Second malignant neoplasms in children: an update from the Late Effects Study Group.

Abstract

This paper presents an update from the Late Effects Study Group on 292 cases of second malignant neoplasms (SMN) occurring in individuals who were diagnosed with their first neoplasm in childhood. Data are presented regarding the types of first and second neoplasm, the therapy administered, and the predisposing factors. Of the 292 cases (308 SMN), the most common primary was retinoblastoma followed by Hodgkin's disease, soft-tissue sarcomas, and Wilms' tumor. This is not similar to the relative frequency of these cancers in children but rather reflects specific risk factors. Bone sarcomas were the most common SMN among the 208 SMN developing in previously irradiated sites while acute leukemia was the most common SMN unassociated with radiation. Known predisposing conditions to cancer were present in 73 cases; retinoblastoma was the most common of these, followed by neurofibromatosis. There were ten patients with three and three patients with four malignant neoplasms. In 14 patients, the cause of SMN was not suggested by known risk factors as these patients had negative family histories and received no radiation or chemotherapy. We note, therefore, that although most cases of SMN in survivors of childhood cancer can be attributed to radiation, genetic disease, chemotherapy, or combinations of these, unrecognized predisposition or chance may also play a role.

Second neoplasms in pediatric patients with primary central nervous system tumors

“…16 Several reports have established a causal relation between the occurrence of multiple malignancies and a genetic syndrome in children with primary brain tumors. 2,3,10,12,13 The relation between NF1 and subsequent neoplasms has been well documented, although the impact of intervening therapies is less well established. A small number of case reports and only two series have demonstrated this relation with respect to syndromes other than NF1.…”

“…It is well recognized that children with NF1 have an increased risk of developing an SN and, in particular, a second brain tumor. 2,3,10,12 The risk of developing a second brain tumor for children with NF1 and an optic pathway glioma is estimated to be between 11% and 52%. 26 -28 The rigorous histologic and radiologic review performed in the current series allowed the exclusion of patients with tumor recurrence or anaplastic progression of low-grade glioma.…”

“…Patients who had a diagnosis of neurofibromatosis type 1 (NF1) were excluded from the study because of their known predisposition toward developing SNs. 2,3,10,12 …”

A study of soft tissue sarcomas after childhood cancer in Britain

“…Thus a growing number of survivors, estimated at 1 in every 1000 young adults (Hawkins and Stevens, 1996), are at risk of various adverse late effects of both the cancer and its treatment. The well-recognised increased risk of a second malignant neoplasm (SMN) (Meadows et al, 1985) may represent the greatest challenge to long-term survival (Robison and Mertens, 1993). Further study of their causes, which include both exposure to chemotherapy (CT), radiotherapy (RT) and genetic predisposition (Kony et al, 1997), requires follow-up of large numbers of survivors with a wide spectrum of treatments.…”

Inibidor de histona deacetilase (HDACi) como possível radiosensibilizante em linhagens celulares de glioblastoma pediátrico

“…(Walter, et al, 1998). No entanto, a classificação do risco sofre variações de acordo com o tipo da neoplasia secundária, do diagnóstico do tumor primário, idade do paciente quando diagnosticado inicialmente, e do tratamento do tumor primário (Meadows et al, 1985;Neglia et al, 2001;Mike;D'Angio, 1982;Garwicz et al, 2000) Crianças que receberam irradiação profilática ou terapêutica no SNC apresentam maior risco de segundo tumor quando comparadas com aquelas não irradiadas. Dentre as neoplasias secundárias relatadas em crianças que sobreviveram ao câncer, aquelas pertencentes ao grupo dos tumores do sistema nervoso central (SNC) são os mais devastadores (Neglia et al, 2006).…”