title: Lung cancer and other second neoplasms after treatment of Hodgkin lymphoma.
abstract: OBJECTIVE
  To evaluate the risk factors associated with lung cancer (LC) and other second neoplasms (SN) in Hodgkin lymphoma (HL) survivors.
  
  
  METHODS
  We retrospectively analyzed the clinical characteristics and outcomes of 604 patients treated in our institution between 1968 and 2012.
  
  
  RESULTS
  90 out of 604 patients developed SN: 27 LC and 63 other SN. The median time elapsed until LC and other SN was 16.5 and 11.8 years, respectively (p = 0.003). In the LC group, 85.5 % of patients were male and 84.6 % smokers (HR 7, 95 % CI 2.4-20.7, p < 0.001). Radiotherapy (RT) doses applied were higher in the SN group with an increased risk of LC (HR: 4.0 95 % CI 1.1-11.6, p = 0.010) and other SN (HR: 3.3 95 % CI 1.6-6.7 p = 0.001) with doses higher than 42 Gy. No association was found between alkylating agents and development of SN. In LC, the most frequent histology was adenocarcinoma with an elapsed time after HL of 13.2 years in early stages and 21.3 in advanced (p = 0.02). Median OS after a diagnosis of LC was 12.6 months ranging from 5.9 (in cases presenting due to symptoms) to 49.1 (incidentally diagnosed cases) (p = 0.005).
  
  
  CONCLUSIONS
  RT treatment, especially with doses higher than 42 Gy, and smoking increase the risk of SN after HL. In this series, LC patients with early stages had a shorter elapsed time from HL diagnosis and longer OS, therefore the role of LC screening in HL survivors should be prospectively evaluated and smoking cessation counseling ought to be a key aspect during follow-up.
authors.affiliation: Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Manuel de Falla 1, 28220, Majadahonda, Spain. e.almagro.c@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Almagro-Casado
authors.affiliation: Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Manuel de Falla 1, 28220, Majadahonda, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Sánchez
authors.affiliation: Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Manuel de Falla 1, 28220, Majadahonda, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Cantos
authors.affiliation: Department of Pathology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Salas
authors.affiliation: Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Manuel de Falla 1, 28220, Majadahonda, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Pérez-Callejo
authors.affiliation: Department of Medical Oncology, Hospital Universitario Puerta de Hierro, Manuel de Falla 1, 28220, Majadahonda, Spain. mprovenciop@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Provencio
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D001761:Bleomycin / Q000009:adverse effects; D003606:Dacarbazine / Q000009:adverse effects; D004317:Doxorubicin / Q000009:adverse effects; D006689:Hodgkin Disease / Q000453:epidemiology* / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D008297:Male; D008466:Mechlorethamine / Q000009:adverse effects; D008875:Middle Aged; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology* / Q000473:pathology; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000473:pathology; D011241:Prednisone / Q000009:adverse effects; D011344:Procarbazine / Q000009:adverse effects; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D014747:Vinblastine / Q000009:adverse effects; D014750:Vincristine / Q000009:adverse effects; D055815:Young Adult
chemical_list: D001761:Bleomycin; D011344:Procarbazine; D008466:Mechlorethamine; D014750:Vincristine; D014747:Vinblastine; D003606:Dacarbazine; D004317:Doxorubicin; D011241:Prednisone
keywords: Lymphoma and Hodgkin disease; Prognostication; Radiation