Second malignant neoplasm risk after mediastinal radiotherapy for pediatric Hodgkin lymphoma on Children’s Oncology Group AHOD1331.

• DOI: 10.1200/jco.2025.43.16_suppl.10019
• Publication Date: 2025-05-28T21:10:54Z
• Authors: Sarah Milgrom; Harald Paganetti; Hitesh Dama; Lindsay A. Renfro; Yue Wu; Isaac Meyer; Susan K. Parsons; Angela Punnett; Anne-Marie Charpe...; Andrea Lo; Raymond Mailhot Vega; Frank G. Keller; Kara M Kelly; Bradford Hoppe; Sharon M. Castellino; David C. Hodgson
• Keywords: Pediatric Oncology

10019 Background: The reported incidence of second malignant neoplasms (SMN) in long-term survivors Hodgkin lymphoma (HL) is derived from patients treated with outdated radiation therapy (RT) techniques. We modeled the risk SMN pediatric high-risk classic HL modern mediastinal RT. Methods: In who received RT on Children’s Oncology Group study AHOD1331, we lifetime attributable (LAR) at 70 years age thyroid, lung, and breast carcinoma. This value indicates absolute increased due to RT, above baseline population (mean rates are 0.7%, 3.3%, 8.9% for carcinoma, respectively, https://seer.cancer.gov/data/ ). Results: 296 protocol-directed median diagnosis was 15.1 years, 55% were female, 98% had large adenopathy. Following 5 cycles chemotherapy, targeting mediastinum based criteria this study; addition, some other supradiaphragmatic sites that contained slowly responding lesions, including axilla (n = 3, 1%), lung 7, 2.4%), upper neck 4, 1.3%), lower 8, 2.7%). modality proton 25.3%, photon intensity modulated (IMRT) 45.6%, 3-dimensional conformal (3D-CRT) 27.7%. prescription dose 21 Gy 83% 30 16% a partial metabolic response completion chemotherapy. mean (range) doses lungs, breasts 12.8 (0-30.3), 8.0 (0.1-15.2), 4.2 (0.2-14.5), respectively. For complete cohort, LAR thyroid carcinoma 0.063% 5.34%. females, 2.92%. Table summarizes each SMN, stratified by modality. Conclusions: recent multi-institutional HL, predicted substantially than historical cohorts. Clinicians should consider toxicity associated current approach when selecting therapies counseling patients. Clinical trial information: NCT02166463 , post hoc modeling includes enrolled study. Mean [range] (%) an attained Thyroid Lung Breast (females) 3D-CRT 0.046 [0.002-0.332]N=81 5.07 [0.12-10.82]N=82 1.82 [0.67-5.98]N=46 IMRT 0.064 [0.001-0.386]N=135 6.24 [2.22-11.79]N=135 4.36 [0.66-8.43]N=76 Proton 0.086 [0-1.160]N=74 4.15 [0.94-7.77]N=75 1.45 [0.17-7.23]N=40