Second Malignant Neoplasms in Pediatric Oncology Patients: A Single Center Experience

Hikmet Gülşah Tanyıldız ,Şule Toprak ,Mehmet Onur Çandır ,Ceyhun Bozkurt ,Şule Yeşil ,Gürses Şahin ,Sibel Akpınar Tekgündüz ,Nazmiye Yüksek ,Ulya Ertem

doi:10.12996/gmj.2017.50

Abstract

Objective: The pediatric malignancy survival rate has increased with new and intensive treatment modality advancements. This has led to an approximately 70% chance of surviving more than 5 years in children diagnosed with cancer. However, the secondary tumor incidence has also increased with these advances. The patient’s quality of life, late side effects, and prevention of secondary malignancies in the future are as important as treating the primary tumor in pediatric cancer patients. Methods: We retrospectively evaluated the charts of 2100 pediatric cancer patients who were diagnosed in our clinic between 1985 and 2012. Results: There were 11 secondary tumors. Male-to-female ratio was 6:5 and median age at diagnosis was 7 years (range, 1 year 3 months–11 years 6 months). Secondary tumor diagnosis was AML in five patients, paraganglioma in one patient, liposarcoma in one patient, rhabdomyosarcoma in one patient, papillary thyroid carcinoma in one patient, malignant fibrous histiocytoma in one patient, and squamous cell carcinoma of the tongue in one patient. AML was the most commonly detected secondary malignancy. Conclusion: We suggest that using less toxic systemic chemotherapy and reduced-dose radiotherapy is increasingly important with targeted treatment modalities to decrease the risk of secondary malignancy.

Highlights

The radiotherapy field was the cranium because there was central nervous system (CNS) involvement of leukemia in five patients, and the tumor region because of ganglioneuroblastoma or Wilms tumor in the other two patients
Cancer treatment success has been increasing in recent years
The 10-fold increase in secondary cancer risk must be taken into account

Summary

Introduction

The median follow-up duration of patients diagnosed with a secondary tumor was 11 years. Malignant fibrous histiocytoma developed in the temporal region in one patient with central involvement because of a diagnosis of T-ALL 9 years 5 months after St. Jude XIII treatment protocol (1800 c Gy cranial RT). The patient had received 1800 c Gy radiotherapy to the cranium as per St. Jude XIII leukemia protocol, and the duration between the two diagnoses was 7 years.

Results

Conclusion