Risk of second cancers increased for decades after neuroblastoma treatment

The risk of second malignant neoplasms in survivors of childhood neuroblastoma is increased with time since initial diagnosis, according to a new analysis. Radiation therapy, but not chemotherapy, is an important risk factor for second malignancy.

Dr. Florent de Vathaire, of the Institut Gustave Roussy in Villejuif, France, and colleagues sought to quantify the risk of second malignant neoplasms among 544 long-term survivors of childhood neuroblastoma. In addition, they examined the influence of treatment on this risk. After a mean follow-up of 15 years, 12 of the children (9 females and 3 males) developed 13 second malignancies. This compares with an expected number of 1.19 in this cohort over the follow-up period, the investigators report in the December 10th issue of the International Journal of Cancer. Of the 13 second malignancies, five were thyroid cancers and three were breast cancers. The others were glioblastoma, sarcoma, osteosarcoma, acute myeloid leukemia and acute lymphoid leukemia.Multivariate analysis demonstrated that the relative risk of a second cancer associated with radiotherapy was 4.3. No increased risk was observed with administration of chemotherapy (relative risk, 0.4). The risk of second malignant neoplasms was increased with time since neuroblastoma diagnosis and attained age. Nine of the 12 patients developed second cancers between 10 and 29 years after initial diagnosis.”The increased risk of second malignant neoplasms over time after neuroblastoma diagnosed at a very young age emphasizes the importance of a long-term surveillance of this population, which requires many more years of follow-up to appreciate the overall extent of treatment-related second malignant neoplasms,” Dr. de Vathaire and colleagues write.They add, “The successes of current treatment regimens for neuroblastoma consisting of intensive chemotherapy have to be considered in light of the increased risk of developing subsequent treatment-related second malignant neoplasms.” (Source: Int J Cancer 2003;107:791-796: Reuters Health: December 23, 2003: Oncolink)