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Ewing's sarcoma as a second malignant neoplasm in a child previously treated for Wilms' tumor
R Fisher1, S C Kaste, D M Parham
1Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
Purpose:
Second malignant neoplasms (SMNs) are a rare occurrence after the successful treatment of childhood cancer. For survivors of Wilms' tumor, the 10-year cumulative risk of developing an SMN has been estimated to be 1%. Bone sarcomas arising within the radiation field are a common occurrence, yet Ewing's sarcoma has been rarely reported as an SMN.
Patients And Methods:
A 10-year-old girl presented with dyspnea 5 years after the diagnosis of stage III favorable histology Wilms' tumor and was found to have a right intrathoracic mass arising from the eighth and ninth ribs. The mass was located at the edge of the previous radiation field.
Results:
Tumor cytogenetics and immunocytochemistry were helpful in establishing the diagnosis of Ewing's sarcoma. Treatment included combination chemotherapy, with hematopoietic growth factor support, and excluded anthracyclines and radiotherapy. More than 1 year after the diagnosis of Ewing's sarcoma, the patient has completed therapy with no evidence of disease.
Conclusions:
This is the first report to our knowledge of Ewing's sarcoma arising in the irradiation field of a patient treated previously for Wilms' tumor.