Risk of Advanced Colorectal Neoplasia Higher Among Some Survivors of Hodgkin Lymphoma

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Treatment with alkylating agents and/or abdominal radiotherapy appears to increase risk of colorectal neoplasia in HL survivors.
Treatment with alkylating agents and/or abdominal radiotherapy appears to increase risk of colorectal neoplasia in HL survivors.

Survivors of Hodgkin lymphoma (HL) treated with abdominal radiotherapy and/or the alkylating chemotherapy procarbazine experience an increased prevalence of advanced colorectal neoplasia, according to results from a study published in Cancer.

In this study, researchers from the Netherlands assessed the diagnostic yield of advanced colorectal neoplasia identified by a first surveillance colonoscopy in 101 HL survivors treated with abdominal radiotherapy and/or procarbazine in a multicenter cohort study. They compared the results with those from a Dutch general population cohort of 1426 asymptomatic patients who underwent a primary screening colonoscopy between ages 50 and 75 years.

According to this predefined interim analysis, at a median age of 51 years (interquartile range [IQR], 45-57), the 101 HL survivors who underwent first surveillance colonoscopy were significantly younger than controls from the general population (median, 60 years; IQR, 55-65; P < .001).

This study defined advanced colorectal neoplasia as colorectal cancer, advanced serrated lesions (dysplasia or diameter of 10-mm or larger), and advanced adenomas (high-grade dysplasia, 25% or greater villous component, or diameter of 10-mm or larger).

Advanced colorectal neoplasia occurred at a higher prevalence in these HL survivors (25% [25/101]) vs controls (12% [171/1426]; P < .001), though detection of advanced adenomas was not statistically different between HL survivors (14% [14/101]) and controls (9% [124/1426]; P = .08).

Advanced serrated lesions were more prevalent in HL survivors (12% [12/101]) compared with controls (4% [55/1426]; P < .001). Similarly, serrated polyposis syndrome was more prevalent in HL survivors (6%), occurring in none of the controls (P < .001).

Although the prevalence of advanced adenomas was higher in male HL survivors (23%) vs male controls (10%; P = .002), the prevalence of advanced serrated lesions was similar between males in the 2 groups (5% in HL survivors vs 4% in controls; P = .64).

“[T]he evidence provided by this interim analysis indicates that colonoscopy surveillance should be considered,” concluded the authors.

Reference

Rigter LS, Spaander MC, Aleman BM, et al. High prevalence of advanced colorectal neoplasia and serrated polyposis syndrome in Hodgkin lymphoma survivors [published online December 18, 2018]. Cancer. doi: 10.1002/cncr.31903
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