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Secondary gastrointestinal cancer in childhood cancer survivors: a cohort study.
Ann Intern Med 2012; 156(11):757-66, W-260AIM

Abstract

BACKGROUND

Childhood cancer survivors develop gastrointestinal cancer more frequently and at a younger age than the general population, but the risk factors have not been well-characterized.

OBJECTIVE

To determine the risk and associated risk factors for gastrointestinal subsequent malignant neoplasms (SMNs) in childhood cancer survivors.

DESIGN

Retrospective cohort study.

SETTING

The Childhood Cancer Survivor Study, a multicenter study of childhood cancer survivors diagnosed between 1970 and 1986.

PATIENTS

14 358 survivors of cancer diagnosed when they were younger than 21 years of age who survived for 5 or more years after the initial diagnosis.

MEASUREMENTS

Standardized incidence ratios (SIRs) for gastrointestinal SMNs were calculated by using age-specific population data. Multivariate Cox regression models identified associations between risk factors and gastrointestinal SMN development.

RESULTS

At median follow-up of 22.8 years (range, 5.5 to 30.2 years), 45 cases of gastrointestinal cancer were identified. The risk for gastrointestinal SMNs was 4.6-fold higher in childhood cancer survivors than in the general population (95% CI, 3.4 to 6.1). The SIR for colorectal cancer was 4.2 (CI, 2.8 to 6.3). The highest risk for gastrointestinal SMNs was associated with abdominal radiation (SIR, 11.2 [CI, 7.6 to 16.4]). However, survivors not exposed to radiation had a significantly increased risk (SIR, 2.4 [CI, 1.4 to 3.9]). In addition to abdominal radiation, high-dose procarbazine (relative risk, 3.2 [CI, 1.1 to 9.4]) and platinum drugs (relative risk, 7.6 [CI, 2.3 to 25.5]) independently increased the risk for gastrointestinal SMNs.

LIMITATION

This cohort has not yet attained an age at which risk for gastrointestinal cancer is greatest.

CONCLUSION

Childhood cancer survivors, particularly those exposed to abdominal radiation, are at increased risk for gastrointestinal SMNs. These findings suggest that surveillance of at-risk childhood cancer survivors should begin at a younger age than that recommended for the general population.

PRIMARY FUNDING SOURCE

National Cancer Institute.

Authors+Show Affiliations

University of Chicago Department of Pediatrics, Section of Hematology, Oncology and Stem Cell Transplantation, 5841 South Maryland Avenue, MC 4060, Chicago, IL 60637, USA. thenderson@peds.bsd.uchicago.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo 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
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural

Language

eng

PubMed ID

22665813

Citation

Henderson, Tara O., et al. "Secondary Gastrointestinal Cancer in Childhood Cancer Survivors: a Cohort Study." Annals of Internal Medicine, vol. 156, no. 11, 2012, pp. 757-66, W-260.
Henderson TO, Oeffinger KC, Whitton J, et al. Secondary gastrointestinal cancer in childhood cancer survivors: a cohort study. Ann Intern Med. 2012;156(11):757-66, W-260.
Henderson, T. O., Oeffinger, K. C., Whitton, J., Leisenring, W., Neglia, J., Meadows, A., ... Nathan, P. C. (2012). Secondary gastrointestinal cancer in childhood cancer survivors: a cohort study. Annals of Internal Medicine, 156(11), pp. 757-66, W-260. doi:10.7326/0003-4819-156-11-201206050-00002.
Henderson TO, et al. Secondary Gastrointestinal Cancer in Childhood Cancer Survivors: a Cohort Study. Ann Intern Med. 2012 Jun 5;156(11):757-66, W-260. PubMed PMID: 22665813.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Secondary gastrointestinal cancer in childhood cancer survivors: a cohort study. AU - Henderson,Tara O, AU - Oeffinger,Kevin C, AU - Whitton,John, AU - Leisenring,Wendy, AU - Neglia,Joseph, AU - Meadows,Anna, AU - Crotty,Catherine, AU - Rubin,David T, AU - Diller,Lisa, AU - Inskip,Peter, AU - Smith,Susan A, AU - Stovall,Marilyn, AU - Constine,Louis S, AU - Hammond,Sue, AU - Armstrong,Greg T, AU - Robison,Leslie L, AU - Nathan,Paul C, PY - 2012/6/6/entrez PY - 2012/6/6/pubmed PY - 2012/8/14/medline SP - 757-66, W-260 JF - Annals of internal medicine JO - Ann. Intern. Med. VL - 156 IS - 11 N2 - BACKGROUND: Childhood cancer survivors develop gastrointestinal cancer more frequently and at a younger age than the general population, but the risk factors have not been well-characterized. OBJECTIVE: To determine the risk and associated risk factors for gastrointestinal subsequent malignant neoplasms (SMNs) in childhood cancer survivors. DESIGN: Retrospective cohort study. SETTING: The Childhood Cancer Survivor Study, a multicenter study of childhood cancer survivors diagnosed between 1970 and 1986. PATIENTS: 14 358 survivors of cancer diagnosed when they were younger than 21 years of age who survived for 5 or more years after the initial diagnosis. MEASUREMENTS: Standardized incidence ratios (SIRs) for gastrointestinal SMNs were calculated by using age-specific population data. Multivariate Cox regression models identified associations between risk factors and gastrointestinal SMN development. RESULTS: At median follow-up of 22.8 years (range, 5.5 to 30.2 years), 45 cases of gastrointestinal cancer were identified. The risk for gastrointestinal SMNs was 4.6-fold higher in childhood cancer survivors than in the general population (95% CI, 3.4 to 6.1). The SIR for colorectal cancer was 4.2 (CI, 2.8 to 6.3). The highest risk for gastrointestinal SMNs was associated with abdominal radiation (SIR, 11.2 [CI, 7.6 to 16.4]). However, survivors not exposed to radiation had a significantly increased risk (SIR, 2.4 [CI, 1.4 to 3.9]). In addition to abdominal radiation, high-dose procarbazine (relative risk, 3.2 [CI, 1.1 to 9.4]) and platinum drugs (relative risk, 7.6 [CI, 2.3 to 25.5]) independently increased the risk for gastrointestinal SMNs. LIMITATION: This cohort has not yet attained an age at which risk for gastrointestinal cancer is greatest. CONCLUSION: Childhood cancer survivors, particularly those exposed to abdominal radiation, are at increased risk for gastrointestinal SMNs. These findings suggest that surveillance of at-risk childhood cancer survivors should begin at a younger age than that recommended for the general population. PRIMARY FUNDING SOURCE: National Cancer Institute. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/22665813/full_citation L2 - https://www.annals.org/article.aspx?doi=10.7326/0003-4819-156-11-201206050-00002 DB - PRIME DP - Unbound Medicine ER -