title: Risk of a Second Kidney Carcinoma Following Childhood Cancer: Role of Chemotherapy and Radiation Dose to Kidneys.
abstract: OBJECTIVE
  Kidney carcinoma is a rare second malignancy following childhood cancer.
  
  
  METHODS
  We sought to quantify risk and assess risk factors for kidney carcinoma following treatment for childhood cancer. We evaluated a cohort of 4,350 patients who were 5-year cancer survivors and had been treated for cancer as children in France and the United Kingdom. Patients were treated between 1943 and 1985, and were followed for an average of 27 years. Radiation dose to the kidneys during treatment was estimated with dedicated software, regardless of the site of childhood cancer.
  
  
  RESULTS
  Kidney carcinoma developed in 13 patients. The cumulative incidence of kidney carcinoma was 0.62% (95% CI 0.27%-1.45%) at 40 years after diagnosis, which was 13.3-fold higher (95% CI 7.1-22.3) than in the general population. The absolute excess risk strongly increased with longer duration of followup (p <0.0001). Compared to the general population, the incidence of kidney carcinoma was 5.7-fold higher (95% CI 1.4-14.7) if radiotherapy was not performed or less than 1 Gy had been absorbed by the kidney but 66.3-fold higher (95% CI 23.8-142.5) if the radiation dose to the kidneys was 10 to 19 Gy and 14.5-fold higher (95% CI 0.8-63.9) for larger radiation doses to the kidney. Treatment with chemotherapy increased the risk of kidney carcinoma (RR 5.1, 95% CI 1.1-22.7) but we were unable to identify a specific drug or drug category responsible for this effect.
  
  
  CONCLUSIONS
  Moderate radiation dose to the kidneys during childhood cancer treatment increases the risk of a second kidney carcinoma. This incidence will be further increased when childhood cancer survivors reach old age.
authors.affiliation: Université Paris-Sud, Villejuif, France. Electronic address: florent.devathaire@gustaveroussy.fr.
authors.forename: Florent
authors.initials: F
authors.lastname: de Vathaire
authors.affiliation: Université Paris-Sud, Villejuif, France.
authors.forename: Boris
authors.initials: B
authors.lastname: Scwhartz
authors.affiliation: Université Paris-Sud, Villejuif, France.
authors.forename: Chiraz
authors.initials: C
authors.lastname: El-Fayech
authors.affiliation: Université Paris-Sud, Villejuif, France.
authors.forename: Rodrigue Sètchéou
authors.initials: RS
authors.lastname: Allodji
authors.affiliation: Radiation Epidemiology Group, INSERM U1018, Institut Gustave Roussy, Villejuif, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Escudier
authors.affiliation: Centre for Childhood Cancer Survivor Studies, Department of Public Health and Epidemiology, University of Birmingham, Birmingham, United Kingdom.
authors.forename: Mike
authors.initials: M
authors.lastname: Hawkins
authors.affiliation: Université Paris-Sud, Villejuif, France.
authors.forename: Ibrahima
authors.initials: I
authors.lastname: Diallo
authors.affiliation: Université Paris-Sud, Villejuif, France.
authors.forename: Nadia
authors.initials: N
authors.lastname: Haddy
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000453:epidemiology* / Q000532:radiotherapy; D002648:Child; D002675:Child, Preschool; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000187:drug effects / Q000528:radiation effects; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000453:epidemiology* / Q000532:radiotherapy; D008297:Male; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents
keywords: drug therapy; kidney neoplasms; neoplasms, second primary; radiation dosage; radiotherapy