RESUMO
PURPOSE: 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.
Assuntos
Doença de Hodgkin/epidemiologia , Doença de Hodgkin/terapia , Neoplasias Pulmonares/epidemiologia , Neoplasias Induzidas por Radiação/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bleomicina/efeitos adversos , Dacarbazina/efeitos adversos , Doxorrubicina/efeitos adversos , Doença de Hodgkin/radioterapia , Humanos , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/patologia , Masculino , Mecloretamina/efeitos adversos , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/patologia , Segunda Neoplasia Primária/patologia , Prednisona/efeitos adversos , Procarbazina/efeitos adversos , Dosagem Radioterapêutica , Estudos Retrospectivos , Fatores de Risco , Vimblastina/efeitos adversos , Vincristina/efeitos adversos , Adulto JovemRESUMO
Lung cancer is the most common cancer in the world. 15 % of all patients with lung cancer are diagnosed at an early stage, and surgery is the treatment of choice for them. 40 % of all patients survive more than 5 years after surgery, and most of them die as a result of systemic disease. Half of all recurrences are diagnosed within the first 24 months after curative treatment, and 90 % in the first 5 years. Despite this, it is not standardized who should do the monitoring, what additional tests are needed and how often should they be performed. We present here a review on the various recommendations in clinical guidelines.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Monitorização Fisiológica/métodos , Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Técnicas e Procedimentos Diagnósticos/estatística & dados numéricos , Humanos , Neoplasias Pulmonares/diagnóstico , Oncologia/métodos , Guias de Prática Clínica como AssuntoRESUMO
Hodgkin's disease (HD) is an example of a curable disease. In addition, it can serve as a lesson about other pathologies because of the delayed side effects it produces and the appearance of associated processes that may simulate disease progression. Here we provide a case report of a patient who encapsulates a compendium of situations that may occur in HD.