The use of radiation therapy (RT) and its impact on survival in advanced Hodgkin lymphoma (HL) is controversial. Data were obtained from the surveillance, epidemiology, and end results (SEER) registries from 1988–2011. There were 9467 adults who met inclusion criteria; 19% received RT. Radiation use declined from 25% in 1988 to 16% in 2011. Five-year overall survival (OS) for stage III and IV patients for the no versus RT cohorts were 79% versus 88% (p < 0.0001) and 73% versus 84% (p < 0.0001), respectively. RT was associated with improved OS (HR = 0.76; 0.68–0.85) on multivariable analysis and in patients diagnosed after 2000. Although there was a decline in utilization of RT from 1988 to 2011, RT was associated with a survival benefit in stage III–IV HL.
Accumulating evidence suggests that physical activity may protect against the development of breast cancer, but less is known about the role of modest physical activity during the postmenopausal years and in the context of physical function.We evaluated this association in the Iowa 65+ Rural Health Study, a population-based, prospective cohort study of elderly adults. The cohort was linked to a population-based cancer registry for the years 1973-93, and the at-risk cohort consisted of 1806 women ages 65 to 102 years with an in-person baseline interview in 1982 and with no documented cancer between 1973 and the baseline interview. Through 1993 (16,857 person-years of follow-up) there were 46 incident cases of breast cancer.Greater level of physical activity in women with no physical disabilities was inversely associated with breast cancer risk (p for trend = .01). Compared to inactive women with no physical disability, women reporting moderate (age-adjusted relative risk [RR] = 0.5, 95% confidence interval [CI] 0.3-1.1) or high (age-adjusted RR = 0.2, 95% CI .05-0.9) activity levels were at decreased risk of breast cancer. Women with any disability were also at decreased risk of breast cancer compared to inactive women with no disability (age-adjusted RR = 0.4; 95% CI 0.2-0.9). Adjustment for education, body mass index, age at menarche, age at menopause, previous use of hormone replacement therapy, pregnancy history, systolic blood pressure, smoking, and alcohol use did not alter these associations. In addition, these associations were similar after exclusion of cases occurring during the first two years of follow-up, after adjusting for the number of doctor visits, and after stratifying by stage at diagnosis.These data suggest that postmenopausal activity level, after accounting for physical disability, is inversely associated with breast cancer risk.
Radiation therapy (RT) is commonly used as definitive treatment for early-stage nodular lymphocyte-predominant Hodgkin's lymphoma (NLPHL). We evaluated the cause-specific survival (CSS), overall survival (OS), and second malignancy (SM) rates in patients with early-stage NLPHL treated with RT.Patients with stage I-II NLPHL between 1988 and 2009 who underwent RT were selected from the Surveillance, Epidemiology and End Results database. Univariate analysis (UVA) for CSS and Os was performed using the Kaplan-Meier method and included age, gender, involved site, year of diagnosis, presence of B-symptoms, and extranodal involvement (ENI). Multivariable analysis (MVA) was performed using Cox Proportional Hazards modeling and included the above clinical variables. SM were classified as RT-related or non-RT-related. Freedom from SM and freedom from RT-related SM were determined using the Kaplan-Meier method.The study cohort included 469 patients. Median age was 37 years. The most common involved sites were the head and neck (36%), axilla/arm (26%), and multiple lymph node regions (18%). Sixty-eight percent had stage I disease, 70% were male, 4% had ENI, and 7% had B-symptoms. Median follow-up was 6 years. Ten-year CSS and Os were 98% and 88%, respectively. On UVA, none of the covariates was associated with CSS. Increasing age (p<0.01) and female gender (p<0.01) were associated with worse Os. On MVA, older age (p<0.01), female gender (p=0.04), multiple regions of involvement (p=0.03), stage I disease (p=0.02), and presence of B-symptoms (p=0.02) were associated with worse Os. Ten-year freedom from SM and freedom from RT-related SM were 89% and 99%, respectively.This is the largest series to evaluate the outcomes of stage I-II NLPHL patients treated with RT and found that this patient population has an excellent long-term prognosis and a low rate of RT-related second malignancies.
'/%3e%3cuse xlink:href='%23a' transform='rotate(23.036 .093 25.536)'/%3e%3cuse xlink:href='%23a' transform='rotate(45.87 1.273 16.18)'/%3e%3cuse xlink:href='%23a' transform='rotate(69.945 .996 12.078)'/%3e%3cuse xlink:href='%23a' transform='rotate(20.66 -19.689 31.932)'/%3e%3c/svg%3e)