Second Malignant Neoplasms Following Childhood Cancer: A Study of a Recent Cohort (1987–2004) from the Childhood Cancer Registry of The Rhône-Alpes Region (ARCERRA) in France

Abstract

Studies of second malignant neoplasms (SMNs) in childhood are generally conducted in old cohorts. The aim of this study was to determine the actual incidence of all SMNs in a recent cohort. The authors studied a cohort of 2907 children included in the population-based Childhood Cancer Registry of the Rhône-Alpes Region for a first cancer diagnosed between 1987 and 2004. Total follow-up was 22,722 person-years, with a median follow-up of 9.8 years (range, 00.0-22.8 years). Fifty-four SMNs were reported in 52 patients. Overall median latency was 5.9 years. Cumulative incidence rates were 2.2% at 10 years and 3.9% at 15, with an overall standardized incidence ratio (SIR) of 13.9 (95% confidence interval [CI], 10.4-18.3) and absolute excess risk of 2.2. The SMNs were 12 thyroid carcinomas (SIR 57.1); 9 bone tumors (SIR 32.0); 8 leukemias (SIR 11.9); 5 lymphomas, all related to Epstein-Barr virus following allograft, (SIR 6.7); 5 CNS tumors (SIR 10.5); 4 soft tissue sarcomas (SIR 17.4); 4 carcinomas (no breast cancer); and 7 other cancers. Twelve SMNs appeared after total body irradiation, 16 after focal radiotherapy, and 8 leukemias after chemotherapy. The risk of secondary cancer was highest after retinoblastomas (SIR 41.8), Hodgkin lymphomas (SIR 20.8), leukemias (SIR 18.4), soft tissue sarcomas, CNS tumors, and bone tumors. These recent cohort findings show, on one hand, a high incidence of SMNs but do not capture breast cancers because of the relatively short follow-up and, on the other hand, a different distribution of first and second cancers.

Self-reported and Record-collected Late Effects in Long-term Survivors of Childhood Cancer: A Population-based Cohort Study of the Childhood Cancer Registry of the Rhône-Alpes Region (ARCERRA)

“…Improved survival of these patients, from 25% in the 1970s to 75% in 2000, suggests that about one French person in 850 has survived childhood cancer [2,3] and that management of treatment, including chemotherapy, surgery, and/or irradiation, and healthcare support services of these patients has greatly improved [4]. Nevertheless, long-term effects of disease and sometimes heavy treatment can include disabilities or even secondary cancers that lead to death [5][6][7][8][9][10][11]. Carcinogenic or not, iatrogenic effects affect about two-thirds of survivors [9][10][11][12][13][14].…”

“…Nevertheless, long-term effects of disease and sometimes heavy treatment can include disabilities or even secondary cancers that lead to death [5][6][7][8][9][10][11]. Carcinogenic or not, iatrogenic effects affect about two-thirds of survivors [9][10][11][12][13][14].…”

Thyroid Sequelae of Pediatric Cancer Therapy

“…Typically, the latency period is long, and studies from the CCSS and the British CCSS cohorts showed a median time to occurrence around 19–20 years after treatment of the first primary cancer [32, 85]. In some studies, the reported shorter latency periods could be in part attributed to the incorporation of routine ultrasound screening in at-risk cancer survivors [86, 89]. …”

“…1). Thyroid cancer, specifically papillary thyroid carcinoma (PTC), is one of the most frequently diagnosed subsequent primary malignancies in childhood cancer survivors [28, 85, 86]. Survivors of childhood Hodgkin disease, for example, are 18.3-fold more likely to develop PTC [26], although benign thyroid nodules are still more common [31].…”

Second Malignant Neoplasms in Pediatric Oncology Patients: A Single Center Experience

“…Median latency between first and second cancers in our study was shorter than that in the Childhood Cancer Survivor Study (CCSS) cohort (5 years versus 11.7 years), but the CCSS does not take into account early leukemias arising less than 5 years after the first cancer. This was partially attributable to the shorter latency of our secondary leukemias (3 year and 5 months versus 7.1 years) (12). However, Rihani et al also noted a shorter latency at 3 years for secondary acute myeloblastic leukemias (13) Carcinogenesis is a complex process and can develop as a result of many factors.…”