Background: It is unclear how intensity-modulated radiation therapy (IMRT) impacts long-term risk of second malignant neoplasms (SMNs) in childhood cancer patients. Procedure: Patients aged ≤21 years treated with IMRT between 1998 and 2009 and who survived ≥5 years after IMRT were included. SMN site in relation to isodose level (IDL) of IMRT was evaluated. Standardized incidence ratios (SIR) and excess absolute risks (EAR) were calculated. Cumulative incidences were estimated with death as a competing risk.Results: Three-hundred twenty-five patients were included with median follow-up of 11.2 years from IMRT (interquartile range: 9.4-14.0) among patients alive at the end of follow-up. Two hundred (62%) patients had ≥10 years of follow-up and 284 (87%) patients were alive at the time of analysis. Fifteen patients developed SMNs (11 solid, four hematologic). Median time from IMRT to solid SMN was 11.0 years (range: 6.8-19.2) with 10-and 15-year cumulative incidences 1.8% (95% CI: 0.7-3.9) and 3.5% (95% CI: 1.4-7.5), respectively; SIR was 13.7 (95% CI: 6.9-24.6) and EAR was 2.8 per 1000 person-years (95% CI: 1.0-4.6). Eight solid SMNs developed within the IMRT field (100% IDL [n = 5], 80% IDL [n = 1], 50% IDL [n = 1], 40% IDL [n = 1]), one within the 70%-80% IDL of a conventional field, one was out-of-field, and one could not be determined. Conclusions:With median follow-up of >10 years, many solid SMNs after IMRT in childhood cancer survivors develop in the high-dose region. These data serve as a foundation for comparison with other modalities of radiation treatment (e.g., proton therapy).

between two and five years after breast cancer surgery. Patients were deemed adherent to follow-up during COVID-19 if they attended an oncology follow-up appointment (in-person or telemedicine) between March 1 and December 1, 2020; patients were deemed non-adherent if they attended follow-up during the same date range in 2019, prior to the pandemic, but did not follow-up during the COVID-19 period. Adherence during COVID-19 was compared with pre-COVID rates of follow-up. Clinical and demographic data were evaluated as potential predictors of adherence. Local COVID-19 case rates were estimated from public data by ZIP code during the peak of the pandemic in April 2020. Multivariate logistic regression was performed to identify associations with follow-up nonadherence.Results: During COVID-19, 496 (68%) of 734 patients were adherent to follow-up. Of the adherent group, 40.5% had telemedicine visits. The rate of follow-up adherence during COVID-19 was dramatically lower than historic adherence rates of 89-96%, which varied depending on time since resection. On multivariate analysis, adherence was more likely among patients who had received adjuvant radiation therapy (adjusted Odds Ratio [aOR] 1.4; P = 0.032) and smokers (aOR 1.6; P = 0.041). When patients who live in The Bronx were stratified by ZIP code, there was no association (R 2 = 0.01) between local COVID-19 case rates and likelihood of adherence during the COVID-19 pandemic. Conclusion: To our knowledge, this is the first analysis evaluating the potential effect of COVID-19 on cancer survivorship care. We observed a dramatic disruption in long-term follow-up during the COVID-19 period, despite prevalent utilization of telemedicine visits. Overall, if the observed rate of non-adherence persists and patients are not reintegrated into regular follow-up patterns after the COVID-19 period, it has the potential to dramatically affect cancer survival outcomes.

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Background It is unclear how intensity-modulated radiation therapy (IMRT) impacts long-term risk of second malignant neoplasms (SMNs) in childhood cancer patients. Procedure Patients aged 10 years, many solid SMNs after IMRT in childhood cancer survivors develop in the high dose region. These data serve as a foundation for comparison with other modalities of radiation treatment (e.g., proton therapy).