Characteristics and outcomes of breast cancer in women with and without a history of radiation for Hodgkin's lymphoma: a multi-institutional, matched cohort study.

PURPOSE: To compare characteristics and outcomes of breast cancer in women with and without a history of radiation therapy (RT) for Hodgkin's lymphoma (HL). PATIENTS AND METHODS: Women with breast cancer diagnosed from 1980 to 2006 after RT for HL were identified from eight North American hospitals and were matched three-to-one with patients with sporadic breast cancer by age, race, and year of breast cancer diagnosis. Information on patient, tumor and treatment characteristics, and clinical outcomes was abstracted from medical records. RESULTS: A total of 253 patients with breast cancer with a history of RT for HL were matched with 741 patients with sporadic breast cancer. Median time from HL to breast cancer diagnosis was 18 years. Median age at breast cancer diagnosis was 42 years. Breast cancer after RT for HL was more likely to be detected by screening, was more likely to be diagnosed at an earlier stage, and was more likely to be bilateral at diagnosis. HL survivors had an increased risk of metachronous contralateral breast cancer (adjusted hazard ratio [HR], 4.3; 95% CI, 1.7 to 11.0) and death as a result of any cause (adjusted HR, 1.9; 95% CI, 1.1 to 3.3). Breast cancer-specific mortality was also elevated, but this difference was not statistically significant (adjusted HR, 1.6; 95% CI, 0.7 to 3.4). CONCLUSION: In women with a history of RT for HL, breast cancer is diagnosed at an earlier stage, but these women are at greater risk for bilateral disease and are more likely to die as a result of causes other than breast cancer. Our findings support close follow-up for contralateral tumors in these patients and ongoing primary care to manage comorbid conditions.

Intensity-modulated radiotherapy for head and neck cancer of unknown primary: toxicity and preliminary efficacy.

PURPOSE: Unknown primary head and neck cancers often require comprehensive mucosal and bilateral neck irradiation. With conventional techniques, significant toxicity can develop. Intensity-modulated radiotherapy (IMRT) has the potential to minimize the toxicity. METHODS AND MATERIALS: Between 2000 and 2005, 21 patients underwent IMRT for unknown primary head and neck cancer at our center. Of the 21 patients, 5 received IMRT with definitive intent and 16 as postoperative therapy; 14 received concurrent chemotherapy and 7 IMRT alone. The target volumes included the bilateral neck and mucosal surface. The median dose was 66 Gy. Acute and chronic toxicities, esophageal strictures, and percutaneous endoscopic gastrostomy tube dependence were evaluated. Progression-free survival, regional progression-free survival, distant metastasis-free survival, and overall survival were estimated with Kaplan-Meier curves. RESULTS: With a median follow-up of 24 months, the 2-year regional progression-free survival, distant metastasis-free survival, and overall survival rate was 90%, 90%, and 85%, respectively. Acute grade 1 and 2 xerostomia was seen in 57% and 43% of patients, respectively. Salivary function improved with time. Percutaneous endoscopic gastrostomy tube placement was required in 72% with combined modality treatment and 43% with IMRT alone. Only 1 patient required percutaneous endoscopic gastrostomy support at the last follow-up visit. Two patients treated with combined modality and one treated with IMRT alone developed esophageal strictures, but all had improvement or resolution with dilation. CONCLUSION: The preliminary analysis of IMRT for unknown primary head and neck cancer has shown acceptable toxicity and encouraging efficacy. The analysis of the dosimetric variables showed excellent tumor coverage and acceptable doses to critical normal structures. Esophageal strictures developed but were effectively treated with dilation. Techniques to limit the esophageal dose could help further minimize this complication.

PET for staging in rhabdomyosarcoma: an evaluation of PET as an adjunct to current staging tools.

BACKGROUND: Complete staging of rhabdomyosarcoma is critical to deliver appropriate therapy. We evaluated the role of F-fluorodeoxyglucose positron emission tomography (PET) in the staging of patients with rhabdomyosarcoma. METHODS: Twenty-four patients with rhabdomyosarcoma had a PET scan during staging evaluation, before or within 13 days of initiation of therapy. PET was compared with computed tomography (CT), magnetic resonance imaging (MRI), bone scan, and pathology. RESULTS: Ninety-six sites were evaluated. All patients had positive PET scans at the primary site. Thirty-one PET positive sites at primary, regional, or distant sites were biopsied. Pathology in all 31 confirmed disease. Standardized uptake value for the primary site at diagnosis ranged from 2.4 to 12.7 (mean 6.4). At 23 sites, CT or MRI was equivocal for the detection of regional or distant spread. In these cases, a negative PET helped to exclude disease in 21 of 23 patients. PET failed to capture sites of disease visualized by CT, MRI, or bone scan at 10 sites. When comparing PET with the final clinical determination of disease extent, PET was 77% sensitive and 95% specific. CONCLUSIONS: These preliminary data indicate that PET is a useful adjunct in staging rhabdomyosarcoma. A prospective study of PET for staging of rhabdomyosarcoma is warranted.