Therapy-related Secondary Malignancy After Treatment of Childhood Malignancy: Cases from a Single Center

Abstract

Background: Therapeutic outcomes for childhood malignancy have dramatically improved. However, secondary malignancies are a major concern, as they greatly affect the quality of life of survivors. This retrospective study evaluated the cumulative incidence, clinical features, and outcomes of secondary malignancies at Nippon Medical School Hospital. Methods: We examined data from 275 cases of primary childhood malignancy diagnosed between 1980 and 2014. Information regarding treatment of the primary malignancy, including irradiation dose, site, and cumulative dose of anticancer drugs, was assessed. We also collected data on secondary malignancy, including patient sex, age at diagnosis, malignancy site, time from primary to secondary malignancy, and outcomes. Results: Secondary malignancies developed in 11 patients and included acute myeloid leukemia (AML) (4), meningioma (4), Ewing sarcoma (1), germ cell tumor (1), and malignant parotid gland tumor (1). The primary malignancies included acute lymphoblastic leukemia (ALL) (9), non-Hodgkin lymphoma (1) and brain tumor (1). In 7 of the 9 ALL patients, chemoradiotherapy was the primary treatment. The meningiomas and 1 solid tumor developed within the radiation field. All AMLs and meningiomas developed within 5 years and after 20 years, respectively, of the primary diagnosis. The 10-and 20-year cumulative incidence rates for secondary malignancy in our hospital were 1.9% and 5.8%, respectively. Conclusions: Our results revealed that the type of secondary malignancy depends on the interval after the end of treatment for primary malignancy. Meningioma, notably, develops many years after completion of primary malignancy treatment. Early detection during long-term follow-up is therefore essential.

Incidence of second primary cancers among survivors of childhood cancer: A population‐based study, Osaka, Japan, 1975–2015

“…First, of the 101 SPCs observed in this study, the largest portion was represented by cancers of the CNS ( n = 29), which may be partly due to the late effect of treatment for FPC. An increased risk of subsequent CNS cancers such as gliomas, meningiomas, and sarcomatous lesions has been reported as a consequence of irradiation for CNS cancers and leukemia 26–29 . In line with this, the most common subsequent CNS cancer in the present study was glioma ( n = 16), followed by meningioma ( n = 6).…”

“…An increased risk of subsequent CNS cancers such as gliomas, meningiomas, and sarcomatous lesions has been reported as a consequence of irradiation for CNS cancers and leukemia. 26 , 27 , 28 , 29 In line with this, the most common subsequent CNS cancer in the present study was glioma ( n = 16), followed by meningioma ( n = 6). Recognition of patients at risk for developing radiation‐induced neoplasms could facilitate early diagnosis through careful clinical observation and follow‐up screening.…”

Development of nomogram and discussion of radiotherapy effect for osteosarcoma survival

“…Fortunately, the application of radiotherapy has greatly improved the local control rate in patients who cannot undergo surgery or have inadequate margins for various reasons, and poorly treatment effect of chemotherapy as well 30 . Ueda et al 31 analyzed data from 275 patients with primary osteosarcoma. In their study, the local control rate was 68% within 5 years in patients with unresectable or positive margins who received radiotherapy.…”

Severe course of radiation-induced meningioma — a new insight in screening for patients after radiotherapy?

“…Although meningioma is the most common post--radiation tumour of the head, accounting for approximately 44-52% of them [16,17], it isn't the only one that may develop as a result of radiotherapy. According to scientific literature, this group of post-radiation head lesions include also sarcoma [16], especially Ewing sarcoma [17], malignant astrocytoma [16], medulloblastoma [16], haemangioma [18], glioma [18,19], germ cell tumour [17], malignant parotid gland tumour [17] and rhabdomyosarcoma [19,20].…”

“…Although meningioma is the most common post--radiation tumour of the head, accounting for approximately 44-52% of them [16,17], it isn't the only one that may develop as a result of radiotherapy. According to scientific literature, this group of post-radiation head lesions include also sarcoma [16], especially Ewing sarcoma [17], malignant astrocytoma [16], medulloblastoma [16], haemangioma [18], glioma [18,19], germ cell tumour [17], malignant parotid gland tumour [17] and rhabdomyosarcoma [19,20]. A single case report also showed patients with various head tumours coexistence: meningioma + angioma [21], meningioma + pituitary adenoma [22], meningioma + subependymoma + cavernoma [23], or meningioma + pituicytoma (hormonally inactive) + cavernoma [24].…”