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ASCO 2025 | The risk of second malignant neoplasm after mediastinal radiotherapy for pediatric Hodgkin lymphoma
Sarah Milgrom, MD, University of Colorado School of Medicine, Aurora, CO, comments on the risk of second malignant neoplasm after mediastinal radiotherapy for pediatric Hodgkin lymphoma (HL). Dr Milgrom notes that lower doses and smaller fields are currently used during radiation therapy to reduce the risk of subsequent malignant neoplasms, but that long-term follow-up is needed to confirm whether this will have the desired effect. Therefore, radiobiological modeling has been used to predict the risk of subsequent malignant neoplasm in survivors. This interview took place during the 2025 American Society of Clinical Oncology (ASCO) Meeting in Chicago, IL.
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Transcript
The way that we use radiation therapy to treat pediatric Hodgkin lymphoma has changed significantly over the past decades. We used to use much higher doses and larger fields and we know that that historic approach was associated with a high risk of subsequent malignant neoplasms in survivors. In particular, there was a high risk of breast cancer in female survivors who had been treated with radiation to the chest at a young age...
The way that we use radiation therapy to treat pediatric Hodgkin lymphoma has changed significantly over the past decades. We used to use much higher doses and larger fields and we know that that historic approach was associated with a high risk of subsequent malignant neoplasms in survivors. In particular, there was a high risk of breast cancer in female survivors who had been treated with radiation to the chest at a young age. Currently, we use much lower doses in smaller fields and that should be associated with a lower risk of subsequent malignant neoplasm, but it takes many decades of follow-up to get a good estimate of the incidence, because second malignant neoplasms are observed very late after radiation therapy.
One way to address this challenge is to use radiobiological modeling to predict the risk. So we used clinical and dosimetric data from a recent Children’s Oncology Group study, AHOD1331, to predict the risk of subsequent malignant neoplasm in survivors, and we found that the risk was substantially lower. Specifically, the risk of breast cancer, attributable to radiation therapy, was 3% above baseline at 70 years of age, and the risk of lung cancer was 5% above baseline at 70 years of age, and these incidences are substantially lower than what’s been observed in historic cohorts.
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