Long-term Risks of Subsequent Primary Neoplasms Among Survivors of Childhood Cancer

Reulen, Raoul C.

doi:10.1001/jama.2011.747

Cited by 295 publications

(271 citation statements)

References 25 publications

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“…However, since some childhood cancers involve an underlying germline mutation, this may also contribute to the observed increase in the susceptibility to second malignancies. 62,83,84 The small size of paediatric patients further increases risk, since scatter radiation will affect more tissues. 33 …”

Section: Studies Providing Indirect Evidence Of the Excess Risk Of Ramentioning

confidence: 99%

Radiotherapy for benign disease; assessing the risk of radiation-induced cancer following exposure to intermediate dose radiation

McKeown

Hatfield

Prestwich

et al. 2015

BJR

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Most radiotherapy (RT) involves the use of high doses (.50 Gy) to treat malignant disease. However, low to intermediate doses (approximately 3-50 Gy) can provide effective control of a number of benign conditions, ranging from inflammatory/proliferative disorders (e.g. Dupuytren's disease, heterotopic ossification, keloid scarring, pigmented villonodular synovitis) to benign tumours (e.g. glomus tumours or juvenile nasopharyngeal angiofibromas). Current use in UK RT departments is very variable. This review identifies those benign diseases for which RT provides good control of symptoms with, for the most part, minimal side effects. However, exposure to radiation has the potential to cause a radiation-induced cancer (RIC) many years after treatment. The evidence for the magnitude of this risk comes from many disparate sources and is constrained by the small number of long-term studies in relevant clinical cohorts. This review considers the types of evidence available, i.e. theoretical models, phantom studies, epidemiological studies, longterm follow-up of cancer patients and those treated for benign disease, although many of the latter data pertain to treatments that are no longer used. Informative studies are summarized and considered in relation to the potential for development of a RIC in a range of key tissues (skin, brain etc.). Overall, the evidence suggests that the risks of cancer following RT for benign disease for currently advised protocols are small, especially in older patients. However, the balance of risk vs benefit needs to be considered in younger adults and especially if RT is being considered in adolescents or children.

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Section: Studies Providing Indirect Evidence Of the Excess Risk Of Ramentioning

confidence: 99%

Radiotherapy for benign disease; assessing the risk of radiation-induced cancer following exposure to intermediate dose radiation

McKeown

Hatfield

Prestwich

et al. 2015

BJR

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“…These late effects, the onset of which basically depends on the type of treatment received, may arise a number of years after treatment and recovery from the tumor (9,10). There is, therefore, a widely shared view that so-called childhood cancer survivors (CCS) should be followed and clinically monitored -also in adulthood and ideally throughout the entire life span -in order to reduce morbidity and mortality related to the late toxicity of antitumor treatments (11,12,13).…”

Section: Introductionmentioning

confidence: 99%

Endocrine health conditions in adult survivors of childhood cancer: the need for specialized adult-focused follow-up clinics

Brignardello

Felicetti

Castiglione

et al. 2013

European Journal of Endocrinology

151

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Background: Survival rates among childhood cancer survivors (CCS) have enormously increased in the last 40 years. However, this improvement has been achieved at the expense of serious late effects that frequently involve the endocrine system. Aim: To evaluate the cumulative incidence of endocrine diseases in a cohort of long-term CCS. Materials and methods: We analyzed the clinical data of 310 adults, followed for a median time of 16.0 years after the first cancer diagnosis. The monitoring protocols applied to each patient were personalized on the basis of cancer diagnosis and previous treatments, according to the Children's Oncology Group guidelines. Results: The cumulative incidence of endocrine late effects steadily increased over time. At the last follow-up visit available, 48.46% of females and 62.78% of males were affected by at least one endocrine disease. The most common disorders were gonadal dysfunction, primary hypothyroidism, and GH deficiency (GHD). The main risk factors for endocrine disease were male sex (hazard ratio (HR)Z1.45, 95% confidence interval (95% CI) 1.05-1.99), radiotherapy (HRZ1.91, 95% CI 1.28-2.84), hematopoietic stem cells transplantation (HRZ3.11, 95% CI 2.23-4.34), and older age at cancer diagnosis (HRZ1.89, 95% CI 1.25-2.85). Male sex was associated with a higher risk of gonadal disorders, whereas radiotherapy specifically increased the risk of GHD and thyroid dysfunction. Conclusions: Endocrine disorders among CCS have a high prevalence and increase over time. Thus, endocrinologists need to cope with an increasing demand for health care in a field that is still little developed and that, in perspective, could also be extended to some selected types of adult cancer survivors.

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“…Bone sarcomas are one of the most common second primary cancers occurring after hereditary retinoblastoma accounting for 25-30% of all second primary cancers [10]. The majority of bone sarcomas occurred within the radiation field in the head region, but up to 40% was diagnosed outside the treatment field, primarily in the lower legs [9].…”

Section: Resultsmentioning

confidence: 99%

Ewing’s Sarcoma as Second Malignancy after Bilateral Retinoblastoma: A Case Report and Literature Review

2012

J Blood Lymph

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Background: Children diagnosed with the hereditary form of retinoblastoma (Rb) have excellent survival, but face an increased risk of bone and soft tissue sarcomas. This predisposition to sarcomas has been attributed to genetic susceptibility due to inactivation of the RB1 gene as well as past radiotherapy for Rb. Objectives:To report the case of a child with hereditary form of bilateral RB, who developed Ewing's sarcoma of the right femur 10 years after the Enucleation of the both eyes. Methods:The child was diagnosed as a case of bilateral RB at the age of 3 months. He was fully investigated and found to have locally advanced RB. Enucleation was done. The patient received chemotherapy and radiotherapy. At 14 years, he was investigated for a small swelling in his right lower leg. After extensive investigations, it was reported as Ewing's sarcoma. He is treated with chemotherapy.Results: This report confirms that patients suffering from RB are at an increased risk of developing Second Malignant Neoplasms (SMNs). Conclusions:This case confirms the increased risk of a SMN in children with hereditary RB. These children need a very close follow-up for the early diagnosis of SMNs.

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Long-term Risks of Subsequent Primary Neoplasms Among Survivors of Childhood Cancer

Abstract: Among a cohort of British childhood cancer survivors, the greatest excess risk associated with subsequent primary neoplasms at older than 40 years was for digestive and genitourinary neoplasms.

Cited by 295 publications

References 25 publications

Radiotherapy for benign disease; assessing the risk of radiation-induced cancer following exposure to intermediate dose radiation

Radiotherapy for benign disease; assessing the risk of radiation-induced cancer following exposure to intermediate dose radiation

Endocrine health conditions in adult survivors of childhood cancer: the need for specialized adult-focused follow-up clinics

Ewing’s Sarcoma as Second Malignancy after Bilateral Retinoblastoma: A Case Report and Literature Review

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