title: Therapy-related leukemia following chemoradiotherapy for esophageal cancer.
abstract: Chemoradiotherapy has improved the outcome of patients with esophageal cancer. Although a sufficiently long-time survival has resulted in the increase of several treatment-related late toxicities, little is still known about the incidence of secondary malignancies. In our hospital, 348 patients with esophageal cancer received chemotherapy consisting of nedaplatin and 5-fluorouracil and concurrent irradiation. Median and average follow-up durations were 8 and 21 months (1-92), respectively. Four patients developed leukemia after 19-48 months of follow-up. Two patients were diagnosed with overt leukemia from myelodysplastic syndrome presenting a complex karyotype, including the deletion of chromosome 5 or 7. Notably, one patient showed an additional chromosomal abnormality with t(9;22)(q34;q11). Other patients developed acute myeloid leukemia with t(9;22)(q34;q11) and Burkitt leukemia with t(8;14)(q24;q32). All patients eventually succumbed to leukemia. Platinum and fluorouracil have shown relatively lower risks for secondary malignancies in comparison with alkylating agents and topoisomerase II inhibitors. Especially, nedaplatin has never been described to introduce secondary neoplasms. Our report supports the idea that the concurrent administration of radiotherapy with these agents affects the risk of leukemia. Interestingly, rare balanced chromosomal abnormalities were observed in the present cases, thus providing new insights into the leukemogenesis of therapy-related leukemia.
authors.affiliation: Division of Hematology-Oncology Division of Gastroenterological Surgery, Chiba Cancer Center, Chiba, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Mimura
authors.forename: Hideki
authors.initials: H
authors.lastname: Tsujimura
authors.forename: Mikiko
authors.initials: M
authors.lastname: Ise
authors.forename: Chikara
authors.initials: C
authors.lastname: Sakai
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Takagi
authors.forename: Matsuo
authors.initials: M
authors.lastname: Nagata
authors.forename: Kyoya
authors.initials: K
authors.lastname: Kumagai
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D002869:Chromosome Aberrations / Q000139:chemically induced; D002895:Chromosomes, Human, Pair 5; D003131:Combined Modality Therapy / Q000009:adverse effects; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D007621:Karyotyping; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000175:diagnosis / Q000473:pathology; D016609:Neoplasms, Second Primary; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D011878:Radiotherapy / Q000009:adverse effects
chemical_list: D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; C053989:nedaplatin; D005472:Fluorouracil