Second malignant neoplasms in digestive organs after childhood cancer: a cohort-nested case-control study

Markhaba Tukenova, Ibrahima Diallo, Harald Anderson, Mike Hawkins, Stanislaw Garwicz, Risto Sankila, Chiraz El Fayech, Dave Winter, Carole Rubino, Elisabeth Adjadj, Nadia Haddy, Odile Oberlin, Torgil Möller, Froydis Langmark, Laufey Tryggvadottir, Helene Pacquement, Gudrun Svahn-Tapper, Florent de Vathaire

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Abstract

Purpose: 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 and Materials: 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. (C) 2012 Elsevier Inc.
Original languageEnglish
Pages (from-to)E383-E390
JournalInternational Journal of Radiation Oncology, Biology, Physics
Volume82
Issue number3
DOIs
Publication statusPublished - 2012

Subject classification (UKÄ)

  • Radiology, Nuclear Medicine and Medical Imaging

Keywords

  • Childhood cancer
  • Second malignancy in digestive tract
  • Radiotherapy
  • Chemotherapy

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