Guidelines for Complications of Cancer Treatment Vol VIII Part B

adiation-related solid SMNs will increase with longer followup.Because nearly 33% of patients die from their disease,recurrence remains the most significant problem. Thedevelopment of improved therapies with fewer long-termconsequences is paramount. Follow-up should focus onmonitoring for both recurrence of primary malignancies anddevelopment of SMNs.2. Constine LS, Tarbell N, Hudson MM, et al: Subsequentmalignancies in children treated for Hodgkin’s disease:associations with gender and radiation doseInt J Radiat Oncol Biol Phys 2008;72(1):24-33PURPOSE: Subsequent malignant neoplasms (SMNs) are adominant cause of morbidity and mortality in children treatedfor Hodgkin’s disease (HD). We evaluated select demographicand therapeutic factors associated with SMNs, specificallygender and radiation dose.METHODS AND MATERIALS: A total of 930 childrentreated for HD at five institutions between 1960 and 1990were studied. Mean age at diagnosis was 13.6 years, and meanfollow-up was 16.8 years (maximum, 39.4 years). Treatmentincluded radiation alone (43%), chemotherapy alone (9%), orboth (48%).RESULTS: We found that SMNs occurred in 102 (11%)patients, with a 25-year actuarial rate of 19%. With 15,154patient years of follow-up, only 7.18 cancers were expected(standardized incidence ratio [SIR] = 14.2; absolute excessrisk [AER] = 63 cases/10,000 years). The SIR for femalesubjects, 19.93, was significantly greater than for males, 8.41(p < 0.0001). After excluding breast cancer, the SIR for femalepatients was 15.4, still significantly greater than for malepatients (p = 0.0012). Increasing radiation dose was associatedwith an increasing SIR (p = 0.0085). On univariate analysis,an increased risk was associated with female gender, increasing293