ABSTRACT
Advances made in the field of chemotherapy and radiotherapy have considerably increased
the survival of patients with Hodgkin's disease (HD), non-Hodgkin's lymphoma (NHL),
and chronic lymphocytic leukemia (CLL). Unfortunately, these antiblastic therapies
have also increased the risk of late complications such as second tumors, especially
second lung cancers. Although the role of ionizing radiations in carcinogenesis is
now clear, less is known about the damage caused by chemotherapy, immunodeficiency
induced by drugs or hematological pathologies, and cigarette smoking. In HD, the relative
risk (RR) of second lung cancer increases considerably in relation to the dose of
ionizing radiation given to the patient, with an RR of 9.6 when more than 9 Gy are
administered. Some studies have reported a significantly higher risk of second lung
cancers in smokers compared with nonsmokers (p = .03). The role of chemotherapy in the development of second lung cancers has yet
to be determined. Although some authors correlate a greater risk with an increased
number of chemotherapy cycles, others maintain that chemotherapy increases the risk
of second lung cancer only if associated with cigarette smoking. Even less is known
about the correlation between NHL and second lung cancer. Although the RR is higher
in long-term NHL survivors than in healthy individuals (RR = 1.36), the heterogeneity
of histotype and treatment does not permit us to confirm a correlation with chemotherapy
and smoking. Conversely, in CLL, the development of second lung cancer appears to
be linked to the immunodeficiency that accompanies this hematological malignancy.
This is confirmed by the identical RR (1.66) for CLL patients subjected to chemotherapy
and for those who have only follow-up.
KEYWORDS
Secondary lung cancer - Hodgkin's disease - non-Hodgkin's lymphoma - chronic lymphocytic
leukemia
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Dino AmadoriM.D.
Division of Oncology and Diagnostics, Ospedale G. B. Morgagni
Via C Forlanini 34, 47100 Forlì, Italy
Email: segronco@ausl.fo.it
