title: Second malignant neoplasms in digestive organs after childhood cancer: a cohort-nested case-control study.
abstract: OBJECTIVE
  Cancers of the digestive system constitute a major risk for childhood cancer survivors treated with radiotherapy once they reach adulthood. The aim of this study was to determine therapy-related risk factors for the development of a second malignancy in the digestive organs (SMDO) after a childhood cancer.
  
  
  METHODS
  Among 4,568 2-year survivors of a childhood solid cancer diagnosed before 17 years of age at eight French and British centers, and among 25,120 patients diagnosed as having a malignant neoplasm before the age of 20 years, whose data were extracted from the Nordic Cancer Registries, we matched 58 case patients (41 men and 17 women) of SMDO and 167 controls, in their respective cohort, for sex, age at first cancer, calendar year of occurrence of the first cancer, and duration of follow-up. The radiation dose received at the site of each second malignancy and at the corresponding site of its matched control was estimated.
  
  
  RESULTS
  The risk of developing a SMDO was 9.7-fold higher in relation to the general populations in France and the United Kingdom. In the case-control study, a strong dose-response relationship was estimated, compared with that in survivors who had not received radiotherapy; the odds ratio was 5.2 (95% CI, 1.7-16.0) for local radiation doses between 10 and 29 Gy and 9.6 (95% CI, 2.6-35.2) for doses equal to or greater than 30 Gy. Chemotherapy was also found to increase the risk of developing SMDO.
  
  
  CONCLUSIONS
  This study confirms that childhood cancer treatments strongly increase the risk of SMDO, which occur only after a very long latency period.
authors.affiliation: Radiation Epidemiology Group, CESP Center for Research in Epidemiology and Population Health, INSERM, Villejuif, France.
authors.forename: Markhaba
authors.initials: M
authors.lastname: Tukenova
authors.forename: Ibrahima
authors.initials: I
authors.lastname: Diallo
authors.forename: Harald
authors.initials: H
authors.lastname: Anderson
authors.forename: Mike
authors.initials: M
authors.lastname: Hawkins
authors.forename: Stanislaw
authors.initials: S
authors.lastname: Garwicz
authors.forename: Risto
authors.initials: R
authors.lastname: Sankila
authors.forename: Chiraz
authors.initials: C
authors.lastname: El Fayech
authors.forename: Dave
authors.initials: D
authors.lastname: Winter
authors.forename: Carole
authors.initials: C
authors.lastname: Rubino
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Adjadj
authors.forename: Nadia
authors.initials: N
authors.lastname: Haddy
authors.forename: Odile
authors.initials: O
authors.lastname: Oberlin
authors.forename: Torgil
authors.initials: T
authors.lastname: Moller
authors.forename: Froydis
authors.initials: F
authors.lastname: Langmark
authors.forename: Laufey
authors.initials: L
authors.lastname: Tryggvadottir
authors.forename: Hélène
authors.initials: H
authors.lastname: Pacquement
authors.forename: Gudrun
authors.initials: G
authors.lastname: Svahn-Tapper
authors.forename: Florent
authors.initials: F
authors.lastname: de Vathaire
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000009:adverse effects; D016022:Case-Control Studies; D002648:Child; D015331:Cohort Studies; D004067:Digestive System Neoplasms / Q000209:etiology*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000188:drug therapy / Q000532:radiotherapy; D009381:Neoplasms, Radiation-Induced; D016609:Neoplasms, Second Primary / Q000209:etiology*; D011879:Radiotherapy Dosage; D018570:Risk Assessment; D017741:Survivors; D006113:United Kingdom; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents