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Second neoplasms in survivors of childhood cancer: findings from the Childhood Cancer Survivor Study cohort.
J Clin Oncol 2009; 27(14):2356-62JC

Abstract

PURPOSE

To review the reports of subsequent neoplasms (SNs) in the Childhood Cancer Survivor Study (CCSS) cohort that were made through January 1, 2006, and published before July 31, 2008, and to discuss the host-, disease-, and therapy-related risk factors associated with SNs.

PATIENTS AND METHODS

SNs were ascertained by survivor self-reports and subsequently confirmed by pathology findings or medical record review. Cumulative incidence of SNs and standardized incidence ratios for second malignant neoplasms (SMNs) were calculated. The impact of host-, disease-, and therapy-related risk factors was evaluated by Poisson regression.

RESULTS

Among 14,358 cohort members, 730 reported 802 SMNs (excluding nonmelanoma skin cancers). This represents a 2.3-fold increase in the number of SMNs over that reported in the first comprehensive analysis of SMNs in the CCSS cohort, which was done 7 years ago. In addition, 66 cases of meningioma and 1,007 cases of nonmelanoma skin cancer were diagnosed. The 30-year cumulative incidence of SMNs was 9.3% and that of nonmelanoma skin cancer was 6.9%. Risk of SNs remains elevated for more than 20 years of follow-up for all primary childhood cancer diagnoses. In multivariate analyses, risks differ by SN subtype, but include radiotherapy, age at diagnosis, sex, family history of cancer, and primary childhood cancer diagnosis. Female survivors whose primary childhood cancer diagnosis was Hodgkin's lymphoma or sarcoma and who received radiotherapy are at particularly increased risk. Analyses of risk associated with radiotherapy demonstrated different dose-response curves for specific SNs.

CONCLUSION

Childhood cancer survivors are at a substantial and increasing risk for SNs, including nonmelanoma skin cancer and meningiomas. Health care professionals should understand the magnitude of these risks to provide individuals with appropriate counseling and follow-up.

Authors+Show Affiliations

Children's Hospital of Philadelphia, Philadelphia, PA 19104-4399, USA. meadows@chop.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

19255307

Citation

Meadows, Anna T., et al. "Second Neoplasms in Survivors of Childhood Cancer: Findings From the Childhood Cancer Survivor Study Cohort." Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, vol. 27, no. 14, 2009, pp. 2356-62.
Meadows AT, Friedman DL, Neglia JP, et al. Second neoplasms in survivors of childhood cancer: findings from the Childhood Cancer Survivor Study cohort. J Clin Oncol. 2009;27(14):2356-62.
Meadows, A. T., Friedman, D. L., Neglia, J. P., Mertens, A. C., Donaldson, S. S., Stovall, M., ... Inskip, P. D. (2009). Second neoplasms in survivors of childhood cancer: findings from the Childhood Cancer Survivor Study cohort. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 27(14), pp. 2356-62. doi:10.1200/JCO.2008.21.1920.
Meadows AT, et al. Second Neoplasms in Survivors of Childhood Cancer: Findings From the Childhood Cancer Survivor Study Cohort. J Clin Oncol. 2009 May 10;27(14):2356-62. PubMed PMID: 19255307.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Second neoplasms in survivors of childhood cancer: findings from the Childhood Cancer Survivor Study cohort. AU - Meadows,Anna T, AU - Friedman,Debra L, AU - Neglia,Joseph P, AU - Mertens,Ann C, AU - Donaldson,Sarah S, AU - Stovall,Marilyn, AU - Hammond,Sue, AU - Yasui,Yutaka, AU - Inskip,Peter D, Y1 - 2009/03/02/ PY - 2009/3/4/entrez PY - 2009/3/4/pubmed PY - 2009/5/16/medline SP - 2356 EP - 62 JF - Journal of clinical oncology : official journal of the American Society of Clinical Oncology JO - J. Clin. Oncol. VL - 27 IS - 14 N2 - PURPOSE: To review the reports of subsequent neoplasms (SNs) in the Childhood Cancer Survivor Study (CCSS) cohort that were made through January 1, 2006, and published before July 31, 2008, and to discuss the host-, disease-, and therapy-related risk factors associated with SNs. PATIENTS AND METHODS: SNs were ascertained by survivor self-reports and subsequently confirmed by pathology findings or medical record review. Cumulative incidence of SNs and standardized incidence ratios for second malignant neoplasms (SMNs) were calculated. The impact of host-, disease-, and therapy-related risk factors was evaluated by Poisson regression. RESULTS: Among 14,358 cohort members, 730 reported 802 SMNs (excluding nonmelanoma skin cancers). This represents a 2.3-fold increase in the number of SMNs over that reported in the first comprehensive analysis of SMNs in the CCSS cohort, which was done 7 years ago. In addition, 66 cases of meningioma and 1,007 cases of nonmelanoma skin cancer were diagnosed. The 30-year cumulative incidence of SMNs was 9.3% and that of nonmelanoma skin cancer was 6.9%. Risk of SNs remains elevated for more than 20 years of follow-up for all primary childhood cancer diagnoses. In multivariate analyses, risks differ by SN subtype, but include radiotherapy, age at diagnosis, sex, family history of cancer, and primary childhood cancer diagnosis. Female survivors whose primary childhood cancer diagnosis was Hodgkin's lymphoma or sarcoma and who received radiotherapy are at particularly increased risk. Analyses of risk associated with radiotherapy demonstrated different dose-response curves for specific SNs. CONCLUSION: Childhood cancer survivors are at a substantial and increasing risk for SNs, including nonmelanoma skin cancer and meningiomas. Health care professionals should understand the magnitude of these risks to provide individuals with appropriate counseling and follow-up. SN - 1527-7755 UR - https://www.unboundmedicine.com/medline/citation/19255307/Second_neoplasms_in_survivors_of_childhood_cancer:_findings_from_the_Childhood_Cancer_Survivor_Study_cohort_ L2 - http://ascopubs.org/doi/full/10.1200/JCO.2008.21.1920?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -