title: Pediatric solid tumors and second malignancies: characteristics and survival outcomes.
abstract: BACKGROUND
  To examine the incidence, characteristics, and outcomes for second malignancies following the diagnosis of a primary solid tumor in pediatric patients.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results (SEER) database was queried from 1973 to 2005, excluding recurrences, in patients <20 y.
  
  
  RESULTS
  A total of 31,685 cases of pediatric solid malignancies were identified. Overall, 177 patients were diagnosed with a unique second malignancy before the age 20 (0.56%) The mean follow-up was for 8.5 y (2 mo-30.8 y). Mean age at diagnosis of the primary tumor was 7.7 y. The most common primary malignancies were CNS tumors (22.5%), followed by soft tissue sarcoma (15.8%), retinoblastoma (14.1%), and bone tumors (13%). Hematologic malignancies (35.5%) were the most common second malignancies noted in the cohort, followed by bone tumors (18%) and soft tissue sarcomas (15%). Hematologic malignancies had a shorter latency (3.1 y) compared with solid second tumors (11.6 y). The overall 10-y survival for the entire cohort was 41.5%. For most tumor categories, development of a secondary malignancy was associated with lower 5- and 10-y survival than expected.
  
  
  CONCLUSIONS
  CNS tumors, retinoblastoma, and soft tissue sarcomas in children are the most common solid primary tumors, with an increased risk of a second malignancy. Leukemia is the most common second malignancy seen in pediatric solid tumors. Second malignancies are associated with significantly reduced survival rates compared with the general childhood cancer population.
authors.affiliation: DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
authors.forename: Vanitha
authors.initials: V
authors.lastname: Vasudevan
authors.forename: Michael C
authors.initials: MC
authors.lastname: Cheung
authors.forename: Relin
authors.initials: R
authors.lastname: Yang
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhuge
authors.forename: Anne C
authors.initials: AC
authors.lastname: Fischer
authors.forename: Leonidas G
authors.initials: LG
authors.lastname: Koniaris
authors.forename: Juan E
authors.initials: JE
authors.lastname: Sola
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000401:mortality; D016543:Central Nervous System Neoplasms / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D009369:Neoplasms / Q000401:mortality*; D016609:Neoplasms, Second Primary / Q000401:mortality*; D012175:Retinoblastoma / Q000401:mortality; D018426:SEER Program; D012509:Sarcoma / Q000401:mortality; D012983:Soft Tissue Neoplasms / Q000401:mortality; D016019:Survival Analysis; D055815:Young Adult