Comparison of Treatments for Breast Cancer Arising After Radiation Treatment for Hodgkin Lymphoma

Abstract

Breast cancer in patients that received radiation therapy (RT) for Hodgkin lymphoma (HL) have traditionally been treated with mastectomy. Prior irradiation is a contraindication for patients to receive breast conserving therapy. However, retrospective studies have found that lumpectomy followed by breast irradiation is an acceptable treatment option for breast cancers that arise after RT for HL. This study compares treatment modalities for breast cancers arising from previously irradiated HL patients, specifically the addition of RT. Data was extracted from the Surveillance, Epidemiology and End Results (SEER) from the years 1983 and 2009. All patients previously treated with RT for HL who subsequently developed breast cancer and received surgical treatment were included. Patients were grouped by breast cancer treatment received, as well as by RT utilization. Patients were staged using AJCC 7th edition criteria. Univariate analysis was then made to compare treatment groups. There were 413 female patients with a history of RT for HL breast cancer identified, who had breast cancer surgery with or without radiation therapy. Of these patients, 406 patients were fully staged. Sixty-eight patients received a bilateral mastectomy, 247 received a mastectomy, and 91 received a lumpectomy. A total of 66 patients received RT. RT was given to 1 patient completing a bilateral mastectomy, 19 patients completing a mastectomy, and 46 patients completing a lumpectomy. On univariate analysis, the addition of radiation therapy did not significantly impact CSS or OS (smallest p = 0.70). When treatment categories were analyzed as a whole, there were no statistically significant differences between treatment groups (greatest p = 0.14). Patients that received RT for Hodgkin lymphoma and subsequently develop breast cancer are typically treated with mastectomy. Using the SEER database, there were no statistically significant differences between surgical treatment modalities (bilateral mastectomy, mastectomy and lumpectomy) with or without RT.