Abstract 2299: Sarcoma as second cancer in pediatric cancer survivors: Large population analysis

Abstract

Abstract Introduction: As the prognosis of a pediatric cancer continues to improve, the burden of long term therapy effects, including subsequent malignant neoplasm (SMN), in survivors is an increasing epidemiologic concern. The mortality rate from cancer in the pediatric population decreased from 6.5 per 100,000 in 1970 to 2.3 in 2015, indicating more chance of SMNs. Sarcoma as a SMN in pediatrics has important clinical significance and has been extensively reported globally. We quantified the percentage of sarcoma as second cancer and determined the primary cancer distribution for patients with sarcoma as second cancer. Methods: The Surveillance, Epidemiology, and End Results (SEER) database, which includes 28% of the U.S population and data from 18 state cancer registries (SEER-18), was probed for the overall incidence of SMN in pediatric cancer survivors and the incidence of sarcoma as the SMN specifically. Results: Our SEER database analysis found that out of 75,665 cases of primary pediatric malignancies, 1218 (1.61%) developed SMN. The second most common SMN was sarcoma, accounting for 14.37% of them in pediatric population. The breakdown of sarcoma into sub groups showed that osteosarcoma, fibrosarcoma, and rhabdomyosarcoma are the most common second sarcomas seen in pediatric cancer survivors. Finally, we looked at the distribution of primary cancer in pediatric cancer survivors who developed sarcoma as a SMN. We found that retinoblastoma, lymphoid leukemia, and Hodgkin lymphomas were the most common types of primary cancer. Similar results were reported among different racial groups around the world, which show a universal trend of sarcomas as second cancers in pediatric cancer survivors. Conclusion: By analyzing the SEER database, we corroborated previous findings, suggesting that about 14% of SMN after a childhood cancer is encompassed by sarcoma. The exact etiology of cancer, be it primary predisposition or secondary to exposures, is uncertain. Radiation and chemotherapies used in patients with pediatric cancers can be carcinogenic. Our study highlights the need for development of novel non-DNA damaging or alternate antineoplastic therapies to avoid the long-term potential of development of SMN. Citation Format: Monish Ram Makena, Thinh H. Nguyen, Siddhartha Yavvari, Maninder Kaur, Teresia Pham, Eduardo Urias, Narendra Panapitiya, Mohamad M. Al-Rahawan. Sarcoma as second cancer in pediatric cancer survivors: Large population analysis [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2299.