title: Osteosarcoma as a second malignant neoplasm in children.
abstract: Nine patients who had an osteosarcoma that had developed as a second malignant neoplasm in a previously irradiated site were managed at a major center for the treatment of tumors in children. The doses of radiation had averaged 4144 centigray (range, 2300 to 8000 centigray) and chemotherapy had been administered, when appropriate, for the primary malignant lesion (Ewing sarcoma, malignant fibrous histiocytoma, Hodgkin lymphoma, neuroblastoma, neurofibrosarcoma, rhabdomyosarcoma, and Wilms tumor). The interval between the initial treatment and the diagnosis of the secondary sarcoma averaged ten years and one month (range, five years and ten months to twenty-one years and nine months). Three patients were alive, two of them with active disease, at the time of writing. The other six had died within three years (average, fifteen months) after the second diagnosis. The prevalence of secondary osteosarcoma is increasing as the survival of children who have a malignant lesion increases. Plans for tumor therapy should take into account the risk of this complication, which is usually fatal.
authors.affiliation: Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine 19114.
authors.forename: J R
authors.initials: JR
authors.lastname: Bechler
authors.forename: W W
authors.initials: WW
authors.lastname: Robertson
authors.forename: A T
authors.initials: AT
authors.lastname: Meadows
authors.forename: R B
authors.initials: RB
authors.lastname: Womer
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality / Q000532:radiotherapy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009381:Neoplasms, Radiation-Induced / Q000209:etiology* / Q000401:mortality; D016609:Neoplasms, Second Primary / Q000209:etiology* / Q000401:mortality; D012516:Osteosarcoma / Q000209:etiology* / Q000401:mortality; D011879:Radiotherapy Dosage; D015996:Survival Rate