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BMC Cancer
Published in: BMC Cancer 1/2017

Open Access 01-12-2017 | Study protocol

Colorectal cancer surveillance in Hodgkin lymphoma survivors at increased risk of therapy-related colorectal cancer: study design

Authors: Lisanne S. Rigter, Manon C. W. Spaander, Leon M. Moons, Tanya M. Bisseling, Berthe M. P. Aleman, Jan Paul de Boer, Pieternella J. Lugtenburg, Cecile P. M. Janus, Eefke J. Petersen, Judith M. Roesink, John M. M. Raemaekers, Richard W. M. van der Maazen, Annemieke Cats, Eveline M. A. Bleiker, Petur Snaebjornsson, Beatriz Carvalho, Iris Lansdorp-Vogelaar, Katarzyna Jóźwiak, Hein te Riele, Gerrit A. Meijer, Flora E. van Leeuwen, Monique E. van Leerdam

Published in: BMC Cancer | Issue 1/2017

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Abstract

Background

Second primary malignancies are a major cause of excess morbidity and mortality in cancer survivors. Hodgkin lymphoma survivors who were treated with infradiaphragmatic radiotherapy and/or high-dose procarbazine have an increased risk to develop colorectal cancer.
Colonoscopy surveillance plays an important role in colorectal cancer prevention by removal of the precursor lesions (adenomas) and early detection of cancer, resulting in improved survival rates. Therefore, Hodgkin lymphoma survivors treated with infradiaphragmatic radiotherapy and/or high-dose procarbazine could benefit from colonoscopy, or other surveillance modalities, which are expected to reduce colorectal cancer incidence and mortality. Current knowledge on clinicopathological and molecular characteristics of therapy-related colorectal cancer is limited. The pathogenesis of such colorectal cancers might be different from the pathogenesis in the general population and therefore these patients might require a different clinical approach.
We designed a study with the primary aim to assess the diagnostic yield of a first surveillance colonoscopy among Hodgkin lymphoma survivors at increased risk of colorectal cancer and to compare these results with different screening modalities in the general population. Secondary aims include assessment of the test characteristics of stool tests and evaluation of burden, acceptance and satisfaction of CRC surveillance through two questionnaires.

Methods/Design

This prospective multicenter cohort study will include Hodgkin lymphoma survivors who survived ≥8 years after treatment with infradiaphragmatic radiotherapy and/or procarbazine (planned inclusion of 259 participants). Study procedures will consist of a surveillance colonoscopy with removal of precursor lesions (adenomas) and 6–8 normal colonic tissue biopsies, a fecal immunochemical test and a stool DNA test. All neoplastic lesions encountered will be classified using relevant histomorphological, immunohistochemical and molecular analyses in order to obtain more insight into colorectal carcinogenesis in Hodgkin lymphoma survivors. The Miscan-model will be used for cost-effectiveness analyses.

Discussion

Evaluation of the diagnostic performance, patient acceptance and burden of colorectal cancer surveillance is necessary for future implementation of an individualized colorectal cancer surveillance program for Hodgkin lymphoma survivors. In addition, more insight into treatment-induced colorectal carcinogenesis will provide the first step towards prevention and personalized treatment. This information may be extrapolated to other groups of cancer survivors.

Trial registration

Registered at the Dutch Trial Registry (NTR): NTR4961.
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Metadata
Title
Colorectal cancer surveillance in Hodgkin lymphoma survivors at increased risk of therapy-related colorectal cancer: study design
Authors
Lisanne S. Rigter
Manon C. W. Spaander
Leon M. Moons
Tanya M. Bisseling
Berthe M. P. Aleman
Jan Paul de Boer
Pieternella J. Lugtenburg
Cecile P. M. Janus
Eefke J. Petersen
Judith M. Roesink
John M. M. Raemaekers
Richard W. M. van der Maazen
Annemieke Cats
Eveline M. A. Bleiker
Petur Snaebjornsson
Beatriz Carvalho
Iris Lansdorp-Vogelaar
Katarzyna Jóźwiak
Hein te Riele
Gerrit A. Meijer
Flora E. van Leeuwen
Monique E. van Leerdam
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2017
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-017-3089-8

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