Radiation therapy in Hodgkin disease: why risk a Pyrrhic victory?

Content Provider	Semantic Scholar
Author	Longo, Dan L.
Copyright Year	2005
Abstract	Pyrrhus became King of Epirus in Northern Greece in 306 BC. He was a brilliant warrior and strategist; for example, he employed elephants in his attack force 60 years before Hannibal's famous use of these animals in the Second Punic War. In 280 BC , he invaded Italy and won a great battle at Heraclea but suffered enormous losses of men in his army. A few months later, in 279 BC , he won a second major battle at Asculum, again enduring severe and irreplaceable casualties. After being complimented on his success by one of his men, he is said to have responded, " Another such victory and we are undone. " Thus, through the centuries the term " Pyrrhic victory " has been used to mean a conquest won at too great a cost for the victor. In this issue of the Journal, Travis et al. (1) have studied the largest number of cases of secondary breast cancer after treatment for Hodgkin disease (106 patients) published to date. Most epidemiologic studies provide relative risks but never translate the results into an absolute risk that can be shared in a way the patient understands. However, Travis et al. have done a case – control study and computed cumulative absolute risks for developing breast cancer as a function of dose of radiation therapy and use of alkylating agent – based chemotherapy. The results are shocking. For a 25-year-old woman who received typical mantle-fi eld radiation therapy for her Hodgkin disease, the risk of developing breast cancer by age 55 years is 29% (95% confi dence interval [CI] = 20.2% to 40.1%). For a 25-year-old woman receiving a lower dose of radiation (20 – 40 Gy), the risk of developing breast cancer by age 55 years is 24.6% (95% CI = 16.6% to 24.8%). In addition, no evidence suggests that the risk declines after 30 years. According to Surveillance, Epidemiology, and End Results (SEER) data, a 25-year-old woman in the general population has about a 3% risk of developing breast cancer by age 55 years. Absolute risks are much easier to put in proper perspective than relative risks. Recall that millions of women stopped taking hormone replacement therapy that was controlling their meno-pausal symptoms and preserving their bone mineral density because of an increased relative risk of breast cancer that translates into quite a modest cumulative absolute risk (2). A 50-year-old woman …
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PubMed reference number	16204683v1
Volume Number	97
Issue Number	19
Journal	Journal of the National Cancer Institute
Language	English
Access Restriction	Open
Subject Keyword	Alkylating Agents Cooley's anemia Elephants Epidemiology Gonadorelin Hodgkin Disease Malignant lymphoma, lymphocytic, intermediate differentiation, diffuse Mammary Neoplasms Mental Suffering Patients Scientific Publication Shock Won breast metastasis
Content Type	Text
Resource Type	Article