Long-term risk of second malignant neoplasms after neuroblastoma in childhood: role of treatment.
The aim of our study was to quantify the risk of second malignant neoplasms (SMNs) among long-term survivors of neuroblastoma and to study the influence of treatment on this risk. We studied data from 544 5-year survival patients diagnosed with neuroblastoma before age 16 years at 8 French and British treatment centres from 1948 to 1986. After an average follow-up of 15 years (range, 5-38 years), 12 children developed a total of 13 SMNs, whereas 1.19 were expected from general population rates. Among these SMNs, there were 5 thyroid and 3 breast cancers. Increases of the risks of SMN were observed with time since neuroblastoma diagnosis and attained age. In a multivariate analysis, the relative risk of SMN associated with radiotherapy was 4.3 (95% CI 0.8-78), whereas no increased risk of SMN was associated with the administration of chemotherapy as a whole (RR = 0.4, 95% CI 0.1-1.9). Young children treated for a neuroblastoma have significantly increased risks of SMN over 3 decades of follow-up. Radiotherapy treatment was found to be an important risk factor for developing SMNs, whereas no effect of chemotherapy was evidenced. Although our findings reflect the late effects of past therapeutic modalities, they underscore the importance of long-term surveillance of young children treated for a neuroblastoma. For these patients, many more years of follow-up are required to appreciate their overall risks of treatment-related SMNs.
Rubino
Carole
C
Research Unit of Cancer Epidemiology (XU521 INSERM), Institut Gustave Roussy, Villejuif, France.
Adjadj
Elisabeth
E
Guérin
Sylvie
S
Guibout
Catherine
C
Shamsaldin
Akhtar
A
Dondon
Marie-Gabrielle
MG
Valteau-Couanet
Dominique
D
Hartmann
Olivier
O
Hawkins
Mike
M
de Vathaire
Florent
F
D000970:Antineoplastic Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D007223:Infant; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology*; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D009447:Neuroblastoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D011877:Radionuclide Imaging; D011878:Radiotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D012307:Risk Factors; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000453:epidemiology; D013997:Time Factors
D000970:Antineoplastic Agents