title: Second malignant neoplasms occuring in survivors of osteosarcoma.
abstract: BACKGROUND
  Second malignant neoplasms have been noted infrequently in survivors of osteosarcoma treated before 1970.
  
  
  METHODS
  For the above reason, the authors surveyed their patients to determine the actuarial incidence and relative risk of second malignancies among patients treated with adjuvant chemotherapy for osteosarcoma.
  
  
  RESULTS
  Between March 1962 and March 1996, 334 patients received chemotherapy for newly diagnosed primary or metastatic osteosarcoma. Of these patients, 47 presented with metastases, 14 had multifocal osteosarcoma, and 273 had localized disease. Nine patients developed second malignant neoplasms 0.45-17.8 years (median, 6.3 years) after receiving definitive surgery and adjuvant chemotherapy for primary osteosarcoma; 2 of these patients had pulmonary metastasectomies before receiving adjuvant chemotherapy. The second neoplasms comprised two cases of malignant fibrous histiocytoma and one case each of melanoma, glioblastoma multiforme, chondrosarcoma, and carcinoma of the breast: stomach, colon, rectum. The overall 10-year cumulative incidence of second malignancies was 2% +/- 1%; by comparison, this rate was 2% +/- 1% for patients with localized osteosarcoma but was 8% +/- 5% (P = 0.15) for those who presented with metastatic disease.
  
  
  CONCLUSIONS
  Since the advent of successful adjuvant chemotherapy, more patients are surviving primary osteosarcoma; therefore, the number of osteosarcoma patients who develop second malignancies can be expected to increase. Recognition of osteosarcoma patients who are members of families with Li-Fraumeni syndrome may lead to earlier intervention for these individuals.
authors.affiliation: Department of Hematology/Oncology, St. Jude Children's Research Hospital, and College of Medicine, University of Tennessee-Memphis, 38105, USA.
authors.forename: C B
authors.initials: CB
authors.lastname: Pratt
authors.forename: W H
authors.initials: WH
authors.lastname: Meyer
authors.forename: X
authors.initials: X
authors.lastname: Luo
authors.forename: A M
authors.initials: AM
authors.lastname: Cain
authors.forename: S C
authors.initials: SC
authors.lastname: Kaste
authors.forename: A S
authors.initials: AS
authors.lastname: Pappo
authors.forename: B N
authors.initials: BN
authors.lastname: Rao
authors.forename: I D
authors.initials: ID
authors.lastname: Fleming
authors.forename: J J
authors.initials: JJ
authors.lastname: Jenkins
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D002648:Child; D005260:Female; D005269:Femur; D006801:Humans; D015994:Incidence; D008297:Male; D008684:Metatarsus; D016609:Neoplasms, Second Primary / Q000139:chemically induced* / Q000453:epidemiology; D012516:Osteosarcoma / Q000188:drug therapy* / Q000601:surgery; D012307:Risk Factors; D018426:SEER Program; D013977:Tibia; D014481:United States / Q000453:epidemiology