Risk, Risk Factors, and Surveillance of Subsequent Malignant Neoplasms in Survivors of Childhood Cancer: A Review

Abstract

Subsequent malignant neoplasms (SMNs) in childhood cancer survivors cause substantial morbidity and mortality. This review summarizes recent literature on SMN epidemiology, risk factors, surveillance, and interventions. Survivors of childhood cancer experience long-term increased SMN risk compared with the general population, with a greater than twofold increased solid tumor risk extending beyond age 40 years. There is a dose-dependent increased risk for solid tumors after radiotherapy, with the highest risks for tumors occurring in or near the treatment field (eg, greater than fivefold increased risk for breast, brain, thyroid, skin, bone, and soft tissue malignancies). Alkylating and anthracycline chemotherapies increase the risk for development of several solid malignancies in addition to acute leukemia/myelodysplasia, and these risks may be modified by other patient characteristics, such as age at exposure and, potentially, inherited genetic susceptibility. Strategies for identifying survivors at risk and initiating long-term surveillance have improved and interventions are underway to improve knowledge about late-treatment effects among survivors and caregivers. Better understanding of treatment-related risk factors and genetic susceptibility holds promise for refining surveillance strategies and, ultimately, upfront cancer therapies.

Colon cancer as a subsequent malignant neoplasm in young adults

“…19 Other limitations of the current study include those inherent to the NCDB, including a lack of information regarding cancer-specific survival or disease recurrence. Unfortunately, we were unable to exclude such patients due to a lack of data in the NCDB, and therefore these individuals were part of the current study cohort.…”

“…19 Survivors of pediatric malignancies in the Childhood Cancer Survivor Study who previously were treated with abdominal radiation experienced an 11-fold increased risk of gastrointestinal SMNs. One possibility is that patients had an associated cancer predisposition syndrome for which guidelines recommend more extensive surgery.…”

“…Patients with colon SMNs also received less chemotherapy, most likely secondary to being diagnosed with earlier stage lesions. 19 Procarbazine and platinum have been associated with 3.2-fold and 7.6-fold increased risks, respectively, for gastrointestinal SMNs. Systemic therapies and radiation have been shown to be associated with the development of colon SMNs.…”

Radiogenomic Predictors of Adverse Effects following Charged Particle Therapy

“…Over the past 40 years, numerous epidemiologic studies provided insight into radiation therapy–related risks for a variety of tissues [38–42]. The highest risks (>5-fold increase) were reported for subsequent malignancies of the brain, bone, soft tissue, skin (basal cell carcinoma), breast, and thyroid [43].…”

Retinoblastoma with late metastatic spread—a case report

“…When treated adequately, more than 95% of patients are long‐term survivors. Late treatment‐associated side effects are a major concern and survivors bear a lifelong risk for developing second RB1 ‐associated cancers …”