Second malignant tumors after elective end of therapy for a first cancer in childhood: A multicenter study in Italy

P. Rosso, B. Terracini, T. R. Fears, M. Jankovic, F. Fossati Bellani, A. Arrighini, M. Carli, L. Cordero di Montezemolo, M. L. Garre, C. Guazzelli, G. Izzi, G. Loiacono, A. Mancini, P. Tamaro, A. M. Testi, G. Masera, R. Haupt

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Abstract

To evaluate the incidence of second malignant tumors in a cohort of subjects previously treated for childhood cancer, we analyzed data from the Off-Therapy Registry (OTR) of the Italian Association of Pediatric Hematology/Oncology, which collects information on children treated for Hodgkin's disease, non-Hodgkin's lymphoma, Wilms' tumor, acute lymphoblastic leukemia (ALL) and acute non-lymphatic leukemia and who had been removed from treatment in the absence of clinical signs of disease, i.e. the off-therapy stage. Second malignant tumors (SMT), diagnosed before December 31, 1988, were identified through a special enquiry to the 36 institutions cooperating in the registry. Observed cases were compared to expected numbers estimated from age- and sex-specific incidence rates derived from the Cancer Registry of the Province of Varese. In a total of 3,3 10 study subjects, 27 SMTs have been registered. The Cumulative Risk (CR) of SMT was 2.9% 15 years after the end of treatment and the Standard Incidence Ratio (SIR) was 10.8. The ALL sub cohort had the highest risk of SMT(SIR 13.6) and 9 cases of CNS tumor occurred in this group (SIR 58.9). All 9 had received praphylactic cranial radiotherapy (CRT) and 5 had been treated on one protocol, characterized by law-dose intrathecal methotrexate (IT MTX) given monthly for 2 years after CRT. The Off-Therapy Registry has unique criteria for inclusion; direct comparisons with similar studies are therefore somewhat problematic. However, our data suggest that the risk of SMT in childhood ALL cancer survivors may be greater than previously reported, and that CNS tumors are the most common SMT in this group. The administration schedule of IT MTX may be an important risk factor.

Original languageEnglish
Pages (from-to)451-456
Number of pages6
JournalInternational Journal of Cancer
Volume59
Issue number4
DOIs
Publication statusPublished - 1994

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Italy
Multicenter Studies
Neoplasms
Registries
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Therapeutics
Incidence
Methotrexate
Radiotherapy
Wilms Tumor
Hematology
Hodgkin Disease
Non-Hodgkin's Lymphoma
Appointments and Schedules
Leukemia
Pediatrics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Second malignant tumors after elective end of therapy for a first cancer in childhood : A multicenter study in Italy. / Rosso, P.; Terracini, B.; Fears, T. R.; Jankovic, M.; Fossati Bellani, F.; Arrighini, A.; Carli, M.; Cordero di Montezemolo, L.; Garre, M. L.; Guazzelli, C.; Izzi, G.; Loiacono, G.; Mancini, A.; Tamaro, P.; Testi, A. M.; Masera, G.; Haupt, R.

In: International Journal of Cancer, Vol. 59, No. 4, 1994, p. 451-456.

Research output: Contribution to journalArticle

Rosso, P, Terracini, B, Fears, TR, Jankovic, M, Fossati Bellani, F, Arrighini, A, Carli, M, Cordero di Montezemolo, L, Garre, ML, Guazzelli, C, Izzi, G, Loiacono, G, Mancini, A, Tamaro, P, Testi, AM, Masera, G & Haupt, R 1994, 'Second malignant tumors after elective end of therapy for a first cancer in childhood: A multicenter study in Italy', International Journal of Cancer, vol. 59, no. 4, pp. 451-456. https://doi.org/10.1002/ijc.2910590402
Rosso, P. ; Terracini, B. ; Fears, T. R. ; Jankovic, M. ; Fossati Bellani, F. ; Arrighini, A. ; Carli, M. ; Cordero di Montezemolo, L. ; Garre, M. L. ; Guazzelli, C. ; Izzi, G. ; Loiacono, G. ; Mancini, A. ; Tamaro, P. ; Testi, A. M. ; Masera, G. ; Haupt, R. / Second malignant tumors after elective end of therapy for a first cancer in childhood : A multicenter study in Italy. In: International Journal of Cancer. 1994 ; Vol. 59, No. 4. pp. 451-456.
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AU - Rosso, P.

AU - Terracini, B.

AU - Fears, T. R.

AU - Jankovic, M.

AU - Fossati Bellani, F.

AU - Arrighini, A.

AU - Carli, M.

AU - Cordero di Montezemolo, L.

AU - Garre, M. L.

AU - Guazzelli, C.

AU - Izzi, G.

AU - Loiacono, G.

AU - Mancini, A.

AU - Tamaro, P.

AU - Testi, A. M.

AU - Masera, G.

AU - Haupt, R.

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N2 - To evaluate the incidence of second malignant tumors in a cohort of subjects previously treated for childhood cancer, we analyzed data from the Off-Therapy Registry (OTR) of the Italian Association of Pediatric Hematology/Oncology, which collects information on children treated for Hodgkin's disease, non-Hodgkin's lymphoma, Wilms' tumor, acute lymphoblastic leukemia (ALL) and acute non-lymphatic leukemia and who had been removed from treatment in the absence of clinical signs of disease, i.e. the off-therapy stage. Second malignant tumors (SMT), diagnosed before December 31, 1988, were identified through a special enquiry to the 36 institutions cooperating in the registry. Observed cases were compared to expected numbers estimated from age- and sex-specific incidence rates derived from the Cancer Registry of the Province of Varese. In a total of 3,3 10 study subjects, 27 SMTs have been registered. The Cumulative Risk (CR) of SMT was 2.9% 15 years after the end of treatment and the Standard Incidence Ratio (SIR) was 10.8. The ALL sub cohort had the highest risk of SMT(SIR 13.6) and 9 cases of CNS tumor occurred in this group (SIR 58.9). All 9 had received praphylactic cranial radiotherapy (CRT) and 5 had been treated on one protocol, characterized by law-dose intrathecal methotrexate (IT MTX) given monthly for 2 years after CRT. The Off-Therapy Registry has unique criteria for inclusion; direct comparisons with similar studies are therefore somewhat problematic. However, our data suggest that the risk of SMT in childhood ALL cancer survivors may be greater than previously reported, and that CNS tumors are the most common SMT in this group. The administration schedule of IT MTX may be an important risk factor.

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