96 results on '"van Leeuwen, Flora E."'
Search Results
2. Reply to G. Wang et al.
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Lubberts, Sjoukje, van Leeuwen, Flora E., Schaapveld, Michael, and Gietema, Jourik A.
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- 2023
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3. Subsequent female breast cancer risk associated with anthracycline chemotherapy for childhood cancer
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Wang, Yuehan, Ronckers, Cécile M., van Leeuwen, Flora E., Moskowitz, Chaya S., Leisenring, Wendy, Armstrong, Gregory T., de Vathaire, Florent, Hudson, Melissa M., Kuehni, Claudia E., Arnold, Michael A., Demoor-Goldschmidt, Charlotte, Green, Daniel M., Henderson, Tara O., Howell, Rebecca M., Ehrhardt, Matthew J., Neglia, Joseph P., Oeffinger, Kevin C., van der Pal, Helena J. H., Robison, Leslie L., Schaapveld, Michael, Turcotte, Lucie M., Waespe, Nicolas, Kremer, Leontien C. M., and Teepen, Jop C.
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Anthracycline-based chemotherapy is associated with increased subsequent breast cancer (SBC) risk in female childhood cancer survivors, but the current evidence is insufficient to support early breast cancer screening recommendations for survivors treated with anthracyclines. In this study, we pooled individual patient data of 17,903 survivors from six well-established studies, of whom 782 (4.4%) developed a SBC, and analyzed dose-dependent effects of individual anthracycline agents on developing SBC and interactions with chest radiotherapy. A dose-dependent increased SBC risk was seen for doxorubicin (hazard ratio (HR) per 100 mg m−2: 1.24, 95% confidence interval (CI): 1.18–1.31), with more than twofold increased risk for survivors treated with ≥200 mg m−2cumulative doxorubicin dose versus no doxorubicin (HR: 2.50 for 200–299 mg m−2, HR: 2.33 for 300–399 mg m−2and HR: 2.78 for ≥400 mg m−2). For daunorubicin, the associations were not statistically significant. Epirubicin was associated with increased SBC risk (yes/no, HR: 3.25, 95% CI: 1.59–6.63). For patients treated with or without chest irradiation, HRs per 100 mg m−2of doxorubicin were 1.11 (95% CI: 1.02–1.21) and 1.26 (95% CI: 1.17–1.36), respectively. Our findings support that early initiation of SBC surveillance may be reasonable for survivors who received ≥200 mg m−2cumulative doxorubicin dose and should be considered in SBC surveillance guidelines for survivors and future treatment protocols.
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- 2023
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4. Development and Validation of Risk Prediction Models for Coronary Heart Disease and Heart Failure After Treatment for Hodgkin Lymphoma.
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de Vries, Simone, Haaksma, Miriam L., Jóźwiak, Katarzyna, Schaapveld, Michael, Hodgson, David C., Lugtenburg, Pieternella J., Krol, Augustinus D.G., Petersen, Eefke J., van Spronsen, Dick Johan, Ahmed, Sameera, Hauptmann, Michael, Aleman, Berthe M.P., and van Leeuwen, Flora E.
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- 2023
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5. Development and Validation of Risk Prediction Models for Coronary Heart Disease and Heart Failure After Treatment for Hodgkin Lymphoma.
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de Vries, Simone, Haaksma, Miriam L., Jóźwiak, Katarzyna, Schaapveld, Michael, Hodgson, David C., Lugtenburg, Pieternella J., Krol, Augustinus D.G., Petersen, Eefke J., van Spronsen, Dick Johan, Ahmed, Sameera, Hauptmann, Michael, Aleman, Berthe M.P., and van Leeuwen, Flora E.
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- 2023
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6. Association of Radiation and Procarbazine Dose With Risk of Colorectal Cancer Among Survivors of Hodgkin Lymphoma
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Geurts, Yvonne M., Shakir, Rebecca, Ntentas, Georgios, Roberti, Sander, Aznar, Marianne C., John, Katinka M., Ramroth, Johanna, Janus, Cécile P. M., Krol, Augustinus D. G., Roesink, Judith M., van der Maazen, Richard W. M., Zijlstra, Josée M., Darby, Sarah C., Aleman, Berthe M. P., van Leeuwen, Flora E., Cutter, David J., and Schaapveld, Michael
- Abstract
IMPORTANCE: Hodgkin lymphoma (HL) survivors have higher rates of colorectal cancer, which may be associated with subdiaphragmatic radiation therapy and/or alkylating chemotherapy. Although radiation dose-response associations with breast, lung, stomach, pancreatic, and esophageal cancer after HL have been demonstrated, the association of radiation therapy with colorectal cancer remains unclear. OBJECTIVE: To quantify the rate of colorectal cancer according to radiation dose to the large bowel and procarbazine dose among HL survivors. DESIGN, SETTING, AND PARTICIPANTS: A nested case-control study examined 5-year HL survivors at 5 hospital centers in the Netherlands. Participants had been diagnosed with HL in 1964 to 2000, when they were 15 to 50 years of age, and were followed for a median of approximately 26 years. Survivors of HL who developed colorectal cancer and survivors who were selected as controls were individually matched on sex, age at HL diagnosis, and date of HL diagnosis. Data were analyzed from July 2021 to October 2022. EXPOSURES: Mean radiation doses to the large bowel were estimated by reconstructing individual radiation therapy treatments on representative computed tomography data sets. MAIN OUTCOMES AND MEASURES: Excess rate ratios (ERRs) were modeled to evaluate the excess risk associated with each 1-gray increase in radiation dose, and potential effect modification by procarbazine was explored. RESULTS: The study population included 316 participants (mean [SD] age at HL diagnosis, 33.0 [9.8] years; 221 [69.9%] men), 78 of whom were HL survivors who developed colorectal cancer (cases) and 238 who did not (controls). The median (IQR) interval between HL and colorectal cancer was 25.7 (18.2-31.6) years. Increased colorectal cancer rates were seen for patients who received subdiaphragmatic radiation therapy (rate ratio [RR], 2.4; 95% CI, 1.4-4.1) and those who received more than 8.4 g/m2 procarbazine (RR, 2.5; 95% CI, 1.3-5.0). Overall, colorectal cancer rate increased linearly with mean radiation dose to the whole large bowel and dose to the affected bowel segment. The association between radiation dose and colorectal cancer rate became stronger with increasing procarbazine dose: the ERR per gray to the whole bowel was 3.5% (95% CI, 0.4%-12.6%) for patients who did not receive procarbazine, and increased 1.2-fold (95% CI, 1.1-1.3) for each 1-g/m2 increase in procarbazine dose. CONCLUSIONS AND RELEVANCE: This nested case-control study of 5-year HL survivors found a dose-response association between radiation therapy and colorectal cancer risk, and modification of this association by procarbazine. These findings may enable individualized colorectal cancer risk estimations, identification of high-risk survivors for subsequent screening, and optimization of treatment strategies.
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- 2023
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7. Cost-Effectiveness of Colorectal Cancer Surveillance in Hodgkin Lymphoma Survivors Treated with Procarbazine and/or Infradiaphragmatic Radiotherapy.
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Ykema, Berbel L. M., Gini, Andrea, Rigter, Lisanne S., Spaander, Manon C. W., Moons, Leon M. G., Bisseling, Tanya M., de Boer, Jan Paul, Verbeek, Wieke H. M., Lugtenburg, Pieternella J., Janus, Cecile P. M., Petersen, Eefke J., Roesink, Judith M., van der Maazen, Richard W. M., Aleman, Berthe M. P., Meijer, Gerrit A., van Leeuwen, Flora E., Snaebjornsson, Petur, Carvalho, Beatriz, van Leerdam, Monique E., and Lansdorp-Vogelaar, Iris
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Background: Hodgkin lymphoma survivors treated with infradiaphragmatic radiotherapy (IRT) and/or procarbazine have an increased risk of developing colorectal cancer. We investigated the cost-effectiveness of colorectal cancer surveillance in Dutch Hodgkin lymphoma survivors to determine the optimal surveillance strategy for different Hodgkin lymphoma subgroups. Methods: The Microsimulation Screening Analysis-Colon model was adjusted to reflect colorectal cancer and other-cause mortality risk in Hodgkin lymphoma survivors. Ninety colorectal cancer surveillance strategies were evaluated varying in starting and stopping age, interval, and modality [colonoscopy, fecal immunochemical test (FIT, OC-Sensor; cutoffs: 10/20/47 µg Hb/g feces), and multi-target stool DNA test (Cologuard)]. Analyses were also stratified per primary treatment (IRT and procarbazine or procarbazine without IRT). Colorectal cancer deaths averted (compared with no surveillance) and incremental cost-effectiveness ratios (ICER) were primary outcomes. The optimal surveillance strategy was identified assuming a willingness-to-pay threshold of €20,000 per life-years gained (LYG). Results: Overall, the optimal surveillance strategy was annual FIT (47 µg) from age 45 to 70 years, which might avert 70% of colorectal cancer deaths in Hodgkin lymphoma survivors (compared with no surveillance; ICER:€18,000/LYG). The optimal surveillance strategy in Hodgkin lymphoma survivors treated with procarbazine without IRT was biennial FIT (47 µg) from age 45 to 70 years (colorectal cancer mortality averted 56%; ICER:€15,000/LYG), and when treated with IRT and procarbazine, annual FIT (47 µg) surveillance from age 40 to 70 was most cost-effective (colorectal cancer mortality averted 75%; ICER:€13,000/LYG). Conclusions: Colorectal cancer surveillance in Hodgkin lymphoma survivors is cost-effective and should commence earlier than screening occurs in population screening programs. For all subgroups, FIT surveillance was the most cost-effective strategy. Impact: Colorectal cancer surveillance should be implemented in Hodgkin lymphoma survivors. [ABSTRACT FROM AUTHOR]
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- 2022
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8. Reaching beyond maximum grade: progress and future directions for modernising the assessment and reporting of adverse events in haematological malignancies
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Thanarajasingam, Gita, Minasian, Lori M, Bhatnagar, Vishal, Cavalli, Franco, De Claro, R Angelo, Dueck, Amylou C, El-Galaly, Tarec C, Everest, Neil, Geissler, Jan, Gisselbrecht, Christian, Gormley, Nicole, Gribben, John, Horowitz, Mary, Ivy, S Percy, Jacobson, Caron A, Keating, Armand, Kluetz, Paul G, Kwong, Yok Lam, Little, Richard F, Matasar, Matthew J, Mateos, Maria-Victoria, McCullough, Kristen, Miller, Robert S, Mohty, Mohamad, Moreau, Philippe, Morton, Lindsay M, Nagai, Sumimasa, Nair, Abhilasha, Nastoupil, Loretta, Robertson, Kaye, Sidana, Surbhi, Smedby, Karin E, Sonneveld, Pieter, Tzogani, Kyriaki, van Leeuwen, Flora E, Velikova, Galina, Villa, Diego, Wingard, John R, Seymour, John F, and Habermann, Thomas M
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Remarkable improvements in outcomes for many haematological malignancies have been driven primarily by a proliferation of novel therapeutics over the past two decades. Targeted agents, immune and cellular therapies, and combination regimens have adverse event profiles distinct from conventional finite cytotoxic chemotherapies. In 2018, a Commission comprising patient advocates, clinicians, clinical investigators, regulators, biostatisticians, and pharmacists representing a broad range of academic and clinical cancer expertise examined issues of adverse event evaluation in the context of both newer and existing therapies for haematological cancers. The Commission proposed immediate actions and long-term solutions in the current processes in adverse event assessment, patient-reported outcomes in haematological malignancies, toxicities in cellular therapies, long-term toxicity and survivorship in haematological malignancies, issues in regulatory approval from an international perspective, and toxicity reporting in haematological malignancies and the real-world setting. In this follow-up report, the Commission describes progress that has been made in these areas since the initial report.
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- 2022
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9. Updated Breast Cancer Surveillance Recommendations for Female Survivors of Childhood, Adolescent, and Young Adult Cancer From the International Guideline Harmonization Group.
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Mulder, Renée L., Hudson, Melissa M., Bhatia, Smita, Landier, Wendy, Levitt, Gill, Constine, Louis S., Wallace, W. Hamish, van Leeuwen, Flora E., Ronckers, Cécile M., Henderson, Tara O., Moskowitz, Chaya S., Friedman, Danielle N., Ng, Andrea K., Jenkinson, Helen C., Demoor-Goldschmidt, Charlotte, Skinner, Roderick, Kremer, Leontien C.M., and Oeffinger, Kevin C.
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- 2020
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10. Risk of male breast cancer after Hodgkin lymphoma
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de Vries, Simone, Krul, Inge M., Schaapveld, Michael, Janus, Cecile P. M., Rademakers, Saskia E., Roesink, Judith M., Nijziel, Marten R., Bilgin, Yavuz M., van Leeuwen, F. E., Nijdam, A., Aleman, B. M. P., de Boer, J. P., Janus, C. P. M., Mutsaers, P. G. N. J., So-Osman, C., Zijlstra, J. M., Meijer, O. W. M., Rademakers, S. E., Krol, A. D. G., Kersten, M. J., Tonino, S. H., Jalink, M., Daniëls, L. A., van Spronsen, D. J., van der Maazen, R. W. M., Loonen, J., Roesink, J. M., Oostvogels, R., de Weijer, R., Buter, D., de Boer, A., Aarsman, K. M., Oudbier, C. W., Nijziel, M. R., van den Berg, M., Verschueren, K., Schippers, M., Boersma, R. S., Issa, D. E., Plattel, W. J., Stedema, F. G., Koene, H. R., Raymakers, E. R. P. M., Schimmel, E., van Hezewijk, M., Bouma, P., Muller, K., Siemes, C., van der Spek, J. M., Ong, F., Jonkman, A., de Jongh, E., Sprangers, S., Kortleve, J. P., Vermeiden, C. M., Ta, B., Vercoulen, L., Paulissen, J., Posthuma, E. F. M., Brouwer, R. E., Soechit, S., van der Wiel, M., Böhmer, L., Bilgin, M. Y., Kuipers, S., Houmes, M., te Boome, L., Gommers, S., Aleman, Berthe M. P., and van Leeuwen, Flora E.
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•Male survivors of HL treated with chest radiotherapy have an increased risk of developing BC compared with the general population.•Although the occurrence of male BC is an uncommon event, clinicians should be alert to BC symptoms in male survivors of HL.
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- 2024
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11. Diagnostic tools for early detection of cardiac dysfunction in childhood cancer survivors: Methodological aspects of the Dutch late effects after childhood cancer (LATER) cardiology study.
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Leerink, Jan M., Feijen, E. Lieke A.M., van der Pal, Helena J.H., Kok, Wouter E.M., Mavinkurve-Groothuis, Annelies M.C., Kapusta, Livia, Pinto, Yigal M., Maas, Angela H.E.M., Bellersen, Louise, Teske, Arco J., Ronckers, Cécile M., Louwerens, Marloes, van Dalen, Elvira C., van Dulmen-den Broeder, Eline, Batenburg, Lilian, van der Heiden-van der Loo, Margriet, van den Heuvel-Eibrink, Marry M., van Leeuwen, Flora E., de Vries, Andrica C.H., and Weijers, Gert
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Background: Cancer therapy-related cardiac dysfunction and heart failure are major problems in long-term childhood cancer survivors (CCS). We hypothesize that assessment of more sensitive echo- and electrocardiographic measurements, and/or biomarkers will allow for improved recognition of patients with cardiac dysfunction before heart failure develops, and may also identify patients at lower risk for heart failure.Objective: To describe the methodology of the Dutch LATER cardiology study (LATER CARD).Methods: The LATER CARD study is a cross-sectional study in long-term CCS treated with (potentially) cardiotoxic cancer therapies and sibling controls. We will evaluate 1) the prevalence and associated (treatment related) risk factors of subclinical cardiac dysfunction in CCS compared to sibling controls and 2) the diagnostic value of echocardiography including myocardial strain and diastolic function parameters, blood biomarkers for cardiomyocyte apoptosis, oxidative stress, cardiac remodeling and inflammation and ECG or combinations of them in the surveillance for cancer therapy-related cardiac dysfunction. From 2017 to 2020 we expect to include 1900 CCS and 500 siblings.Conclusions: The LATER CARD study will provide knowledge on different surveillance modalities for detection of cardiac dysfunction in long-term CCS at risk for heart failure. The results of the study will enable us to improve long-term follow-up surveillance guidelines for CCS at risk for heart failure. [ABSTRACT FROM AUTHOR]- Published
- 2020
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12. Risk of digestive cancers in a cohort of 69 460 five-year survivors of childhood cancer in Europe: the PanCareSurFup study
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Reulen, Raoul C, Wong, Kwok F, Bright, Chloe J, Winter, David L, Alessi, Daniela, Allodji, Rodrigue M, Bagnasco, Francesca, Bárdi, Edit, Bautz, Andrea, Byrne, Julianne, Feijen, Elizabeth AM, Fidler-Benaoudia, Miranda M, Diallo, Ibrahim, Garwicz, Stanislaw, Grabow, Desiree, Gudmundsdottir, Thorgerdur, Guha, Joyeeta, Haddy, Nadia, Høgsholt, Stine, Jankovic, Moncilo, Kaatsch, Peter, Kaiser, Melanie, Kuonen, Rahel, Linge, Helena, Øfstaas, Hilde, Ronckers, Cecile M, Hau, Eva-Maria, Skinner, Roderick, van Leeuwen, Flora E, Teepen, Jop C, Veres, Cristina, Zrafi, Wael, Debiche, Ghazi, Llanas, Damien, Terenziani, Monica, Vu-Bezin, Giao, Wesenberg, Finn, Wiebe, Thomas, Sacerdote, Carlotta, Jakab, Zsuzsanna, Haupt, Riccardo, La¨hteenma¨ki, Pa¨ivi M, Zadravec Zaletel, Lorna, Kuehni, Claudia E, Winther, Jeanette F, de Vathaire, Florent, Kremer, Leontien C, Hjorth, Lars, and Hawkins, Michael M
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BackgroundSurvivors of childhood cancer are at risk of subsequent primary neoplasms (SPNs), but the risk of developing specific digestive SPNs beyond age 40 years remains uncertain. We investigated risks of specific digestive SPNs within the largest available cohort worldwide.MethodsThe PanCareSurFup cohort includes 69 460 five-year survivors of childhood cancer from 12 countries in Europe. Risks of digestive SPNs were quantified using standardised incidence ratios (SIRs), absolute excess risks and cumulative incidence.Results427 digestive SPNs (214 colorectal, 62 liver, 48 stomach, 44 pancreas, 59 other) were diagnosed in 413 survivors. Wilms tumour (WT) and Hodgkin lymphoma (HL) survivors were at greatest risk (SIR 12.1; 95% CI 9.6 to 15.1; SIR 7.3; 95% CI 5.9 to 9.0, respectively). The cumulative incidence increased the most steeply with increasing age for WT survivors, reaching 7.4% by age 55% and 9.6% by age 60 years (1.0% expected based on general population rates). Regarding colorectal SPNs, WT and HL survivors were at greatest risk; both seven times that expected. By age 55 years, 2.3% of both WT (95% CI 1.4 to 3.9) and HL (95% CI 1.6 to 3.2) survivors had developed a colorectal SPN—comparable to the risk among members of the general population with at least two first-degree relatives affected.ConclusionsColonoscopy surveillance before age 55 is recommended in many European countries for individuals with a family history of colorectal cancer, but not for WT and HL survivors despite a comparable risk profile. Clinically, serious consideration should be given to the implementation of colonoscopy surveillance while further evaluation of its benefits, harms and cost-effectiveness in WT and HL survivors is undertaken.
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- 2021
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13. Chromosome 20 loss is characteristic of breast implant–associated anaplastic large cell lymphoma
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Los-de Vries, G. Tjitske, de Boer, Mintsje, van Dijk, Erik, Stathi, Phylicia, Hijmering, Nathalie J., Roemer, Margaretha G.M., Mendeville, Matias, Miedema, Daniel M., de Boer, Jan Paul, Rakhorst, Hinne A., van Leeuwen, Flora E., van der Hulst, René R.W.J., Ylstra, Bauke, and de Jong, Daphne
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Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is a very rare type of T-cell lymphoma that is uniquely caused by a single environmental stimulus. Here, we present a comprehensive genetic analysis of a relatively large series of BIA-ALCL (n = 29), for which genome-wide chromosomal copy number aberrations (CNAs) and mutational profiles for a subset (n = 7) were determined. For comparison, CNAs for anaplastic lymphoma kinase (ALK)−nodal anaplastic large cell lymphomas (ALCLs; n = 24) were obtained. CNAs were detected in 94% of BIA-ALCLs, with losses at chromosome 20q13.13 in 66% of the samples. Loss of 20q13.13 is characteristic of BIA-ALCL compared with other classes of ALCL, such as primary cutaneous ALCL and systemic type ALK+and ALK−ALCL. Mutational patterns confirm that the interleukin-6–JAK1–STAT3 pathway is deregulated. Although this is commonly observed across various types of T-cell lymphomas, the extent of deregulation is significantly higher in BIA-ALCL, as indicated by phosphorylated STAT3 immunohistochemistry. The characteristic loss of chromosome 20 in BIA-ALCL provides further justification to recognize BIA-ALCL as a separate disease entity. Moreover, CNA analysis may serve as a parameter for future diagnostic assays for women with breast implants to distinguish seroma caused by BIA-ALCL from other causes of seroma accumulation, such as infection or trauma.
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- 2020
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14. Chromosome 20 loss is characteristic of breast implant–associated anaplastic large cell lymphoma
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Los-de Vries, G. Tjitske, de Boer, Mintsje, van Dijk, Erik, Stathi, Phylicia, Hijmering, Nathalie J., Roemer, Margaretha G. M., Mendeville, Matias, Miedema, Daniel M., de Boer, Jan Paul, Rakhorst, Hinne A., van Leeuwen, Flora E., van der Hulst, René R. W. J., Ylstra, Bauke, and de Jong, Daphne
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Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is a very rare type of T-cell lymphoma that is uniquely caused by a single environmental stimulus. Here, we present a comprehensive genetic analysis of a relatively large series of BIA-ALCL (n = 29), for which genome-wide chromosomal copy number aberrations (CNAs) and mutational profiles for a subset (n = 7) were determined. For comparison, CNAs for anaplastic lymphoma kinase (ALK)− nodal anaplastic large cell lymphomas (ALCLs; n = 24) were obtained. CNAs were detected in 94% of BIA-ALCLs, with losses at chromosome 20q13.13 in 66% of the samples. Loss of 20q13.13 is characteristic of BIA-ALCL compared with other classes of ALCL, such as primary cutaneous ALCL and systemic type ALK+ and ALK− ALCL. Mutational patterns confirm that the interleukin-6–JAK1–STAT3 pathway is deregulated. Although this is commonly observed across various types of T-cell lymphomas, the extent of deregulation is significantly higher in BIA-ALCL, as indicated by phosphorylated STAT3 immunohistochemistry. The characteristic loss of chromosome 20 in BIA-ALCL provides further justification to recognize BIA-ALCL as a separate disease entity. Moreover, CNA analysis may serve as a parameter for future diagnostic assays for women with breast implants to distinguish seroma caused by BIA-ALCL from other causes of seroma accumulation, such as infection or trauma.
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- 2020
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15. Increased prevalence of BRCA1/2 mutations in women with macrotextured breast implants and anaplastic large cell lymphoma of the breast
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de Boer, Mintsje, Hauptmann, Michael, Hijmering, Nathalie J., van Noesel, Carel J. M., Rakhorst, Hinne A., Meijers-Heijboer, Hanne E. J., de Boer, Jan Paul, van der Hulst, René R. W. J., de Jong, Daphne, and van Leeuwen, Flora E.
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- 2020
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16. Increased prevalence of BRCA1/2mutations in women with macrotextured breast implants and anaplastic large cell lymphoma of the breast
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de Boer, Mintsje, Hauptmann, Michael, Hijmering, Nathalie J., van Noesel, Carel J.M., Rakhorst, Hinne A., Meijers-Heijboer, Hanne E.J., de Boer, Jan Paul, van der Hulst, René R.W.J., de Jong, Daphne, and van Leeuwen, Flora E.
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- 2020
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17. High-Dose Chemotherapy With Hematopoietic Stem Cell Transplant in Patients With High-Risk Breast Cancer and 4 or More Involved Axillary Lymph Nodes: 20-Year Follow-up of a Phase 3 Randomized Clinical Trial
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Steenbruggen, Tessa G., Steggink, Lars C., Seynaeve, Caroline M., van der Hoeven, Jacobus J. M., Hooning, Maartje J., Jager, Agnes, Konings, Inge R., Kroep, Judith R., Smit, Wim M., Tjan-Heijnen, Vivianne C. G., van der Wall, Elsken, Bins, Adriaan D., Linn, Sabine C., Schaapveld, Michael, Jacobse, Judy N., van Leeuwen, Flora E., Schröder, Carolien P., van Tinteren, Harm, de Vries, Elisabeth G. E., Sonke, Gabe S., and Gietema, Jourik A.
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IMPORTANCE: Trials of adjuvant high-dose chemotherapy (HDCT) have failed to show a survival benefit in unselected patients with breast cancer, but long-term follow-up is lacking. OBJECTIVE: To determine 20-year efficacy and safety outcomes of a large trial of adjuvant HDCT vs conventional-dose chemotherapy (CDCT) for patients with stage III breast cancer. DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis used data from a randomized phase 3 multicenter clinical trial of 885 women younger than 56 years with breast cancer and 4 or more involved axillary lymph nodes conducted from August 1, 1993, to July 31, 1999. Additional follow-up data were collected between June 1, 2016, and December 31, 2017, from medical records, general practitioners, the Dutch national statistical office, and nationwide cancer registries. Analysis was performed on an intention-to-treat basis. Statistical analysis was performed from February 1, 2018, to October 14, 2019. INTERVENTIONS: Participants were randomized 1:1 to receive 5 cycles of CDCT consisting of fluorouracil, 500 mg/m2, epirubicin, 90 mg/m2, and cyclophosphamide, 500 mg/m2, or HDCT in which the first 4 cycles were identical to CDCT and the fifth cycle was replaced by cyclophosphamide, 6000 mg/m2, thiotepa, 480 mg/m2, and carboplatin, 1600 mg/m2, followed by hematopoietic stem cell transplant. MAIN OUTCOMES AND MEASURES: Main end points were overall survival and safety and cumulative incidence risk of a second malignant neoplasm or cardiovascular events. RESULTS: Of the 885 women in the study (mean [SD] age, 44.5 [6.6] years), 442 were randomized to receive HDCT, and 443 were randomized to receive CDCT. With 20.4 years median follow-up (interquartile range, 19.2-22.0 years), the 20-year overall survival was 45.3% with HDCT and 41.5% with CDCT (hazard ratio, 0.89; 95% CI, 0.75-1.06). The absolute improvement in 20-year overall survival was 14.6% (hazard ratio, 0.72; 95% CI, 0.54-0.95) for patients with 10 or more invoved axillary lymph nodes and 15.4% (hazard ratio, 0.67; 95% CI, 0.42-1.05) for patients with triple-negative breast cancer. The cumulative incidence risk of a second malignant neoplasm at 20 years or major cardiovascular events was similar in both treatment groups (20-year cumulative incidence risk for second malignant neoplasm was 12.1% in the HDCT group vs 16.2% in the CDCT group, P = .10), although patients in the HDCT group more often had hypertension (21.7% vs 14.3%, P = .02), hypercholesterolemia (15.7% vs 10.6%, P = .04), and dysrhythmias (8.6% vs 4.6%, P = .005). CONCLUSIONS AND RELEVANCE: High-dose chemotherapy provided no long-term survival benefit in unselected patients with stage III breast cancer but did provide improved overall survival in very high-risk patients (ie, with ≥10 involved axillary lymph nodes). High-dose chemotherapy did not affect long-term risk of a second malignant neoplasm or major cardiovascular events. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03087409
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- 2020
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18. Discordant Marker Expression Between Invasive Breast Carcinoma and Corresponding Synchronous and Preceding DCIS
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Visser, Lindy L., Elshof, Lotte E., Van de Vijver, Koen, Groen, Emma J., Almekinders, Mathilde M., Sanders, Joyce, Bierman, Carolien, Peters, Dennis, Hofland, Ingrid, Broeks, Annegien, van Leeuwen, Flora E., Rutgers, Emiel J. Th, Schmidt, Marjanka K., Schaapveld, Michael, Lips, Esther H., and Wesseling, Jelle
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Supplemental Digital Content is available in the text.Ductal carcinoma in situ (DCIS) is considered a potential precursor of invasive breast carcinoma (IBC). Studies aiming to find markers involved in DCIS progression generally have compared characteristics of IBC lesions with those of adjacent synchronousDCIS lesions. The question remains whether synchronousDCIS and IBC comparisons are a good surrogate for primaryDCIS and subsequentIBC. In this study, we compared both primary DCIS and synchronous DCIS with the associated IBC lesion, on the basis of immunohistochemical marker expression. Immunohistochemical analysis of ER, PR, HER2, p53, and cyclo-oxygenase 2 (COX-2) was performed for 143 primary DCIS and subsequent IBC lesions, including 81 IBC lesions with synchronous DCIS. Agreement between DCIS and IBC was assessed using kappa, and symmetry tests were performed to assess the pattern in marker conversion. The primary DCIS and subsequent IBC more often showed discordant marker expression than synchronous DCIS and IBC. Strikingly, 18 of 49 (36%) women with HER2-positive primary DCIS developed an HER2-negative IBC. Such a difference in HER2 expression was not observed when comparing synchronous DCIS and IBC. The frequency of discordant marker expression did not increase with longer time between primary DCIS and IBC. In conclusion, comparison of primary DCIS and subsequent IBC yields different results than a comparison of synchronous DCIS and IBC, in particular with regard to HER2 status. To gain more insight into the progression of DCIS to IBC, it is essential to focus on the relationship between primaryDCIS and subsequentIBC, rather than comparing IBC with synchronousDCIS.
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- 2019
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19. Prognostic Impact of Breast-Conserving Therapy Versus Mastectomy of BRCA1/2 Mutation Carriers Compared With Noncarriers in a Consecutive Series of Young Breast Cancer Patients.
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van den Broek, Alexandra J., Schmidt, Marjanka K., van 't Veer, Laura J., Oldenburg, Hester S. A., Rutgers, Emiel J., Russell, Nicola S., Smit, Vincent T. H. B. M., Voogd, Adri C., Koppert, Linetta B., Siesling, Sabine, Jobsen, Jan J., Westenend, Pieter J., van Leeuwen, Flora E., and Tollenaar, Rob A. E. M.
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Supplemental Digital Content is available in the text Objective: To investigate the effects of different types of surgery on breast cancer prognosis in germline BRCA1 / BRCA2 mutation carriers compared with noncarriers. Summary of Background Data: Although breast-conserving therapy (breast-conserving surgery followed by radiotherapy) has been associated with more local recurrences than mastectomy, no differences in overall survival have been found in randomized trials performed in the general breast cancer population. Whether breast-conservation can be safely offered to BRCA1/2 mutation carriers is debatable. Methods: The study comprised a cohort of women with invasive breast cancer diagnosed <50 years and treated between 1970 and 2003 in 10 Dutch centers. Germline DNA for BRCA1/2 testing of most-prevalent mutations (covering ∼61%) was mainly derived from paraffin-blocks. Survival analyses were performed taking into account competing risks. Results: In noncarriers (N = 5820), as well as in BRCA1 (N = 191) and BRCA2 (N = 70) mutation carriers, approximately half of the patients received breast-conserving therapy. Patients receiving mastectomy followed by radiotherapy had prognostically worse tumor characteristics and more often received systemic therapy. After adjustment for these potential confounders, patients who received breast-conserving therapy had a similar overall survival compared with patients who received mastectomy, both in noncarriers (hazard ratio [HR] = 0.95, confidence interval [CI] = 0.85–1.07, P = 0.41) and BRCA1 mutation carriers (HR = 0.80, CI = 0.42–1.51, P = 0.50). Numbers for BRCA2 were insufficient to draw conclusions. The rate of local recurrences after breast-conserving therapy did not differ between BRCA1 carriers (10-year risk = 7.3%) and noncarriers (10-year risk = 7.9%). Conclusion: Our results, together with the available literature, provide reassurance that breast-conserving therapy is a safe local treatment option to offer to BRCA1 mutation carriers with invasive breast cancer. [ABSTRACT FROM AUTHOR]
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- 2019
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20. Predictors of an Invasive Breast Cancer Recurrence after DCIS: A Systematic Review and Meta-analyses.
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Visser, Lindy L., Groen, Emma J., van Leeuwen, Flora E., Lips, Esther H., Schmidt, Marjanka K., and Wesseling, Jelle
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We performed a systematic review with meta-analyses to summarize current knowledge on prognostic factors for invasive disease after a diagnosis of ductal carcinoma in situ (DCIS). Eligible studies assessed risk of invasive recurrence in women primarily diagnosed and treated for DCIS and included at least 10 ipsilateral-invasive breast cancer events and 1 year of follow-up. Quality in Prognosis Studies tool was used for risk of bias assessment. Meta-analyses were performed to estimate the average effect size of the prognostic factors. Of 1,781 articles reviewed, 40 articles met the inclusion criteria. Highest risk of bias was attributable to insufficient handling of confounders and poorly described study groups. Six prognostic factors were statistically significant in the meta-analyses: African-American race [pooled estimate (ES), 1.43; 95% confidence interval (CI), 1.15-1.79], premenopausal status (ES, 1.59; 95% CI, 1.20-2.11), detection by palpation (ES, 1.84; 95% CI, 1.47-2.29), involved margins (ES, 1.63; 95% CI, 1.14-2.32), high histologic grade (ES, 1.36; 95% CI, 1.04-1.77), and high p16 expression (ES, 1.51; 95% CI, 1.04-2.19). Six prognostic factors associated with invasive recurrence were identified, whereas many other factors need confirmation in well-designed studies on large patient numbers. Furthermore, we identified frequently occurring biases in studies on invasive recurrence after DCIS. Avoiding these common methodological pitfalls can improve future study designs. [ABSTRACT FROM AUTHOR]
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- 2019
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21. Risk, Risk Factors, and Surveillance of Subsequent Malignant Neoplasms in Survivors of Childhood Cancer: A Review.
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Turcotte, Lucie M., Neglia, Joseph P., Reulen, Raoul C., Ronckers, Cecile M., van Leeuwen, Flora E., Morton, Lindsay M., Hodgson, David C., Yasui, Yutaka, Oeffinger, Kevin C., and Henderson, Tara O.
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- 2018
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22. Cause-specific Mortality in a Population-based Cohort of 9799 Women Treated for Ductal Carcinoma In Situ.
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Elshof, Lotte E., Schmidt, Marjanka K., Rutgers, Emiel J.Th., van Leeuwen, Flora E., Wesseling, Jelle, and Schaapveld, Michael
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Objective: To assess cause-specific mortality in women treated for ductal carcinoma in situ (DCIS). Background: From screening and treatment perspective, it is relevant to weigh the low breast cancer mortality after DCIS against mortality from other causes and expected mortality in the general population. Methods: We conducted a population-based cohort study comprising 9799 Dutch women treated for primary DCIS between 1989 and 2004 and estimated standardized mortality ratios (SMRs). Results: After a median follow up of 9.8 years, 1429 patients had died of whom 284 caused by breast cancer (2.9% of total cohort). DCIS patients <50 years experienced higher mortality compared with women in the general population (SMR 1.7; 95% confidence interval, CI: 1.4–2.0), whereas patients >50 had significantly lower mortality (SMR 0.9; 95% CI: 0.8–0.9). Overall, the risk of dying from general diseases and cancer other than breast cancer was lower than in the general population, whereas breast cancer mortality was increased. The SMR for breast cancer decreased from 7.5 (95% CI: 5.9–9.3) to 2.8 (95% CI: 2.4–3.2) for women aged <50 and >50 years, respectively. The cumulative breast cancer mortality 10 years after DCIS was 2.3% for women <50 years and 1.4% for women >50 years treated for DCIS between 1999 and 2004. Conclusions: DCIS patients >50 years had lower risk of dying from all causes combined compared with the general female population, which may reflect differences in health behavior. Women with DCIS had higher risk of dying from breast cancer than the general population, but absolute 10-year risks were low. [ABSTRACT FROM AUTHOR]
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- 2018
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23. Prediction of Ischemic Heart Disease and Stroke in Survivors of Childhood Cancer.
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Chow, Eric J., Chen, Yan, Hudson, Melissa M., Feijen, Elizabeth A.M., Kremer, Leontien C., Border, William L., Green, Daniel M., Meacham, Lillian R., Mulrooney, Daniel A., Ness, Kirsten K., Oeffinger, Kevin C., Ronckers, Cécile M., Sklar, Charles A., Stovall, Marilyn, van der Pal, Helena J., van Dijk, Irma W.E.M., van Leeuwen, Flora E., Weathers, Rita E., Robison, Leslie L., and Armstrong, Gregory T.
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- 2018
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24. Incidence of and Risk Factors for Histologically Confirmed Solid Benign Tumors Among Long-term Survivors of Childhood Cancer
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Kok, Judith L., Teepen, Jop C., van der Pal, Helena J., van Leeuwen, Flora E., Tissing, Wim J. E., Neggers, Sebastian J. C. M. M., Loonen, Jacqueline J., Louwerens, Marloes, Versluys, Birgitta, van den Heuvel-Eibrink, Marry M., van Dulmen-den Broeder, Eline, Jaspers, Monique M. W., van Santen, Hanneke M., van der Heiden-van der Loo, Margriet, Janssens, Geert O., Maduro, John H., Bruggink, Annette H., Jongmans, Marjolijn C., Kremer, Leontien C. M., and Ronckers, Cécile M.
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IMPORTANCE: Survivors of childhood cancer (CCSs) face risk of developing subsequent tumors. Solid benign tumors may be cancer precursors; benign tumors and cancers may share etiologic factors. However, comprehensive data on the risk for solid benign tumors are lacking. OBJECTIVE: To quantify the incidence of and treatment-related risk factors for histologically confirmed solid nonskin benign tumors among CCSs. DESIGN, SETTING, AND PARTICIPANTS: This record linkage study involves the Dutch Childhood Oncology Group–Long-Term Effects After Childhood Cancer (DCOG-LATER) cohort of 6165 individuals diagnosed with childhood cancer at younger than 18 years from January 1, 1963, through December 31, 2001, in 7 Dutch pediatric centers and who survived at least 5 years after the diagnosis. Study groups eligible for record linkage from 1990 onward included 5843 CCSs (94.8%) and 883 siblings. Benign tumors were identified from the population-based Dutch histopathology and cytopathology registry (PALGA). Follow-up was completed on May 1, 2015. Data were analyzed from January 1, 1990, through May 1, 2015. MAIN OUTCOMES AND MEASURES: Cumulative incidence of any subsequent benign tumor for cohort strata and multivariable Cox proportional hazards regression models (hazard ratios [HRs]) were used to evaluate potential risk factors for 8 major benign tumor subtypes. RESULTS: Of the 5843 eligible CCSs (55.9% male), 542 (9.3%) developed a histologically confirmed subsequent benign tumor after a median follow-up of 22.7 years (range, 5.0-52.2 years). Among women, abdominopelvic radiotherapy inferred dose-dependent increased risks for uterine leiomyoma (n = 43) for doses of less than 20 Gy (HR, 1.9; 95% CI, 0.5-7.0), 20 to less than 30 Gy (HR, 3.4; 95% CI, 1.1-10.4), and at least 30 Gy (HR, 5.4; 95% CI, 2.4-12.4) compared with no abdominopelvic radiotherapy (P = .002 for trend). High-dose radiotherapy to the trunk was not associated with breast fibroadenoma (n = 45). Of 23 osseous and/or chondromatous neoplasms, 16 occurred among leukemia survivors, including 11 after total body irradiation (HR, 37.4; 95% CI, 14.8-94.7). Nerve sheath tumors (n = 55) were associated with radiotherapy (HR at 31 years of age, 2.9; 95% CI, 1.5-5.5) and a crude indicator of neurofibromatosis type 1 or 2 status (HR, 5.6; 95% CI, 2.3-13.7). Subsequent risk for benign tumors was higher than the risks for subsequent nonskin solid malignant neoplasms and for benign tumors among siblings. CONCLUSIONS AND RELEVANCE: This record linkage study uses a unique resource for valid and complete outcome assessment and shows that CCSs have an approximately 2-fold risk of developing subsequent benign tumors compared with siblings. Site-specific new findings, including for uterine leiomyoma, osteochondroma, and nervous system tumors, are important to enable early diagnosis; this information will be the first step for future surveillance guidelines that include some benign tumors in CCSs and will provide leads for in-depth etiologic studies.
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- 2019
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25. The Dutch Breast Implant Registry: Registration of Breast Implant–Associated Anaplastic Large Cell Lymphoma—A Proof of Concept
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Becherer, Babette E., de Boer, Mintsje, Spronk, Pauline E. R., Bruggink, Annette H., de Boer, Jan Paul, van Leeuwen, Flora E., Mureau, Marc A. M., van der Hulst, René R. J. W., de Jong, Daphne, and Rakhorst, Hinne A.
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Patient Safety CME.
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- 2019
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26. Genetic susceptibility to radiation-induced breast cancer after Hodgkin lymphoma
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Opstal-van Winden, Annemieke W.J., de Haan, Hugoline G., Hauptmann, Michael, Schmidt, Marjanka K., Broeks, Annegien, Russell, Nicola S., Janus, Cécile P.M., Krol, Augustinus D.G., van der Baan, Frederieke H., De Bruin, Marie L., van Eggermond, Anna M., Dennis, Joe, Anton-Culver, Hoda, Haiman, Christopher A., Sawyer, Elinor J., Cox, Angela, Devilee, Peter, Hooning, Maartje J., Peto, Julian, Couch, Fergus J., Pharoah, Paul, Orr, Nick, Easton, Douglas F., Aleman, Berthe M.P., Strong, Louise C., Bhatia, Smita, Cooke, Rosie, Robison, Leslie L., Swerdlow, Anthony J., and van Leeuwen, Flora E.
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Female Hodgkin lymphoma (HL) patients treated with chest radiotherapy (RT) have a very high risk of breast cancer. The contribution of genetic factors to this risk is unclear. We therefore examined 211 155 germline single-nucleotide polymorphisms (SNPs) for gene-radiation interaction on breast cancer risk in a case-only analysis including 327 breast cancer patients after chest RT for HL and 4671 first primary breast cancer patients. Nine SNPs showed statistically significant interaction with RT on breast cancer risk (false discovery rate, <20%), of which 1 SNP in the PVT1oncogene attained the Bonferroni threshold for statistical significance. A polygenic risk score (PRS) composed of these SNPs (RT-interaction-PRS) and a previously published breast cancer PRS (BC-PRS) derived in the general population were evaluated in a case-control analysis comprising the 327 chest-irradiated HL patients with breast cancer and 491 chest-irradiated HL patients without breast cancer. Patients in the highest tertile of the RT-interaction-PRS had a 1.6-fold higher breast cancer risk than those in the lowest tertile. Remarkably, we observed a fourfold increased RT-induced breast cancer risk in the highest compared with the lowest decile of the BC-PRS. On a continuous scale, breast cancer risk increased 1.4-fold per standard deviation of the BC-PRS, similar to the effect size found in the general population. This study demonstrates that genetic factors influence breast cancer risk after chest RT for HL. Given the high absolute breast cancer risk in radiation-exposed women, these results can have important implications for the management of current HL survivors and future patients.
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- 2019
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27. Genetic susceptibility to radiation-induced breast cancer after Hodgkin lymphoma
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Opstal-van Winden, Annemieke W. J., de Haan, Hugoline G., Hauptmann, Michael, Schmidt, Marjanka K., Broeks, Annegien, Russell, Nicola S., Janus, Cécile P. M., Krol, Augustinus D. G., van der Baan, Frederieke H., De Bruin, Marie L., van Eggermond, Anna M., Dennis, Joe, Anton-Culver, Hoda, Haiman, Christopher A., Sawyer, Elinor J., Cox, Angela, Devilee, Peter, Hooning, Maartje J., Peto, Julian, Couch, Fergus J., Pharoah, Paul, Orr, Nick, Easton, Douglas F., Aleman, Berthe M. P., Strong, Louise C., Bhatia, Smita, Cooke, Rosie, Robison, Leslie L., Swerdlow, Anthony J., and van Leeuwen, Flora E.
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Female Hodgkin lymphoma (HL) patients treated with chest radiotherapy (RT) have a very high risk of breast cancer. The contribution of genetic factors to this risk is unclear. We therefore examined 211?155 germline single-nucleotide polymorphisms (SNPs) for gene-radiation interaction on breast cancer risk in a case-only analysis including 327 breast cancer patients after chest RT for HL and 4671 first primary breast cancer patients. Nine SNPs showed statistically significant interaction with RT on breast cancer risk (false discovery rate, <20%), of which 1 SNP in the PVT1 oncogene attained the Bonferroni threshold for statistical significance. A polygenic risk score (PRS) composed of these SNPs (RT-interaction-PRS) and a previously published breast cancer PRS (BC-PRS) derived in the general population were evaluated in a case-control analysis comprising the 327 chest-irradiated HL patients with breast cancer and 491 chest-irradiated HL patients without breast cancer. Patients in the highest tertile of the RT-interaction-PRS had a 1.6-fold higher breast cancer risk than those in the lowest tertile. Remarkably, we observed a fourfold increased RT-induced breast cancer risk in the highest compared with the lowest decile of the BC-PRS. On a continuous scale, breast cancer risk increased 1.4-fold per standard deviation of the BC-PRS, similar to the effect size found in the general population. This study demonstrates that genetic factors influence breast cancer risk after chest RT for HL. Given the high absolute breast cancer risk in radiation-exposed women, these results can have important implications for the management of current HL survivors and future patients.
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- 2019
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28. Risks for lymphoma and gastrointestinal carcinoma in patients with newly diagnosed adult-onset celiac disease: Consequences for follow-up: Celiac disease, lymphoma and GI carcinoma
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van Gils, Tom, Nijeboer, Petula, Overbeek, Lucy IH, Hauptmann, Michael, Castelijn, Daan AR, Bouma, Gerd, Mulder, Chris JJ, van Leeuwen, Flora E, and de Jong, Daphne
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Background The association between celiac disease (CD) and the development of lymphoid and gastrointestinal (GI) malignancies have been reported. However, data are scarce yet needed to develop evidence-based follow-up programs.Objective The objective of this article is to assess relative (RR) and absolute risks of lymphoma and GI carcinoma for newly diagnosed patients.Methods A case-control design to determine RR was performed with cases (lymphoma or GI carcinoma) and controls (melanoma or basal cell carcinoma) diagnosed 1994–2014, retrieved from the Dutch nationwide population-based pathology database (PALGA). Within this population, individuals with histologically proven CD before or simultaneously diagnosed with the malignancy were identified.Results A total of 349/301,425 cases (0.1%) and 282/576,971 (0.05%) controls were diagnosed with CD. Risk of T-cell lymphoma, predominantly enteropathy-associated T-cell lymphoma (EATL), was strongly associated with CD diagnosis (RR = 35.8 (95% CI 27.1–47.4)). Although most often synchronously diagnosed, T-cell lymphoma RR ≥ 1 year after CD diagnosis was still elevated (RR = 12.7 (95% CI 7.6–21.3)). Other CD-associated malignancies were small bowel adenocarcinoma (RR = 11.9 (95% CI 8.2–17.2)) and esophageal squamous cell carcinoma (RR = 3.5 (95% CI 2.1–5.8)). Absolute risks were relatively low. Other types of lymphomas and GI carcinomas were not associated with CD.Conclusion Increased risk for specific malignancies in CD should alert physicians for EATL (both intestinal and extraintestinal) and small bowel adenocarcinoma in patients with CD diagnosed at age ≥ 50 years.
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- 2018
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29. Risk of subsequent myeloid neoplasms after radiotherapy treatment for a solid cancer among adults in the United States, 2000–2014
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Teepen, Jop C., Curtis, Rochelle E., Dores, Graça M., Berrington de Gonzalez, Amy, van den Heuvel-Eibrink, Marry M., Kremer, Leontien C. M., Gilbert, Ethel S., van Leeuwen, Flora E., Ronckers, Cécile M., and Morton, Lindsay M.
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Although increased risk of acute myeloid leukemia (AML) has been observed after chemotherapy and radiotherapy, less is known about radiotherapy-related risks of specific AML subtypes and other specific myeloid neoplasms. We used the US population-based cancer registry data to evaluate risk of myeloid neoplasms among three cohorts of cancer survivors initially treated with radiotherapy only. We included 1-year survivors of first primary thyroid (radioiodine only, stages I–IV; N= 49 879), prostate (excluding stage IV; N= 237 439), or uterine corpus cancers (stage I–II; N= 16 208) diagnosed during 2000–2013. We calculated standardized incidence ratios (SIRs) and excess absolute risks (EARs). Thyroid cancer survivors had significantly elevated risks of total AML (SIR = 2.77, 95% CI: 1.99–3.76), AML with cytogenetic abnormalities (SIR = 3.90, 95% CI: 1.57–8.04), AML with myelodysplasia-related changes (SIR = 2.87, 95% CI: 1.05–6.25), and BCR-ABL1-positive chronic myelogenous leukemia (CML) (SIR = 5.38, 95% CI: 2.58–9.89). Irradiated prostate and uterine corpus cancer survivors were at elevated risk for total AML (SIR = 1.14, 95% CI: 1.03–1.27 and SIR = 1.77, 95% CI: 1.01–2.87, respectively), AML with cytogenetic abnormalities (SIR = 2.52, 95% CI: 1.84–3.37 and SIR = 7.21, 95% CI: 2.34–16.83, respectively), and acute promyelocytic leukemia (SIR = 3.20, 95% CI: 2.20–4.49 and SIR = 8.88, 95% CI: 2.42–22.73, respectively). In addition, prostate cancer survivors were at increased risk of BCR-ABL1-positive CML (SIR = 2.11, 95% CI: 1.52–2.85). Our findings support the importance of diagnostic precision in myeloid neoplasm classification since susceptibility following radiotherapy may vary by myeloid neoplasm subtype, thereby informing risk/benefit discussions in first primary cancer treatment.
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- 2018
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30. Beyond maximum grade: modernising the assessment and reporting of adverse events in haematological malignancies
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Thanarajasingam, Gita, Minasian, Lori M, Baron, Frederic, Cavalli, Franco, De Claro, R Angelo, Dueck, Amylou C, El-Galaly, Tarec C, Everest, Neil, Geissler, Jan, Gisselbrecht, Christian, Gribben, John, Horowitz, Mary, Ivy, S Percy, Jacobson, Caron A, Keating, Armand, Kluetz, Paul G, Krauss, Aviva, Kwong, Yok Lam, Little, Richard F, Mahon, Francois-Xavier, Matasar, Matthew J, Mateos, María-Victoria, McCullough, Kristen, Miller, Robert S, Mohty, Mohamad, Moreau, Philippe, Morton, Lindsay M, Nagai, Sumimasa, Rule, Simon, Sloan, Jeff, Sonneveld, Pieter, Thompson, Carrie A, Tzogani, Kyriaki, van Leeuwen, Flora E, Velikova, Galina, Villa, Diego, Wingard, John R, Wintrich, Sophie, Seymour, John F, and Habermann, Thomas M
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Tremendous progress in treatment and outcomes has been achieved across the whole range of haematological malignancies in the past two decades. Although cure rates for aggressive malignancies have increased, nowhere has progress been more impactful than in the management of typically incurable forms of haematological cancer. Population-based data have shown that 5-year survival for patients with chronic myelogenous and chronic lymphocytic leukaemia, indolent B-cell lymphomas, and multiple myeloma has improved markedly. This improvement is a result of substantial changes in disease management strategies in these malignancies. Several haematological malignancies are now chronic diseases that are treated with continuously administered therapies that have unique side-effects over time. In this Commission, an international panel of clinicians, clinical investigators, methodologists, regulators, and patient advocates representing a broad range of academic and clinical cancer expertise examine adverse events in haematological malignancies. The issues pertaining to assessment of adverse events examined here are relevant to a range of malignancies and have been, to date, underexplored in the context of haematology. The aim of this Commission is to improve toxicity assessment in clinical trials in haematological malignancies by critically examining the current process of adverse event assessment, highlighting the need to incorporate patient-reported outcomes, addressing issues unique to stem-cell transplantation and survivorship, appraising challenges in regulatory approval, and evaluating toxicity in real-world patients. We have identified a range of priority issues in these areas and defined potential solutions to challenges associated with adverse event assessment in the current treatment landscape of haematological malignancies.
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- 2018
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31. Long-Term Risk of Subsequent Malignant Neoplasms After Treatment of Childhood Cancer in the DCOG LATER Study Cohort: Role of Chemotherapy.
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Teepen, Jop C., van Leeuwen, Flora E., Tissing, Wim J., van Dulmen-den Broeder, Eline, van den Heuvel-Eibrink, Marry M., van der Pal, Helena J., Loonen, Jacqueline J., Bresters, Dorine, Versluys, Birgitta, Neggers, Sebastian J. C. M. M., Jaspers, Monique W. M., Hauptmann, Michael, van der Heiden-van der Loo, Margriet, Visser, Otto, Kremer, Leontien C. M., Ronckers, Cécile M., and DCOG LATER Study Group
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- 2017
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32. Chemotherapy-related late adverse effects on ovarian function in female survivors of childhood and young adult cancer: A systematic review.
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Overbeek, Annelies, van den Berg, Marleen H., van Leeuwen, Flora E., Kaspers, Gertjan J. L., Lambalk, Cornells B., van Dulmen-den Breeder, Eline, Lambalk, Cornelis B, and van Dulmen-den Broeder, Eline
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Background: Anti-cancer treatment may reduce the fertile life span and induce premature menopause. This review aims to provide an overview of the available literature on effects of chemotherapy only on the incidence of ovarian dysfunction and to evaluate the relationship between dose of chemotherapy, age at time of treatment, and time since treatment in female survivors of childhood and young adult cancer.Methods: A comprehensive search of electronic databases was performed (search date December 2015).Results: 45 studies were included, describing, in total, 5607 female survivors. Median age at menopause was earlier in cancer survivors than in the general population. The prevalence of amenorrhoea varied from 0% to 83%. Those exposed to MVPP protocols were at highest risk for amenorrhoea (39-79%), as were breast cancer survivors receiving cyclophosphamide-containing regimens, in whom the prevalence of amenorrhoea was 40-80%. The most important risk factors for ovarian dysfunction were: (1) alkylating agents, specifically procarbazine and busulfan, (2) older age at treatment.Conclusion: Breast cancer survivors, those treated with procarbazine or other alkylating agents and those with a higher age at diagnosis are at highest risk of diminished ovarian function. However, all studies included in this review showed methodological limitations. It is imperative that nation-wide registries guarantee long term follow-up during the adult life of cancer survivors. [ABSTRACT FROM AUTHOR]- Published
- 2017
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33. Cause-specific Mortality in a Population-based Cohort of 9799 Women Treated for Ductal Carcinoma In Situ
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Elshof, Lotte E., Schmidt, Marjanka K., Rutgers, Emiel J.Th., van Leeuwen, Flora E., Wesseling, Jelle, and Schaapveld, Michael
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Supplemental Digital Content is available in the text
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- 2018
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34. Breast Implants and the Risk of Anaplastic Large-Cell Lymphoma in the Breast
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de Boer, Mintsje, van Leeuwen, Flora E., Hauptmann, Michael, Overbeek, Lucy I. H., de Boer, Jan Paul, Hijmering, Nathalie J., Sernee, Arthur, Klazen, Caroline A. H., Lobbes, Marc B. I., van der Hulst, René R. W. J., Rakhorst, Hinne A., and de Jong, Daphne
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IMPORTANCE: Breast implants are among the most commonly used medical devices. Since 2008, the number of women with breast implants diagnosed with anaplastic large-cell lymphoma in the breast (breast-ALCL) has increased, and several reports have suggested an association between breast implants and risk of breast-ALCL. However, relative and absolute risks of breast-ALCL in women with implants are still unknown, precluding evidence-based counseling about implants. OBJECTIVE: To determine relative and absolute risks of breast-ALCL in women with breast implants. DESIGN, SETTING, AND PARTICIPANTS: Through the population-based nationwide Dutch pathology registry we identified all patients diagnosed with primary non-Hodgkin lymphoma in the breast between 1990 and 2016 and retrieved clinical data, including breast implant status, from the treating physicians. We estimated the odds ratio (OR) of ALCL associated with breast implants in a case-control design, comparing implant prevalence between women with breast-ALCL and women with other types of breast lymphoma. Cumulative risk of breast-ALCL was derived from the age-specific prevalence of breast implants in Dutch women, estimated from an examination of 3000 chest x-rays and time trends from implant sales. MAIN OUTCOMES AND MEASURES: Relative and absolute risks of breast-ALCL in women with breast implants. RESULTS: Among 43 patients with breast-ALCL (median age, 59 years), 32 had ipsilateral breast implants, compared with 1 among 146 women with other primary breast lymphomas (OR, 421.8; 95% CI, 52.6-3385.2). Implants among breast-ALCL cases were more often macrotextured (23 macrotextured of 28 total implants of known type, 82%) than expected (49 193 sold macrotextured implants of total sold 109 449 between 2010 and 2015, 45%) based on sales data (P < .001). The estimated prevalence of breast implants in women aged 20 to 70 years was 3.3%. Cumulative risks of breast-ALCL in women with implants were 29 per million at 50 years and 82 per million at 70 years. The number of women with implants needed to cause 1 breast-ALCL case before age 75 years was 6920. CONCLUSIONS AND RELEVANCE: Breast implants are associated with increased risk of breast-ALCL, but the absolute risk remains small. Our results emphasize the need for increased awareness among the public, medical professionals, and regulatory bodies, promotion of alternative cosmetic procedures, and alertness to signs and symptoms of breast-ALCL in women with implants.
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- 2018
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35. Double somatic mutations in mismatch repair genes are frequent in colorectal cancer after Hodgkin's lymphoma treatment
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Rigter, Lisanne S, Snaebjornsson, Petur, Rosenberg, Efraim H, Atmodimedjo, Peggy N, Aleman, Berthe M, ten Hoeve, Jelle, Geurts-Giele, Willemina R, van Ravesteyn, Thomas W, Hoeksel, Johan, Meijer, Gerrit A, te Riele, Hein, van Leeuwen, Flora E, Dinjens, Winand N, and van Leerdam, Monique E
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ObjectiveHodgkin's lymphoma survivors who were treated with infradiaphragmatic radiotherapy or procarbazine-containing chemotherapy have a fivefold increased risk of developing colorectal cancer (CRC). This study aims to provide insight into the development of therapy-related CRC (t-CRC) by evaluating histopathological and molecular characteristics.Design54 t-CRCs diagnosed in a Hodgkin's lymphoma survivor cohort were analysed for mismatch repair (MMR) proteins by immunohistochemistry, microsatellite instability (MSI) and KRAS/BRAFmutations. MSI t-CRCs were evaluated for promoter methylation and mutations in MMR genes. Pathogenicity of MMR gene mutations was evaluated by in silicopredictions and functional analyses. Frequencies were compared with a general population cohort of CRC (n=1111).ResultsKRASand BRAFmutations were present in 41% and 15% t-CRCs, respectively. Compared with CRCs in the general population, t-CRCs had a higher MSI frequency (24% vs 11%, p=0.003) and more frequent loss of MSH2/MSH6 staining (13% vs 1%, p<0.001). Loss of MLH1/PMS2 staining and MLH1promoter methylation were equally common in t-CRCs and the general population. In MSI CRCs without MLH1promoter methylation, double somatic MMR gene mutations (or loss of heterozygosity as second hit) were detected in 7/10 (70%) t-CRCs and 8/36 (22%) CRCs in the general population (p=0.008). These MMR gene mutations in t-CRCs were classified as pathogenic. MSI t-CRC cases could not be ascribed to Lynch syndrome.ConclusionsWe have demonstrated a higher frequency of MSI among t-CRCs, which results from somatic MMR gene mutations. This suggests a novel association of somatic MMR gene mutations with prior anticancer treatment.
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- 2018
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36. Anthracyclines and Alkylating Agents: New Risk Factors for Breast Cancer in Childhood Cancer Survivors?
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van Leeuwen, Flora E., Ronckers, Cecile M., and Ronckers, Cécile M
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- 2016
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37. Impact of Age at Primary Breast Cancer on Contralateral Breast Cancer Risk in BRCA1/2 Mutation Carriers.
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van den Broek, Alexandra J., van't Veer, Laura J., Hooning, Maartje J., Cornelissen, Sten, Broeks, Annegien, Rutgers, Emiel J., Smit, Vincent T. H. B. M., Cornelisse, Cees J., van Beek, Mike, Janssen-Heijnen, Maryska L., Seynaeve, Caroline, Westenend, Pieter J., Jobsen, Jan J., Siesling, Sabine, Tollenaar, Rob A. E. M., van Leeuwen, Flora E., and Schmidt, Marjanka K.
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- 2016
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38. Risk of subsequent gastrointestinal cancer among childhood cancer survivors: A systematic review.
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Teepen, Jop C., de Vroom, Suzanne L., van Leeuwen, Flora E., Tissing, Wim J., Kremer, Leontien C., and Ronckers, Cécile M.
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Background: Childhood cancer survivors (CCS) are at increased risk of developing subsequent malignant neoplasms, including gastrointestinal (GI) cancer. We performed a systematic review to summarize all available literature on the risk of, risk factors for, and outcome after subsequent GI cancer among CCS.Methods: A systematic search of the literature databases Medline/PubMed (1945-2014) and Embase (1947-2014) was performed to identify studies that consisted of ⩾1000 CCS and assessed incidence of or mortality from subsequent GI cancer as an outcome.Results: A total of 45 studies were included. Studies that reported risk measures for subsequent GI cancer compared to the general population showed a 3.2 to 9.7-fold elevated risk in cohort studies including all childhood cancer types. Abdominal radiotherapy was associated with an increased risk of subsequent GI cancer in all four studies that assessed this risk. Survivors who had received procarbazine and platinum agents were also suggested to be at increased risk.Conclusion: Abdominal radiotherapy is a risk factor for developing a subsequent GI cancer. Few studies examined detailed treatment-related risk factors and most studies had small number of GI cancer cases. Therefore, no conclusions could be drawn on the effect of time since childhood cancer on GI cancer risk and on outcome after a subsequent GI cancer. Additional research is necessary to further explore risk factors for and outcome after a subsequent GI cancer, and to systematically evaluate the harms and benefits of GI screening among high-risk survivors in order to give sound screening recommendations. [ABSTRACT FROM AUTHOR]- Published
- 2016
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39. Radiation Dose-Response Relationship for Risk of Coronary Heart Disease in Survivors of Hodgkin Lymphoma.
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van Nimwegen, Frederika A., Schaapveld, Michael, Cutter, David J., Janus, Cècile P. M., Krol, Augustinus D. G., Hauptmann, Michael, Kooijman, Karen, Roesink, Judith, van der Maazen, Richard, Darby, Sarah C., Aleman, Berthe M. P., and van Leeuwen, Flora E.
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- 2016
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40. Risk of heart failure in survivors of Hodgkin lymphoma: effects of cardiac exposure to radiation and anthracyclines
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van Nimwegen, Frederika A., Ntentas, Georgios, Darby, Sarah C., Schaapveld, Michael, Hauptmann, Michael, Lugtenburg, Pieternella J., Janus, Cecile P.M., Daniels, Laurien, van Leeuwen, Flora E., Cutter, David J., and Aleman, Berthe M.P.
- Abstract
Hodgkin lymphoma (HL) survivors treated with radiotherapy and/or chemotherapy are known to have increased risks of heart failure (HF), but a radiation dose-response relationship has not previously been derived. A case-control study, nested in a cohort of 2617 five-year survivors of HL diagnosed before age 51 years during 1965 to 1995, was conducted. Cases (n = 91) had moderate or severe HF as their first cardiovascular diagnosis. Controls (n = 278) were matched to cases on age, sex, and HL diagnosis date. Treatment and follow-up information were abstracted from medical records. Mean heart doses and mean left ventricular doses (MLVD) were estimated by reconstruction of individual treatments on representative computed tomography datasets. Average MLVD was 16.7 Gy for cases and 13.8 Gy for controls (Pdifference= .003). HF rate increased with MLVD: relative to 0 Gy, HF rates following MVLD of 1-15, 16-20, 21-25, and ≥26 Gy were 1.27, 1.65, 3.84, and 4.39, respectively (Ptrend< .001). Anthracycline-containing chemotherapy increased HF rate by a factor of 2.83 (95% CI: 1.43-5.59), and there was no significant interaction with MLVD (Pinteraction= .09). Twenty-five–year cumulative risks of HF following MLVDs of 0-15 Gy, 16-20 Gy, and ≥21 Gy were 4.4%, 6.2%, and 13.3%, respectively, in patients treated without anthracycline-containing chemotherapy, and 11.2%, 15.9%, and 32.9%, respectively, in patients treated with anthracyclines. We have derived quantitative estimates of HF risk in patients treated for HL following radiotherapy with or without anthracycline-containing chemotherapy. Our results enable estimation of HF risk for patients before treatment, during radiotherapy planning, and during follow-up.
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- 2017
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41. Risk of heart failure in survivors of Hodgkin lymphoma: effects of cardiac exposure to radiation and anthracyclines
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van Nimwegen, Frederika A., Ntentas, Georgios, Darby, Sarah C., Schaapveld, Michael, Hauptmann, Michael, Lugtenburg, Pieternella J., Janus, Cecile P. M., Daniels, Laurien, van Leeuwen, Flora E., Cutter, David J., and Aleman, Berthe M. P.
- Abstract
Hodgkin lymphoma (HL) survivors treated with radiotherapy and/or chemotherapy are known to have increased risks of heart failure (HF), but a radiation dose-response relationship has not previously been derived. A case-control study, nested in a cohort of 2617 five-year survivors of HL diagnosed before age 51 years during 1965 to 1995, was conducted. Cases (n = 91) had moderate or severe HF as their first cardiovascular diagnosis. Controls (n = 278) were matched to cases on age, sex, and HL diagnosis date. Treatment and follow-up information were abstracted from medical records. Mean heart doses and mean left ventricular doses (MLVD) were estimated by reconstruction of individual treatments on representative computed tomography datasets. Average MLVD was 16.7 Gy for cases and 13.8 Gy for controls (Pdifference = .003). HF rate increased with MLVD: relative to 0 Gy, HF rates following MVLD of 1-15, 16-20, 21-25, and ≥26 Gy were 1.27, 1.65, 3.84, and 4.39, respectively (Ptrend < .001). Anthracycline-containing chemotherapy increased HF rate by a factor of 2.83 (95% CI: 1.43-5.59), and there was no significant interaction with MLVD (Pinteraction = .09). Twenty-five–year cumulative risks of HF following MLVDs of 0-15 Gy, 16-20 Gy, and ≥21 Gy were 4.4%, 6.2%, and 13.3%, respectively, in patients treated without anthracycline-containing chemotherapy, and 11.2%, 15.9%, and 32.9%, respectively, in patients treated with anthracyclines. We have derived quantitative estimates of HF risk in patients treated for HL following radiotherapy with or without anthracycline-containing chemotherapy. Our results enable estimation of HF risk for patients before treatment, during radiotherapy planning, and during follow-up.
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- 2017
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42. Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment
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van Leeuwen, Flora E. and Ng, Andrea K.
- Abstract
Long-term survivors of Hodgkin lymphoma (HL) experience several late adverse effects of treatment, with second malignant neoplasms (SMNs) and cardiovascular diseases (CVDs) being the leading causes of death in these patients. Other late effects have also been identified, such as pulmonary dysfunction, endocrinopathies (thyroid dysfunction, infertility), neck muscle atrophy, and persistent fatigue. HL survivors have two- to fourfold increased risks to develop SMNs and CVD compared with the general population. With respect to SMNs, radiotherapy is associated with 1.5- to 15-fold increased risk of solid malignancies. The relative risk (RR) of solid tumors increases steadily with increasing follow-up time from 5 to 15 years since radiotherapy, and remains elevated for at least 40 years. The RR of solid SMNs increases strongly with younger age at first treatment. Risks of lung, breast, and gastrointestinal (GI) cancers increase with higher radiation dose. Alkylating agent chemotherapy, especially procarbazine, does not only increase risk of leukemia but also of solid malignancies, in particular, cancers of the lung and GI tract. In contrast, gonadotoxic chemotherapy decreases the risk of radiation-associated breast cancer, through induction of premature menopause. Smoking appears to multiply the radiation- and chemotherapy-associated risks of lung cancer. Both radiotherapy and chemotherapy for HL may cause cardiovascular toxicity. Radiotherapy increases the risk of coronary heart disease, valvular heart disease, congestive heart failure (HF), and pericarditis, whereas anthracycline-containing chemotherapy increases the risks of HF and valvular heart disease. Cardiovascular toxicity following radiotherapy is usually observed from 5 to at least 35 years after therapy, whereas anthracycline-related toxicity is already observed during treatment, up to at least 25 years. The joint effects of anthracyclines, radiotherapy, and conventional cardiovascular risk factors (eg, hypertension, smoking, and physical inactivity) appear to be additive rather than multiplicative. HL survivors need lifelong risk-based screening for selected SMNs and CVDs. Furthermore, preventive strategies should include lifestyle and drug-based interventions to minimize exposure to conventional risk factors for cancer and CVD.
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- 2016
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43. Variation in Mutation Spectrum Partly Explains Regional Differences in the Breast Cancer Risk of Female BRCA Mutation Carriers in the Netherlands.
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Vos, Janet R., Teixeira, Natalia, van der Kolk, Dorina M., Mourits, Marian J. E., Rookus, Matti A., van Leeuwen, Flora E., Collée, Margriet, van Asperen, Christi J., Mensenkamp, Arjen R., Ausems, Margreet G. E. M., van Os, Theo A. M., Meijers-Heijboer, Hanne E. J., Gómez-Garcia, Encarna B., Vasen, Hans F., Brohet, Richard M., van der Hout, Annemarie H., Jansen, Liesbeth, Oosterwijk, Jan C., and de Bock, Geertruida H.
- Abstract
The article presents research that aims to observed whether cancer risks in BRCA2 mutation carriers older than 60 years in the Northern Netherlands could be explained by mutation spectrum. It informs that study included all known pathogenic BRCA1 and BRCA2 carriers in the Northern Netherlands and regional differences were assessed. The result showed that all BRCA 1 and BRCA2 carriers younger than 60 years had a lower breast cancer risk.
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- 2014
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44. Risk of Diabetes Mellitus in Long-Term Survivors of Hodgkin Lymphoma.
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van Nimwegen, Frederika A., Schaapveld, Michael, Janus, Cecile P. M., Krol, Augustinus D. G., Raemaekers, John M. M., Kremer, Leontien C. M., Stovall, Marilyn, Aleman, Berthe M. P., and van Leeuwen, Flora E.
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- 2014
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45. Hodgkin lymphoma: Late effects of treatment and guidelines for surveillance
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Ng, Andrea K. and van Leeuwen, Flora E.
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Long-term survivors of Hodgkin lymphoma (HL) are at risk for a range of late effects, with second malignant neoplasm and cardiovascular diseases being the leading causes of death in these patients. The excess risks remain significantly elevated decades after treatment, and are clearly associated with extent of treatment exposures. Other late effects have also been identified, such as pulmonary dysfunction, endocrinopathies, muscle atrophy, and persistent fatigue. Systemic documentation of late effects and recognition of treatment- and patient-related risk factors are important, as they inform optimal surveillance and risk-reduction strategies, as well as guide therapeutic modifications in newly diagnosed patients to minimize treatment-related complications. As HL therapy evolves over time, with adoption of novel agents and contemporary treatment techniques, late effect risks and follow-up recommendations need to be continuously updated.
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- 2016
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46. Cardiovascular Disease After Hodgkin Lymphoma Treatment: 40-Year Disease Risk
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van Nimwegen, Frederika A., Schaapveld, Michael, Janus, Cécile P. M., Krol, Augustinus D. G., Petersen, Eefke J., Raemaekers, John M. M., Kok, Wouter E. M., Aleman, Berthe M. P., and van Leeuwen, Flora E.
- Abstract
IMPORTANCE: Hodgkin lymphoma (HL) survivors are at increased risk of cardiovascular diseases. It is unclear, however, how long the increased risk persists and what the risk factors are for various cardiovascular diseases. OBJECTIVES: To examine relative and absolute excess risk up to 40 years since HL treatment compared with cardiovascular disease incidence in the general population and to study treatment-related risk factors for different cardiovascular diseases. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included 2524 Dutch patients diagnosed as having HL at younger than 51 years (median age, 27.3 years) who had been treated from January 1, 1965, through December 31, 1995, and had survived for 5 years since their diagnosis. EXPOSURES: Treatment for HL, including prescribed mediastinal radiotherapy dose and anthracycline dose. MAIN OUTCOMES AND MEASURES: Data were collected from medical records and general practitioners. Cardiovascular events, including coronary heart disease (CHD), valvular heart disease (VHD), and cardiomyopathy and congestive heart failure (HF), were graded according to the Common Terminology Criteria for Adverse Events, version 4.0. RESULTS: After a median follow-up of 20 years, we identified 1713 cardiovascular events in 797 patients. After 35 years or more, patients still had a 4- to 6-fold increased standardized incidence ratio of CHD or HF compared with the general population, corresponding to 857 excess events per 10 000 person-years. Highest relative risks were seen in patients treated before 25 years of age, but substantial absolute excess risks were also observed for patients treated at older ages. Within the cohort, the 40-year cumulative incidence of cardiovascular diseases was 50% (95% CI, 47%-52%). Fifty-one percent of patients with a cardiovascular disease developed multiple events. For patients treated before 25 years of age, cumulative incidences at 60 years or older were 20%, 31%, and 11% for CHD, VHD, and HF as first events, respectively. Mediastinal radiotherapy increased the risks of CHD (hazard ratio [HR], 2.7; 95% CI, 2.0-3.7), VHD (HR, 6.6; 95% CI, 4.0-10.8), and HF (HR, 2.7; 95% CI, 1.6-4.8), and anthracycline-containing chemotherapy increased the risks of VHD (HR, 1.5; 95% CI, 1.1-2.1) and HF (HR, 3.0; 95% CI, 1.9-4.7) as first events compared with patients not treated with mediastinal radiotherapy or anthracyclines, respectively. Joint effects of mediastinal radiotherapy, anthracyclines, and smoking appeared to be additive. CONCLUSIONS AND RELEVANCE: Throughout their lives, HL survivors treated at adolescence or adulthood are at high risk for various cardiovascular diseases. Physicians and patients should be aware of this persistently increased risk.
- Published
- 2015
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47. High Risk of Symptomatic Cardiac Events in Childhood Cancer Survivors.
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van der Pal, Helena J., van Dalen, Elvira C., van Delden, Evelien, van Dijk, Irma W., Kok, Wouter E., Geskus, Ronald B., Sieswerda, Elske, Oldenburger, Foppe, Koning, Caro C., van Leeuwen, Flora E., Caron, Huib N., and Kremer, Leontien C.
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- 2012
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48. Methods to Assess Adverse Health-Related Outcomes in Cancer Survivors.
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Oeffinger, Kevin C., van Leeuwen, Flora E., and Hodgson, David C.
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The article discusses a research study on the assessment of cancer survivors concerning adverse health-related outcomes. Several cohort studies were examined which focused on populations, health outcomes and measures of risk including the Childhood Cancer Survivor Study (CCSS) and data from the U.S. Surveillance, Epidemiology and End Results (SEER) Program. The study concluded that ischemic coronary heart disease is a precancer comorbidity that can affect cancer outcomes.
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- 2011
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49. Reproductive and Hormonal Factors, and Ovarian Cancer Risk for BRCA1 and BRCA2 Mutation Carriers: Results from the International BRCA1/2 Carrier Cohort Study.
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Antoniou, Antonis C., Rookus, Matti, Andrieu, Nadine, Brohet, Richard, Chang-Claude, Jenny, Peock, Susan, Cook, Margaret, Evans, D. Gareth, Eeles, Rosalind, Nogues, Catherine, Faivre, Laurence, Gesta, Paul, van Leeuwen, Flora E., Ausems, Margreet G. E. M., Osorio, Ana, Caldes, Trinidad, Simard, Jacques, Lubinski, Jan, Gerdes, Anne-Marie, and Olah, Edith
- Abstract
The article presents a study regarding the link between hormonal and reproductive factors and risk of ovarian cancer (OC) and the mutation carriers of breast cancers 1 and 2 (BRCA1 and BRCA2). Accordingly, researchers found out that the study BRCA1 and BRCA2 mutation carriers has been examined in few studies and they assessed the connection between hormonal and reproductive factors and OC risk. Moreover, they determined the strong correlation between BRCA1 carriers and OC.
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- 2009
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50. No Effect of Red Clover—Derived Isoflavone Intervention on the Insulin-Like Growth Factor System in Women at Increased Risk of Colorectal Cancer.
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Vrieling, Alma, Rookus, Matti A., Kampman, Ellen, Bonfrer, Johannes M. G., Bosma, Astrid, Cats, Annemieke, Van Doom, Jaap, Korse, Catharina M., Witteman, Ben J. M., Van Leeuwen, Flora E., Van't Veer, Laura J., and Voskuil, Dorien W.
- Abstract
The article presents a study which examines the effect of isolated isoflavones on serum concentrations of insulin-like growth (IGF) system components. It states that a randomized, placebo-controlled, double blinded, crossover trial in four hospitals in Netherlands was conducted to investigate the effect of an 8-week supplementation with red clover-derived isoflavones . It notes that 34 postmenopausal women with a family history of colorectal cancer were the population of the study.
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- 2008
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