Secondary gastrointestinal cancer in childhood cancer survivors: a cohort study.
BACKGROUND
Childhood cancer survivors develop gastrointestinal cancer more frequently and at a younger age than the general population, but the risk factors have not been well-characterized.


OBJECTIVE
To determine the risk and associated risk factors for gastrointestinal subsequent malignant neoplasms (SMNs) in childhood cancer survivors.


METHODS
Retrospective cohort study.


METHODS
The Childhood Cancer Survivor Study, a multicenter study of childhood cancer survivors diagnosed between 1970 and 1986.


METHODS
14 358 survivors of cancer diagnosed when they were younger than 21 years of age who survived for 5 or more years after the initial diagnosis.


METHODS
Standardized incidence ratios (SIRs) for gastrointestinal SMNs were calculated by using age-specific population data. Multivariate Cox regression models identified associations between risk factors and gastrointestinal SMN development.


RESULTS
At median follow-up of 22.8 years (range, 5.5 to 30.2 years), 45 cases of gastrointestinal cancer were identified. The risk for gastrointestinal SMNs was 4.6-fold higher in childhood cancer survivors than in the general population (95% CI, 3.4 to 6.1). The SIR for colorectal cancer was 4.2 (CI, 2.8 to 6.3). The highest risk for gastrointestinal SMNs was associated with abdominal radiation (SIR, 11.2 [CI, 7.6 to 16.4]). However, survivors not exposed to radiation had a significantly increased risk (SIR, 2.4 [CI, 1.4 to 3.9]). In addition to abdominal radiation, high-dose procarbazine (relative risk, 3.2 [CI, 1.1 to 9.4]) and platinum drugs (relative risk, 7.6 [CI, 2.3 to 25.5]) independently increased the risk for gastrointestinal SMNs.


CONCLUSIONS
This cohort has not yet attained an age at which risk for gastrointestinal cancer is greatest.


CONCLUSIONS
Childhood cancer survivors, particularly those exposed to abdominal radiation, are at increased risk for gastrointestinal SMNs. These findings suggest that surveillance of at-risk childhood cancer survivors should begin at a younger age than that recommended for the general population.


BACKGROUND
National Cancer Institute.
University of Chicago Department of Pediatrics, Section of Hematology, Oncology and Stem Cell Transplantation, 5841 South Maryland Avenue, MC 4060, Chicago, IL 60637, USA. thenderson@peds.bsd.uchicago.edu
Tara O
TO
Henderson
Kevin C
KC
Oeffinger
John
J
Whitton
Wendy
W
Leisenring
Joseph
J
Neglia
Anna
A
Meadows
Catherine
C
Crotty
David T
DT
Rubin
Lisa
L
Diller
Peter
P
Inskip
Susan A
SA
Smith
Marilyn
M
Stovall
Louis S
LS
Constine
Sue
S
Hammond
Greg T
GT
Armstrong
Leslie L
LL
Robison
Paul C
PC
Nathan
D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D002170:Canada / Q000453:epidemiology; D002648:Child; D015179:Colorectal Neoplasms / Q000453:epidemiology; D005770:Gastrointestinal Neoplasms / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D017671:Platinum Compounds / Q000008:administration & dosage / Q000009:adverse effects; D011159:Population Surveillance; D011344:Procarbazine / Q000008:administration & dosage / Q000009:adverse effects; D016016:Proportional Hazards Models; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D000970:Antineoplastic Agents; D017671:Platinum Compounds; D011344:Procarbazine