alone (p=0·047, HR 2·75, 95% CI 1·01-7.45).


CONCLUSIONS
Radiotherapy for HL is associated with a strongly increased long-term risk of secondary skin cancers, both compared to the general population and to treatment with chemotherapy alone.
Department of Clinical Oncology, Leiden University Medical Center, The Netherlands. Electronic address: l.a.daniels@lumc.nl.
Laurien A
LA
Daniëls
Augustinus D G
AD
Krol
Michael
M
Schaapveld
Hein
H
Putter
Patty M
PM
Jansen
Erik W A
EW
Marijt
Flora E
FE
van Leeuwen
Carien L
CL
Creutzberg
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006689:Hodgkin Disease / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000209:etiology*
Hodgkin’s lymphoma; Radiation therapy; Secondary cancers; Skin cancers