J Korean Med Sci.  2016 Aug;31(8):1254-1261. 10.3346/jkms.2016.31.8.1254.

Characteristics and Outcomes of Second Malignant Neoplasms after Childhood Cancer Treatment: Multi-Center Retrospective Survey

Affiliations
  • 1Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea. jjseo@amc.seoul.kr
  • 2Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 3Department of Pediatrics, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
  • 4Center for Pediatric Oncology, National Cancer Center, Goyang, Korea.
  • 5Department of Pediatrics, Chonnam National University College of Medicine, Gwangju, Korea.
  • 6Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea.
  • 7Department of Pediatrics, Yeungnam University College of Medicine, Daegu, Korea.
  • 8Department of Pediatrics, Korea University College of Medicine, Seoul, Korea.
  • 9Department of Pediatrics, Inha University College of Medicine, Incheon, Korea.
  • 10Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea.
  • 11Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea.

Abstract

This retrospective study investigated the clinical characteristics and outcomes of second malignant neoplasms (SMNs) in survivors of childhood cancer from multiple institutions in Korea. A total of 102 patients from 11 institutions who developed SMN after childhood cancer treatment between 1998 and 2011 were retrospectively enrolled. The most common primary malignant neoplasms (PMNs) were central nervous system (CNS) tumors (n = 17), followed by acute lymphoblastic leukemia (n = 16), non-Hodgkin lymphoma (n = 13), and osteosarcoma (n = 12). The most common SMNs were therapy-related myeloid neoplasms (t-MNs; acute myeloid leukemia [AML], 29 cases; myelodysplastic syndrome [MDS], 12 cases), followed by thyroid carcinomas (n = 15) and CNS tumors (n = 10). The median latency period was 4.9 years (range, 0.5-18.5 years). Among 45 patients with solid tumors defined as an SMN, 15 (33%) developed the lesion in a field previously subjected to radiation. The 5-year overall survival (OS) rate of patients with an SMN was 45% with a median follow-up time of 8.6 years. Patients with AML, MDS, and CNS tumors exhibited the poorest outcomes with 5-year OS rates of 18%, 33%, and 32%, respectively, whereas those with second osteosarcoma showed comparable outcomes (64%) to patients with primary counterpart and those with second thyroid carcinoma had a 100% OS rate. Further therapeutic efforts are recommended to improve the survival outcomes in patients with SMNs, especially in cases with t-MNs and CNS tumors.

Keyword

Childhood; Cancer; Survivors; Second Neoplasm

MeSH Terms

Adolescent
Antineoplastic Agents/therapeutic use
Central Nervous System Neoplasms/diagnosis/drug therapy/radiotherapy
Child
Child, Preschool
Disease-Free Survival
Hospitals
Humans
Infant
Leukemia, Myeloid, Acute/diagnosis/epidemiology/mortality/therapy
Myelodysplastic Syndromes/diagnosis/epidemiology/mortality/therapy
Neoplasms, Second Primary/*diagnosis/epidemiology/mortality/therapy
Osteosarcoma/diagnosis/epidemiology
Retrospective Studies
Stem Cell Transplantation
Survival Rate
Transplantation, Autologous
Young Adult
Antineoplastic Agents

Figure

  • Fig. 1 The latency period between the diagnosis of primary and second malignant neoplasms. ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; CNS, central nervous system; MDS, myelodysplastic syndrome.

  • Fig. 2 Survival outcomes of the patients with second malignant neoplasm. (A) The 5-year overall survival rates of patients with second malignant neoplasms. (B) The 5-year overall survival rates of patients with AML, MDS, CNS tumors, osteosarcoma, and thyroid carcinoma. AML, acute myeloid leukemia; CNS, central nervous system; MDS, myelodysplastic syndrome.


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