Comparison of treatment modalities for breast cancer arising in Hodgkin's lymphoma survivors

Breast cancer (BC) in Hodgkin's lymphoma (HL) survivors is traditionally treated with mastectomy, especially in those who received prior supradiaphragmatic radiation therapy (RT). Chest irradiation is a contraindication for breast-conserving therapy (BCT); however, retrospective studies have found that BCT is an acceptable treatment option for BCs that arise after prior RT. This study compares BC treatment modalities for female HL survivors. Data was extracted from the Surveillance, Epidemiology, and End Results (SEER) from 1983 to 2009. All female HL survivors who subsequently developed BC and received surgical treatment were included. BC events were grouped by the type of surgical resection and RT utilization. All were staged using the American Joint Committee on Cancer (AJCC) seventh edition criteria. Multivariate analysis was performed to compare treatment groups. There were 413 BC events arising in female HL survivors that received surgical management. Of these BC events, 371 were fully staged. Sixty-one received a bilateral mastectomy, 227 received a mastectomy, and 83 received a lumpectomy. A total of 65 BC events received RT, 19 after mastectomy and 46 after lumpectomy. On multivariate analysis for overall survival (OS) and cause-specific survival (CSS), there were no statistically significant favorable or adverse prognostic factors, including treatment modality. BCT did not have an inferior CSS or OS compared to other treatment modalities for female HL survivors. BCT is an acceptable treatment option for a select group of female HL survivors who develop BC.