A study of soft tissue sarcomas after childhood cancer in Britain.
Among 16 541 3-year survivors of childhood cancer in Britain, 39 soft tissue sarcomas (STSs) occurred and 1.1 sarcomas were expected, yielding a standardised incidence ratio (SIR) of 16.1. When retinoblastomas were excluded from the cohort, the SIR for STSs was 15.9, and the cumulative risk of developing a soft tissue tumour after childhood cancer within 20 years of 3-year survival was 0.23%. In the case-control study, there was a significant excess of STSs in those patients exposed to both radiotherapy (RT) and chemotherapy, which was five times that observed among those not exposed (P=0.02). On the basis of individual radiation dosimetry, there was evidence of a strong dose-response effect with a significant increase in the risk of STS with increasing dose of RT (P<0.001). This effect remained significant in a multivariate model. The adjusted risk in patients exposed to RT doses of over 3000 cGy was over 50 times the risk in the unexposed. There was evidence of a dose-response effect with exposure to alkylating agents, the risk increasing substantially with increasing cumulative dose (P=0.05). This effect remained after adjusting for the effect of radiation exposure.
Jenkinson
H C
HC
Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK.
Winter
D L
DL
Marsden
H B
HB
Stovall
M A
MA
Stevens
M C G
MC
Stiller
C A
CA
Hawkins
M M
MM
D016022:Case-Control Studies; D002648:Child; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D016015:Logistic Models; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy; D011878:Radiotherapy / Q000009:adverse effects; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D012509:Sarcoma / Q000453:epidemiology* / Q000209:etiology; D006113:United Kingdom / Q000453:epidemiology