title: Stomach cancer risk after treatment for hodgkin lymphoma.
abstract: OBJECTIVE
  Treatment-related stomach cancer is an important cause of morbidity and mortality among the growing number of Hodgkin lymphoma (HL) survivors, but risks associated with specific HL treatments are unclear.
  
  
  METHODS
  We conducted an international case-control study of stomach cancer nested in a cohort of 19,882 HL survivors diagnosed from 1953 to 2003, including 89 cases and 190 matched controls. For each patient, we quantified cumulative doses of specific alkylating agents (AAs) and reconstructed radiation dose to the stomach tumor location.
  
  
  RESULTS
  Stomach cancer risk increased with increasing radiation dose to the stomach (Ptrend < .001) and with increasing number of AA-containing chemotherapy cycles (Ptrend = .02). Patients who received both radiation to the stomach ≥ 25 Gy and high-dose procarbazine (≥ 5,600 mg/m(2)) had strikingly elevated stomach cancer risk (25 cases, two controls; odds ratio [OR], 77.5; 95% CI, 14.7 to 1452) compared with those who received radiation < 25 Gy and procarbazine < 5,600 mg/m(2) (Pinteraction < .001). Risk was also elevated (OR, 2.8; 95% CI, 1.3 to 6.4) among patients who received radiation to the stomach ≥ 25 Gy but procarbazine < 5,600 mg/m(2); however, no procarbazine-related risk was evident with radiation < 25 Gy. Treatment with dacarbazine also increased stomach cancer risk (12 cases, nine controls; OR, 8.8; 95% CI, 2.1 to 46.6), after adjustment for radiation and procarbazine doses.
  
  
  CONCLUSIONS
  Patients with HL who received subdiaphragmatic radiotherapy had dose-dependent increased risk of stomach cancer, with marked risks for patients who also received chemotherapy containing high-dose procarbazine. For current patients, risks and benefits of exposure to both procarbazine and subdiaphragmatic radiotherapy should be weighed carefully. For patients treated previously, GI symptoms should be evaluated promptly.
authors: Lindsay M. Morton, Graça M. Dores, Rochelle E. Curtis, Ethel S. Gilbert, Ruth A. Kleinerman, and Joseph F. Fraumeni Jr, National Cancer Institute, Bethesda, MD; Graça M. Dores, Department of Veterans Affairs Medical Center, Oklahoma City, OK; Charles F. Lynch, University of Iowa, Iowa City, IA; Marilyn Stovall, Susan A. Smith, and Rita E. Weathers, University of Texas MD Anderson Cancer Center, Houston, TX; Per Hall and Magnus Kaijser, Karolinska Institute, Stockholm, Sweden; David C. Hodgson and Eric J. Holowaty, University of Toronto, Toronto, Ontario, Canada; Hans H. Storm, Danish Cancer Society; Michael Andersson, Copenhagen University Hospital, Copenhagen, Denmark; Tom Børge Johannesen and Frøydis Langmark, Cancer Registry of Norway; Sophie D. Fossa, Oslo University Hospital and University of Oslo, Oslo, Norway; Michael Hauptmann, Alexandra W. Van den Belt-Dusebout, Berthe M. Aleman, and Flora E. van Leeuwen, Netherlands Cancer Institute, Amsterdam, the Netherlands; Heikki Joensuu and Leila Vaalavirta, Helsinki University Central Hospital; Eero Pukkala, Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland; Lois B. Travis, University of Rochester Medical Center, Rochester, NY.
authors: Lindsay M
authors: LM
authors: Morton
authors: Graça M
authors: GM
authors: Dores
authors: Rochelle E
authors: RE
authors: Curtis
authors: Charles F
authors: CF
authors: Lynch
authors: Marilyn
authors: M
authors: Stovall
authors: Per
authors: P
authors: Hall
authors: Ethel S
authors: ES
authors: Gilbert
authors: David C
authors: DC
authors: Hodgson
authors: Hans H
authors: HH
authors: Storm
authors: Tom Børge
authors: TB
authors: Johannesen
authors: Susan A
authors: SA
authors: Smith
authors: Rita E
authors: RE
authors: Weathers
authors: Michael
authors: M
authors: Andersson
authors: Sophie D
authors: SD
authors: Fossa
authors: Michael
authors: M
authors: Hauptmann
authors: Eric J
authors: EJ
authors: Holowaty
authors: Heikki
authors: H
authors: Joensuu
authors: Magnus
authors: M
authors: Kaijser
authors: Ruth A
authors: RA
authors: Kleinerman
authors: Frøydis
authors: F
authors: Langmark
authors: Eero
authors: E
authors: Pukkala
authors: Leila
authors: L
authors: Vaalavirta
authors: Alexandra W
authors: AW
authors: van den Belt-Dusebout
authors: Joseph F
authors: JF
authors: Fraumeni
authors: Lois B
authors: LB
authors: Travis
authors: Berthe M
authors: BM
authors: Aleman
authors: Flora E
authors: FE
authors: van Leeuwen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000453:epidemiology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000473:pathology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
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