770 Breast cancer (BC) after hodgkin's disease (HD). Analysis of 35 cases

Abstract

Introduction The second cancers represents the most important problem among the survivors of HD. A possible link with chemotherapy (CT) and radiotherapy (RT) is suggested but genetic and immunologic factors may also be involved. Material In seven Cancer Centers, we found 35 women, previously treated for HD, who developed 37 BC. The median age at diagnosis of HD was 25 years, with 12 less than 20 years. HD stage was: 1 = 3, II = 21, III = 5, IV = 4, NS = 2. 33 women received supradiaphragmatic RT with doses varying from 35 to 45 Gy. 16 women received CT (mainly MOPP). The median interval between the diagnosis of HD and BC was 16 years. According to TNM, we found: 2 T0, 10 Tl, 12 T2, 4 T3, 6 T4 and 3 Tx. 32 were ductal infiltrating carcinoma, 2 medullary, 2 in situ and one fibrosarcoma. Axillary involvement was present in 51% of cases. Mastectomy was performed in 23 cases, a radiosurgical conservative treatment in 12 and exclusive radiotherapy in 2. Fourteen women underwent chemotherapy. Results 7 women had local relapse of BC and 15 had metastases (40%). Three had contralateral metachronous BC. 17 women are in complete remission for both diseases; 15 died of BC. Three women died of intercurrent disease. Conclusion The women treated for HD, especially before 20 years, seem to have an increased risk of subsequent BC. According to other reports, we confirm that these BC are frequently aggressive, with rapid evolution and high risk of bilaterality. Consequently, a regular mammographic follow-up is necessary to detect these lesions earlier, to allow a better prognosis and a possible conservative treatment. The second cancers represents the most important problem among the survivors of HD. A possible link with chemotherapy (CT) and radiotherapy (RT) is suggested but genetic and immunologic factors may also be involved. In seven Cancer Centers, we found 35 women, previously treated for HD, who developed 37 BC. The median age at diagnosis of HD was 25 years, with 12 less than 20 years. HD stage was: 1 = 3, II = 21, III = 5, IV = 4, NS = 2. 33 women received supradiaphragmatic RT with doses varying from 35 to 45 Gy. 16 women received CT (mainly MOPP). The median interval between the diagnosis of HD and BC was 16 years. According to TNM, we found: 2 T0, 10 Tl, 12 T2, 4 T3, 6 T4 and 3 Tx. 32 were ductal infiltrating carcinoma, 2 medullary, 2 in situ and one fibrosarcoma. Axillary involvement was present in 51% of cases. Mastectomy was performed in 23 cases, a radiosurgical conservative treatment in 12 and exclusive radiotherapy in 2. Fourteen women underwent chemotherapy. 7 women had local relapse of BC and 15 had metastases (40%). Three had contralateral metachronous BC. 17 women are in complete remission for both diseases; 15 died of BC. Three women died of intercurrent disease. The women treated for HD, especially before 20 years, seem to have an increased risk of subsequent BC. According to other reports, we confirm that these BC are frequently aggressive, with rapid evolution and high risk of bilaterality. Consequently, a regular mammographic follow-up is necessary to detect these lesions earlier, to allow a better prognosis and a possible conservative treatment.