Secondary tumors after chemoradiotherapy of Hodgkin’s lymphoma in children and adolescents of the Republic of Belarus

Introduction . The article analyzes the incidence of secondary malignant tumors (SMT) after therapy of Hodgkin’s lymphoma (HL) in 508 patients aged 0–18 years in the Republic of Belarus. Materials and methods . Patients received program therapy under the DAL-HD-90(m) protocol. The observation period is from 10 months to 25 years. During the entire follow-up period, 27 secondary malignant tumors were diagnosed in 26 (4.1 %) patients: thyroid cancer – 11 (40.7 %), acute myeloid leukemia – 2 (7.4 %), stomach cancer – 2 (7.4 %), upper lobe bronchus cancer – 1 (3.7 %), parotid salivary gland carcinoma – 2 (7.4 %), breast cancer – 1 (3.7 %), hepatocellular liver cancer – 1 (3.7 %), soft tissue sarcoma – 2 (7.4 %), renal cell carcinoma – 1 (3.7 %), ovarian tumor – 1 (3.7 %), myelodysplastic syndrome – 1 (3.7 %), basal cell skin cancer – 2 (7.4 %). All cases of secondary hematological tumors were fatal. Results. It was found that solid SMT developed within the area of radiation exposure to organs and tissues. The risk of developing SMT in patients with HL increases with increasing follow-up time after treatment. The cumulative incidence of SMT was 3.4 ± 0.8 % after 10 years, 4.6 ± 1.0 % after 15 years, and 7.0 ± 1.6 % 20 years after the diagnosis of HL. The latent period of SMT development after HL was 8.4 years (from 5 months to 23 years). Conclusion . The data confirmed the need to optimize the therapy volume, reduce doses and indications for radiation therapy (RT), consider prognostic factors, introduce new RT methods, and use new treatment regimens for children with HL.