Second malignant neoplasms after a first cancer in childhood: temporal pattern of risk according to type of treatment

Abstract

SummaryThe variation in the risk of solid second malignant neoplasms (SMN) with time since first cancer during childhood has been previously reported. However, no study has been performed that controls for the distribution of radiation dose and the aggressiveness of past chemotherapy, which could be responsible for the observed temporal variation of the risk. The purpose of this study was to investigate the influence of the treatment on the long-term pattern of the incidence of solid SMN after a first cancer in childhood. We studied a cohort of 4400 patients from eight centres in France and the UK. Patients had to be alive 3 years or more after a first cancer treated before the age of 17 years and before the end of 1985. For each patient in the cohort, the complete clinical, chemotherapy and radiotherapy history was recorded. For each patient who had received external radiotherapy, the dose of radiation received by 151 sites of the body were estimated. After a mean follow-up of 15 years, 113 children developed a solid SMN, compared to 12.3 expected from general population rates. A similar distribution pattern was observed among the 1045 patients treated with radiotherapy alone and the 2064 patients treated with radiotherapy plus chemotherapy; the relative risk, but not the excess absolute risk, of solid SMN decreased with time after first treatment; the excess absolute risk increased during a period of at least 30 years after the first cancer. This pattern remained after controlling for chemotherapy and for the average dose of radiation to the major sites of SMN. It also remained when excluding patients with a first cancer type or an associated syndrome known to predispose to SMN. When compared with radiotherapy alone, the addition of chemotherapy increases the risk of solid SMN after a first cancer in childhood, but does not significantly modify the variation of this risk during the time after the first cancer.

The cancer epidemiology of radiation

“…In general, the combined carcinogenic risk has been found to be greater than additive (Travis et al, 1996;de Vathaire et al, 1999;Garwicz et al, 2000), although this…”

Risk of thyroid cancer in survivors of childhood cancer: Results from the British Childhood Cancer Survivor Study

“…10 Thyroid cancer has been frequently reported as a SPN after treatment for childhood cancers including Hodgkin's disease, neuroblastoma and other malignancies that involve radiation to the neck region. [11][12][13] We carried out a cohort study to determine the overall risk of developing a thyroid SPN in 5-year childhood cancer survivors in the British Childhood Cancer Survivor Study (BCCSS).…”

Screening for Subsequent Pancreatic Cancer in Childhood Cancer Survivors is Needed. A Case Report

“…In the same study the risk increased with the number of ChT cycles of ChT with AA or platinum agents as well. Besides that, it is reported that CCS treated for Ewing sarcoma, Hodgkin lymphoma and bilateral retinoblastoma are at the highest risk for SPN [5,13]. Our patient got SPC after a relatively long latency period of 28 years after treatment for Ewing sarcoma.…”