title: Radiation dose, chemotherapy and risk of soft tissue sarcoma after solid tumours during childhood.
abstract: Soft tissue sarcoma (STS) is one of the most frequent second primary cancer that occurs during the first 20 years following treatment for a solid cancer in childhood. Our aim was to quantify the risk of STS as a second malignant neoplasm and to investigate its relationship with radiotherapy and chemotherapy. A cohort study of 4,400 3-year survivors of a first solid cancer diagnosed during childhood in France or the United Kingdom, between 1942 and 1985, was followed 15 years on average. In a partially nested case-control study, we matched 25 cases of STS and 121 controls for sex, type of first cancer, age at first cancer and duration of follow-up. Sixteen STS occurred in the cohort, as compared to 0.3 expected from the general population (Standardized Incidence Radio, SIR = 54 (95%CI: 34-89)). The SIR was 113 (95% CI: 62-185) after chemotherapy plus radiotherapy (13 STS), whereas it was 28 (95%CI: 2-125) after chemotherapy alone (1 STS) and 19 (95%CI: 3-60) after radiotherapy alone (2 STS). After adjustment for treatment, there was no evidence of variation in the annual excess of incidence or in the SIR with either age at first cancer or time since 1st cancer. In the case-control study, the risk of a STS was increased with the square of the dose of radiation to the site of STS development and with the administration of Procarbazine. The increased risk of soft tissue sarcoma that occurred after childhood cancer is independently related to exposure to radiotherapy and Procarbazine. A closer surveillance of children treated with this treatment combination is strongly recommended.
authors.affiliation: National Institute of Public Health and Medical Research, Unit XUR521, Gustave Roussy Institute, 39 rue Camille Desmoulins, 94805 Villejuif Cedex, France.
authors.forename: Axelle
authors.initials: A
authors.lastname: Menu-Branthomme
authors.forename: Carole
authors.initials: C
authors.lastname: Rubino
authors.forename: Akhtar
authors.initials: A
authors.lastname: Shamsaldin
authors.forename: Michael M
authors.initials: MM
authors.lastname: Hawkins
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Grimaud
authors.forename: Marie-Gabrielle
authors.initials: MG
authors.lastname: Dondon
authors.forename: Claire
authors.initials: C
authors.lastname: Hardiman
authors.forename: Gilles
authors.initials: G
authors.lastname: Vassal
authors.forename: Sarah
authors.initials: S
authors.lastname: Campbell
authors.forename: Xavier
authors.initials: X
authors.lastname: Panis
authors.forename: Nicolas
authors.initials: N
authors.lastname: Daly-Schveitzer
authors.forename: Jean-Leon
authors.initials: JL
authors.lastname: Lagrange
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Zucker
authors.forename: Jean
authors.initials: J
authors.lastname: Chavaudra
authors.forename: Olivier
authors.initials: O
authors.lastname: Hartman
authors.forename: Florent
authors.initials: F
authors.lastname: de Vathaire
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D016609:Neoplasms, Second Primary / Q000209:etiology*; D011879:Radiotherapy Dosage; D012306:Risk; D012509:Sarcoma / Q000209:etiology*
chemical_list: D000970:Antineoplastic Agents