Occurrence of multiple subsequent neoplasms in long-term survivors of childhood cancer: A report from the childhood cancer survivor study

Gregory Armstrong, Wei Liu, Wendy Leisenring, Yutaka Yasui, Sue Hammond, Smita Bhatia, Joseph P. Neglia, Marilyn Stovall, Deokumar Srivastava, Leslie L. Robison

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Abstract

Purpose: Childhood cancer survivors experience an increased incidence of subsequent neoplasms (SNs). Those surviving the first SN (SN1) remain at risk to develop multiple SNs. Because SNs are a common cause of late morbidity and mortality, characterization of rates of multiple SNs is needed. Patients and Methods: In a total of 14,358 5-year survivors of childhood cancer diagnosed between 1970 and 1986, analyses were carried out among 1,382 survivors with an SN1. Cumulative incidence of second subsequent neoplasm (SN2), either malignant or benign, was calculated. Results: A total of 1,382 survivors (9.6%) developed SN1, of whom 386 (27.9%) developed SN2. Of those with SN2, 153 (39.6%) developed more than two SNs. Cumulative incidence of SN2 was 46.9% (95% CI, 41.6% to 52.2%) at 20 years after SN1. The cumulative incidence of SN2 among radiation-exposed survivors was 41.3% (95% CI, 37.2% to 45.4%) at 15 years compared with 25.7% (95% CI, 16.5% to 34.9%) for those not treated with radiation. Radiation-exposed survivors who developed an SN1 of nonmelanoma skin cancer (NMSC) had a cumulative incidence of subsequent malignant neoplasm (SMN; ie, malignancies excluding NMSC) of 20.3% (95% CI, 13.0% to 27.6%) at 15 years compared with only 10.7% (95% CI, 7.2% to 14.2%) for those who were exposed to radiation and whose SN1 was an invasive SMN (excluding NMSC). Conclusion: Multiple SNs are common among aging survivors of childhood cancer. SN1 of NMSC identifies a population at high risk for invasive SMN. Survivors not exposed to radiation who develop multiple SNs represent a population of interest for studying genetic susceptibility to neoplasia.

Original languageEnglish (US)
Pages (from-to)3056-3064
Number of pages9
JournalJournal of Clinical Oncology
Volume29
Issue number22
DOIs
StatePublished - Aug 1 2011

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Survivors
Neoplasms
Skin Neoplasms
Radiation
Incidence
Second Primary Neoplasms
Genetic Predisposition to Disease
Morbidity

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

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Occurrence of multiple subsequent neoplasms in long-term survivors of childhood cancer : A report from the childhood cancer survivor study. / Armstrong, Gregory; Liu, Wei; Leisenring, Wendy; Yasui, Yutaka; Hammond, Sue; Bhatia, Smita; Neglia, Joseph P.; Stovall, Marilyn; Srivastava, Deokumar; Robison, Leslie L.

In: Journal of Clinical Oncology, Vol. 29, No. 22, 01.08.2011, p. 3056-3064.

Research output: Contribution to journalArticle

Armstrong, G, Liu, W, Leisenring, W, Yasui, Y, Hammond, S, Bhatia, S, Neglia, JP, Stovall, M, Srivastava, D & Robison, LL 2011, 'Occurrence of multiple subsequent neoplasms in long-term survivors of childhood cancer: A report from the childhood cancer survivor study', Journal of Clinical Oncology, vol. 29, no. 22, pp. 3056-3064. https://doi.org/10.1200/JCO.2011.34.6585
Armstrong, Gregory ; Liu, Wei ; Leisenring, Wendy ; Yasui, Yutaka ; Hammond, Sue ; Bhatia, Smita ; Neglia, Joseph P. ; Stovall, Marilyn ; Srivastava, Deokumar ; Robison, Leslie L. / Occurrence of multiple subsequent neoplasms in long-term survivors of childhood cancer : A report from the childhood cancer survivor study. In: Journal of Clinical Oncology. 2011 ; Vol. 29, No. 22. pp. 3056-3064.
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abstract = "Purpose: Childhood cancer survivors experience an increased incidence of subsequent neoplasms (SNs). Those surviving the first SN (SN1) remain at risk to develop multiple SNs. Because SNs are a common cause of late morbidity and mortality, characterization of rates of multiple SNs is needed. Patients and Methods: In a total of 14,358 5-year survivors of childhood cancer diagnosed between 1970 and 1986, analyses were carried out among 1,382 survivors with an SN1. Cumulative incidence of second subsequent neoplasm (SN2), either malignant or benign, was calculated. Results: A total of 1,382 survivors (9.6{\%}) developed SN1, of whom 386 (27.9{\%}) developed SN2. Of those with SN2, 153 (39.6{\%}) developed more than two SNs. Cumulative incidence of SN2 was 46.9{\%} (95{\%} CI, 41.6{\%} to 52.2{\%}) at 20 years after SN1. The cumulative incidence of SN2 among radiation-exposed survivors was 41.3{\%} (95{\%} CI, 37.2{\%} to 45.4{\%}) at 15 years compared with 25.7{\%} (95{\%} CI, 16.5{\%} to 34.9{\%}) for those not treated with radiation. Radiation-exposed survivors who developed an SN1 of nonmelanoma skin cancer (NMSC) had a cumulative incidence of subsequent malignant neoplasm (SMN; ie, malignancies excluding NMSC) of 20.3{\%} (95{\%} CI, 13.0{\%} to 27.6{\%}) at 15 years compared with only 10.7{\%} (95{\%} CI, 7.2{\%} to 14.2{\%}) for those who were exposed to radiation and whose SN1 was an invasive SMN (excluding NMSC). Conclusion: Multiple SNs are common among aging survivors of childhood cancer. SN1 of NMSC identifies a population at high risk for invasive SMN. Survivors not exposed to radiation who develop multiple SNs represent a population of interest for studying genetic susceptibility to neoplasia.",
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T1 - Occurrence of multiple subsequent neoplasms in long-term survivors of childhood cancer

T2 - A report from the childhood cancer survivor study

AU - Armstrong, Gregory

AU - Liu, Wei

AU - Leisenring, Wendy

AU - Yasui, Yutaka

AU - Hammond, Sue

AU - Bhatia, Smita

AU - Neglia, Joseph P.

AU - Stovall, Marilyn

AU - Srivastava, Deokumar

AU - Robison, Leslie L.

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N2 - Purpose: Childhood cancer survivors experience an increased incidence of subsequent neoplasms (SNs). Those surviving the first SN (SN1) remain at risk to develop multiple SNs. Because SNs are a common cause of late morbidity and mortality, characterization of rates of multiple SNs is needed. Patients and Methods: In a total of 14,358 5-year survivors of childhood cancer diagnosed between 1970 and 1986, analyses were carried out among 1,382 survivors with an SN1. Cumulative incidence of second subsequent neoplasm (SN2), either malignant or benign, was calculated. Results: A total of 1,382 survivors (9.6%) developed SN1, of whom 386 (27.9%) developed SN2. Of those with SN2, 153 (39.6%) developed more than two SNs. Cumulative incidence of SN2 was 46.9% (95% CI, 41.6% to 52.2%) at 20 years after SN1. The cumulative incidence of SN2 among radiation-exposed survivors was 41.3% (95% CI, 37.2% to 45.4%) at 15 years compared with 25.7% (95% CI, 16.5% to 34.9%) for those not treated with radiation. Radiation-exposed survivors who developed an SN1 of nonmelanoma skin cancer (NMSC) had a cumulative incidence of subsequent malignant neoplasm (SMN; ie, malignancies excluding NMSC) of 20.3% (95% CI, 13.0% to 27.6%) at 15 years compared with only 10.7% (95% CI, 7.2% to 14.2%) for those who were exposed to radiation and whose SN1 was an invasive SMN (excluding NMSC). Conclusion: Multiple SNs are common among aging survivors of childhood cancer. SN1 of NMSC identifies a population at high risk for invasive SMN. Survivors not exposed to radiation who develop multiple SNs represent a population of interest for studying genetic susceptibility to neoplasia.

AB - Purpose: Childhood cancer survivors experience an increased incidence of subsequent neoplasms (SNs). Those surviving the first SN (SN1) remain at risk to develop multiple SNs. Because SNs are a common cause of late morbidity and mortality, characterization of rates of multiple SNs is needed. Patients and Methods: In a total of 14,358 5-year survivors of childhood cancer diagnosed between 1970 and 1986, analyses were carried out among 1,382 survivors with an SN1. Cumulative incidence of second subsequent neoplasm (SN2), either malignant or benign, was calculated. Results: A total of 1,382 survivors (9.6%) developed SN1, of whom 386 (27.9%) developed SN2. Of those with SN2, 153 (39.6%) developed more than two SNs. Cumulative incidence of SN2 was 46.9% (95% CI, 41.6% to 52.2%) at 20 years after SN1. The cumulative incidence of SN2 among radiation-exposed survivors was 41.3% (95% CI, 37.2% to 45.4%) at 15 years compared with 25.7% (95% CI, 16.5% to 34.9%) for those not treated with radiation. Radiation-exposed survivors who developed an SN1 of nonmelanoma skin cancer (NMSC) had a cumulative incidence of subsequent malignant neoplasm (SMN; ie, malignancies excluding NMSC) of 20.3% (95% CI, 13.0% to 27.6%) at 15 years compared with only 10.7% (95% CI, 7.2% to 14.2%) for those who were exposed to radiation and whose SN1 was an invasive SMN (excluding NMSC). Conclusion: Multiple SNs are common among aging survivors of childhood cancer. SN1 of NMSC identifies a population at high risk for invasive SMN. Survivors not exposed to radiation who develop multiple SNs represent a population of interest for studying genetic susceptibility to neoplasia.

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