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Second neoplasms in pediatric patients treated for cancer: a center's 30-year experience
Kudret Cağlar1, Ali Varan, Canan Akyüz
1Department of Pediatric Oncology, Hacettepe University, Ankara, Turkey. caglar@tr.net
Insights
Childhood cancer survivors face a 1.7% risk of developing secondary neoplasms, with osteosarcoma being the most common. This highlights the need for less toxic cancer treatments to reduce long-term risks.
Area of Science:
- Pediatric Oncology
- Cancer Epidemiology
- Clinical Research
Background:
- Childhood cancer treatment has advanced significantly, leading to increased long-term survival rates.
- Understanding the long-term risks associated with cancer therapies, such as secondary malignancies, is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence and types of secondary neoplasms in pediatric cancer survivors.
- To analyze the risk factors and characteristics of secondary malignancies in this patient cohort.
Main Methods:
- Retrospective analysis of 1511 long-term survivors (followed >36 months) diagnosed with childhood cancer between 1971 and 2000.
- Data collection included patient demographics, primary cancer type, time to secondary malignancy, and type of secondary neoplasm.
Main Results:
- Twenty-six patients (1.7% risk) developed secondary malignancies.
- Osteosarcoma was the most frequent secondary neoplasm (6 patients), with four cases occurring within the radiation field.
- Other secondary cancers included acute lymphoblastic leukemia, acute myelogenous leukemia, and various rare malignancies.
Conclusions:
- Pediatric cancer survivors have a notable risk of developing secondary neoplasms, particularly osteosarcoma.
- The findings underscore the importance of employing less toxic treatment modalities to mitigate the risk of secondary cancers in childhood cancer survivors.
Abstract:
To investigate the incidence and outcome of secondary neoplasms in pediatric patients treated for childhood cancer. Between December 1971 and January 2000, a total of 5859 patients younger than age 17 were diagnosed and treated for childhood cancers in our center. Of this group, 1511 (36%) patients were followed for more than 36 months. These long-term survivors were included in this analysis. Twenty-six patients developed a secondary malignancy with an overall risk of 1.7% in this cohort. The male:female ratio was 17:10, with a median age of 7.66 at diagnosis (range, 2 to 16 y). Four patients (14.8%) with Hodgkin lymphoma; 3 each (11.1%) with retinoblastoma and rhabdomyosarcoma; 2 each (7.4%) with Wilms tumor, Ewing sarcoma, medulloblastoma, ganglioneuroblastoma, and non-Hodgkin lymphoma; and 1 each (3.7%) with ependymoma, nasopharyngeal carcinoma, osteosarcoma, astrocytoma had a secondary malignant disease during the long-term follow-up period. Secondary malignant diseases were osteosarcoma in 6 patients, acute lymphoblastic leukemia in 2, acute myelogenous leukemia in 2, and rare malignant disease in others. Four patients with osteosarcoma developed disease within the radiation field. Osteosarcoma was the most frequently occurring secondary neoplasm. Less toxic treatment modalities should be used to decrease the risk of secondary malignant diseases.
