Second malignancies diagnosed in patients receiving chemotherapy at the Pennsylvania Hospital

During the past 15 years, the records of 2,020 patients who received chemotherapy on the surgical oncology, chemotherapy service at the Pennsylvania Hospital were reviewed. Thirty-five patients had pathologically confirmed second independent malignant tumors (not recurrences). The second cancers that developed were varied. The patients who developed these second malignancies ranged in age from 35 to 77 years (24 females, 11 males). The time interval involved was two to 102 months. Nine patients in this group of second malignancies received prior radiation therapy. The following is a list of the second cancers. There were 8 colons, 5 ovaries, 5 lungs, 6 acute myelogenous leukemias, 1 esophagus, 2 bladders, 2 epidermoid carcinomas of the skin, 2 melanomas, 1 chronic lymphatic leukemia, 1 breast cancer, 1 non-Hodgkin's malignant lymphoma, and 1 stomach cancer. The majority of second malignant tumors were amenable to some form of therapy, ie, surgery, radiation or chemotherapy. However, all of the acute myelogenous leukemias were totally refractory to any therapeutic modalities and rapidly expired. The majority of second cancers developed in patients receiving adjuvant chemotherapy. This is a patient population with a much longer expected survival time, particularly when compared to patients receiving chemotherapy for advanced disease. Twenty-five of the 34 second cancers developed in patients who received adjuvant chemotherapy for breast (14) or colorectal (11) cancers. The etiology of the second malignancies is very difficult to determine. However, alkylating agents appeared to be the possible etiologic agent involved in the development of acute myelogenous leukemia.