Skip to main content
NCBI home page
British Journal of Cancer logoLink to British Journal of Cancer
. 1999 Apr;79(11-12):1884–1893. doi: 10.1038/sj.bjc.6690300

Second malignant neoplasms after a first cancer in childhood: temporal pattern of risk according to type of treatment

F de Vathaire 1, M Hawkins 4, S Campbell 5, O Oberlin 3, M-A Raquin 3, J-Y Schlienger 6, A Shamsaldin 1,3, I Diallo 1,3, J Bell 5, E Grimaud 3, C Hardiman 1,3, J-L Lagrange 7, N Daly-Schveitzer 8, X Panis 6, J-M Zucker 9, H Sancho-Garnier 1, F Eschwège 3, J Chavaudra 3, J Lemerle 2
PMCID: PMC2362818  PMID: 10206309

Abstract

The variation in the risk of solid second malignant neoplasms (SMN) with time since first cancer during childhood has been previously reported. However, no study has been performed that controls for the distribution of radiation dose and the aggressiveness of past chemotherapy, which could be responsible for the observed temporal variation of the risk. The purpose of this study was to investigate the influence of the treatment on the long-term pattern of the incidence of solid SMN after a first cancer in childhood. We studied a cohort of 4400 patients from eight centres in France and the UK. Patients had to be alive 3 years or more after a first cancer treated before the age of 17 years and before the end of 1985. For each patient in the cohort, the complete clinical, chemotherapy and radiotherapy history was recorded. For each patient who had received external radiotherapy, the dose of radiation received by 151 sites of the body were estimated. After a mean follow-up of 15 years, 113 children developed a solid SMN, compared to 12.3 expected from general population rates. A similar distribution pattern was observed among the 1045 patients treated with radiotherapy alone and the 2064 patients treated with radiotherapy plus chemotherapy; the relative risk, but not the excess absolute risk, of solid SMN decreased with time after first treatment; the excess absolute risk increased during a period of at least 30 years after the first cancer. This pattern remained after controlling for chemotherapy and for the average dose of radiation to the major sites of SMN. It also remained when excluding patients with a first cancer type or an associated syndrome known to predispose to SMN. When compared with radiotherapy alone, the addition of chemotherapy increases the risk of solid SMN after a first cancer in childhood, but does not significantly modify the variation of this risk during the time after the first cancer. © 1999 Cancer Research Campaign

Full Text

The Full Text of this article is available as a PDF (109.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andrieu J. M., Ifrah N., Payen C., Fermanian J., Coscas Y., Flandrin G. Increased risk of secondary acute nonlymphocytic leukemia after extended-field radiation therapy combined with MOPP chemotherapy for Hodgkin's disease. J Clin Oncol. 1990 Jul;8(7):1148–1154. doi: 10.1200/JCO.1990.8.7.1148. [DOI] [PubMed] [Google Scholar]
  2. Bhatia S., Robison L. L., Oberlin O., Greenberg M., Bunin G., Fossati-Bellani F., Meadows A. T. Breast cancer and other second neoplasms after childhood Hodgkin's disease. N Engl J Med. 1996 Mar 21;334(12):745–751. doi: 10.1056/NEJM199603213341201. [DOI] [PubMed] [Google Scholar]
  3. Blayney D. W., Longo D. L., Young R. C., Greene M. H., Hubbard S. M., Postal M. G., Duffey P. L., DeVita V. T., Jr Decreasing risk of leukemia with prolonged follow-up after chemotherapy and radiotherapy for Hodgkin's disease. N Engl J Med. 1987 Mar 19;316(12):710–714. doi: 10.1056/NEJM198703193161203. [DOI] [PubMed] [Google Scholar]
  4. Curtis R. E., Boice J. D., Jr, Stovall M., Bernstein L., Greenberg R. S., Flannery J. T., Schwartz A. G., Weyer P., Moloney W. C., Hoover R. N. Risk of leukemia after chemotherapy and radiation treatment for breast cancer. N Engl J Med. 1992 Jun 25;326(26):1745–1751. doi: 10.1056/NEJM199206253262605. [DOI] [PubMed] [Google Scholar]
  5. Diallo I., Lamon A., Shamsaldin A., Grimaud E., de Vathaire F., Chavaudra J. Estimation of the radiation dose delivered to any point outside the target volume per patient treated with external beam radiotherapy. Radiother Oncol. 1996 Mar;38(3):269–271. doi: 10.1016/0167-8140(96)01713-6. [DOI] [PubMed] [Google Scholar]
  6. Francois P., Beurtheret C., Dutreix A. Calculation of the dose delivered to organs outside the radiation beams. Med Phys. 1988 Nov-Dec;15(6):879–883. doi: 10.1118/1.596170. [DOI] [PubMed] [Google Scholar]
  7. Francois P., Beurtheret C., Dutreix A., De Vathaire F. A mathematical child phantom for the calculation of dose to the organs at risk. Med Phys. 1988 May-Jun;15(3):328–333. doi: 10.1118/1.596226. [DOI] [PubMed] [Google Scholar]
  8. Hawkins M. M., Draper G. J., Kingston J. E. Incidence of second primary tumours among childhood cancer survivors. Br J Cancer. 1987 Sep;56(3):339–347. doi: 10.1038/bjc.1987.200. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hawkins M. M., Wilson L. M., Burton H. S., Potok M. H., Winter D. L., Marsden H. B., Stovall M. A. Radiotherapy, alkylating agents, and risk of bone cancer after childhood cancer. J Natl Cancer Inst. 1996 Mar 6;88(5):270–278. doi: 10.1093/jnci/88.5.270. [DOI] [PubMed] [Google Scholar]
  10. Hawkins M. M., Wilson L. M., Stovall M. A., Marsden H. B., Potok M. H., Kingston J. E., Chessells J. M. Epipodophyllotoxins, alkylating agents, and radiation and risk of secondary leukaemia after childhood cancer. BMJ. 1992 Apr 11;304(6832):951–958. doi: 10.1136/bmj.304.6832.951. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Henry-Amar M., Dietrich P. Y. Acute leukemia after the treatment of Hodgkin's disease. Hematol Oncol Clin North Am. 1993 Apr;7(2):369–387. [PubMed] [Google Scholar]
  12. Little M. P., Hawkins M. M., Shore R. E., Charles M. W., Hildreth N. G. Time variations in the risk of cancer following irradiation in childhood. Radiat Res. 1991 Jun;126(3):304–316. [PubMed] [Google Scholar]
  13. Olsen J. H., Garwicz S., Hertz H., Jonmundsson G., Langmark F., Lanning M., Lie S. O., Moe P. J., Møller T., Sankila R. Second malignant neoplasms after cancer in childhood or adolescence. Nordic Society of Paediatric Haematology and Oncology Association of the Nordic Cancer Registries. BMJ. 1993 Oct 23;307(6911):1030–1036. doi: 10.1136/bmj.307.6911.1030. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Tokunaga M., Land C. E., Tokuoka S., Nishimori I., Soda M., Akiba S. Incidence of female breast cancer among atomic bomb survivors, 1950-1985. Radiat Res. 1994 May;138(2):209–223. [PubMed] [Google Scholar]
  15. Tucker M. A., Jones P. H., Boice J. D., Jr, Robison L. L., Stone B. J., Stovall M., Jenkin R. D., Lubin J. H., Baum E. S., Siegel S. E. Therapeutic radiation at a young age is linked to secondary thyroid cancer. The Late Effects Study Group. Cancer Res. 1991 Jun 1;51(11):2885–2888. [PubMed] [Google Scholar]
  16. Tucker M. A., Meadows A. T., Boice J. D., Jr, Stovall M., Oberlin O., Stone B. J., Birch J., Voûte P. A., Hoover R. N., Fraumeni J. F., Jr Leukemia after therapy with alkylating agents for childhood cancer. J Natl Cancer Inst. 1987 Mar;78(3):459–464. [PubMed] [Google Scholar]
  17. de Vathaire F., Shamsaldin A., Grimaud E., Campbell S., Guerra M., Raquin M., Bessa E., Hardiman C., Jan P., Rumeau N. Solid malignant neoplasms after childhood irradiation: decrease of the relative risk with time after irradiation. C R Acad Sci III. 1995 Apr;318(4):483–490. [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES