Second Malignancies in Children Following Treatment for Neuroblastoma

On the basis of currently available information, the cumulative incidence of second malignant neoplasm (SMN) for neuroblastoma patients is approximately 2% at 20 years from the initial diagnosis. The most commonly observed SMNs include thyroid carcinomas, osteogenic and soft tissue sarcomas, breast and colon carcinomas, acute myeloid and lymphoid leukemias, Hodgkin's and non-Hodgkin's lymphomas, and brain tumors. Female survivors of neuroblastoma seem to be at higher risk of developing an SMN than males. Other predisposing factors include young age at the time of diagnosis of the first cancer, radiotherapy associated with chemotherapy, high-doses of alkylating agents and administration of topo-isomerase II inhibitors, as well as high cumulative doses and protracted schedules of epipodophyllotoxins. Longer and more targeted surveillance should be recommended including specific cancer screening at younger ages compared to the general population. Risk adapted and response-related regimens should be applied to these patients in an effort to decrease SMNs.