Abstract
The Hungarian Pediatric Oncology Network provides centralized treatment and population-based registration for cases of childhood cancer since 1973. We collected and analized data on late mortality, secondary malignancies and cardiac diseases in survivors (> 5 years) of childhood cancer to evaluate long-term risks. We extracted all solid tumour cases (3,650 followed up for 5–39.3 years, diagnosis: 1973–2008) from the database of the Hungarian Childhood Cancer Registry and checked against the Population Registry. Among the 301 patients who died after 5 years (8.2%) the most common causes of death were progression of primary cancer (52.5%), secondary malignancies (16%) and cardiovascular diseases (8%). Late mortality rates (SMR, total: 35,006 pyrs) showed highly elevated risk of death (SMR: 10.7 95% CI 9–12.4) for the second 5 years of follow up and moderately elevated risk for 10-year survivors (SMR: 3.5 95% CI 3–4.1). Marked differences were detected in the pattern of causes of death between diagnostic groups of primary cancer; with highest risks beyond 10 years for CNS tumours, Hodgkin disease, osteosarcoma and advanced stage neuroblastoma. The longstanding mortality risk for 5-year survivors underlines the need for tailored long-term follow-up and monitoring of late consequences according to the context of different primary diseases of childhood cancer.
Highlights
The Hungarian Pediatric Oncology Network provides centralized treatment and population-based registration for cases of childhood cancer since 1973
Frequency of late deaths showed considerable differences according to the primary disease, exceeding 10% in Hodgkin lymphoma (HL), certain subgroups of CNS tumours, stage III-IV. neuroblastoma, Ewing sarcoma and osteosarcoma
Late mortality rates (SMR) (Table 2) showed highly elevated near 11-fold risk of death (10.7) for the second 5 years of follow-up corresponding to an Absolute excess risks (AER) of 39.1 and moderately elevated risk for 10-year survivors (SMR:3.5, 95% confidence interval (CI) 3–4.1; AER:16.3 95 CI 12.1–20.6)
Summary
The Hungarian Pediatric Oncology Network provides centralized treatment and population-based registration for cases of childhood cancer since 1973. We collected and analized data on late mortality, secondary malignancies and cardiac diseases in survivors (> 5 years) of childhood cancer to evaluate long-term risks. The longstanding mortality risk for 5-year survivors underlines the need for tailored long-term follow-up and monitoring of late consequences according to the context of different primary diseases of childhood cancer. Detailed data were collected on all cases including benign CNS (central nervous system) tumours on the basis of compulsory registration including wide range of variables including primary tumour sites, histologic and prognostic markers, details of treatment and outcome, relapses, early and late toxicities and long-term follow-up[1,2,3]. There is a great need for long-term surveillance involving all cases
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