Cumulative Incidence Of Second Neoplasms Research Articles

RONC-03. Secondary Neoplasms in Children with Central Nervous System (CNS) Tumors Following Radiotherapy in the Modern Era

PURPOSE: To assess reduction of secondary radiation-induced neoplasms over the past two decades, focusing on children with CNS tumors who received intensity modulated radiotherapy (IMRT) or proton therapy (PT). METHODS: A total of 1044 children received radiotherapy for a primary CNS tumor at 2 institutions between 1999 and 2020, including 99 treated with IMRT and 945 treated with PT. Median age was 8.7 years old. Median follow-up was 6.0 years and included 83 and 510 patients with >5 years follow-up in the IMRT and proton cohorts, respectively. Cumulative incidence method provided estimates of secondary neoplasms encompassing benign and malignant solid tumors as well as leukemia. Multiple variables were assessed using proportional hazard regression for competing risks. RESULTS: Ten-year overall survival was 87.4%. Patients treated with IMRT were significantly older, with a median age of 10.4 vs 8.4 years old (p <0.001), but were more likely to receive craniospinal irradiation (31.3% vs 14.2%, p <0.001) or alkylating chemotherapy (50.5% vs 29.7%, p <0.001). The 5- and 10-year cumulative incidence of second neoplasm was 0.7% and 2.3%, respectively. On multivariate analysis, age <5 (4.9% vs 0.7% at 10 years) and tumor predisposition syndrome (34.3% vs 1.5% at 10 years) were significantly associated with a second neoplasm (p < 0.01 for each). On both univariate and multivariate analyses, PT was not associated with a lower incidence of second neoplasm. Following IMRT, 1/2 second solid tumors occurred outside the target volume, compared to 2/11 after PT. CONCLUSION: Following modern radiotherapy, approximately 2% of children with a CNS tumor will develop a second neoplasm within 10 years of treatment. Compared to IMRT, PT was not associated with an overall reduction in second neoplasms. More events and follow-up beyond 10 years are needed to determine if proton therapy reduces the incidence of second solid tumors occurring specifically in the low dose region.

Quality of life and current needs of cancer survivors enrolled in Humanitas Research Hospital's survivorship care model.

170 Background: While there are different studies investigating the quality of life (QoL) of cancer patients (pts) during active treatment, few studies report QoL of cancer survivors (CS) after at least 5 years (yrs) from achieving complete remission. We have investigated QoL and concerns about physical\psychological symptom of CS enrolled in our survivorship program from April 2015 to December 2016. Methods: We included pts &gt; 18 yrs affected by hematologic or solid tumors after at least 5 yrs from achieving complete remission. A cross-sectional survey was carried out using validated scales: Cancer Survivors Survey of Needs subscale and a single-item measure of global QoL perception. Results: We analyzed data from 178 CS. The median age was 62 yrs (52 yrs at diagnosis), 70% were females. The most frequent histological types were breast (50%), colorectal (11%) and hematologic tumors (16%). Most pts received both chemotherapy and radiation therapy. With a median observation time of 139 months, the 10-yrs cumulative incidence of second neoplasm and cardiac adverse event was 8% and 7% respectively. 133 pts (65%) reported a good QoL (score &gt; 3). The most frequent symptoms reported were weight changes (77%), memory\concentration deficit (65%), dental\mouth problems (61%). The most common physical\psychological symptoms were fear of relapse (83%), genetic counseling (68%), living with uncertainty (66%). A positive statistically significant association (p &lt; 0.05) was observed between previous hormonal therapy and the following concerns (score ≥2): sleep disturbance (42% vs 35%); weight gain (31% vs 24%), osteoporosis (35% vs 18%), living with uncertainty (44% vs 38%). Female reported more fear of relapse (p 0.023) and sense of uncertainty (p 0.006) than males. 92% of pts have fully or partially adhered to the survivorship care plan. Conclusions: Most CS have a good QoL perception but we observed a high percentage of pts with a low score indicating different needs to be addressed. Pts treated with hormonal therapy are at higher risk of having both physical and psychological concerns. So far, the compliance of pts with the program was high.

GH replacement therapy and second neoplasms in adult survivors of childhood cancer: a retrospective study from a single institution.

Growth hormone deficiency (GHD) is the most common endocrine late effect observed in childhood cancer survivors (CCS) previously submitted to cranial irradiation. Radiation therapy can also increase the risk of second neoplasms (SNs). Since in previous studies GH replacement therapy was associated with increased incidence of neoplasia, we explored the association between SNs and GH replacement therapy in a cohort of CCS with GHD. Within the clinical cohort of CCS referred to the Transition Unit for Childhood Cancer Survivors of Turin between November 2001 and December 2012, we considered all patients who developed GHD as a consequence of cancer therapies. GHD was always diagnosed in childhood. To evaluate the quality of data, our cohort was linked to the Childhood Cancer Registry of Piedmont. GHD was diagnosed in 49 out of 310 CCS included in our clinical cohort. At least one SN was diagnosed in 14 patients, meningioma and basal cell carcinoma being the most common SNs. The cumulative incidence of SNs was similar in GH-treated and -untreated patients (8 SNs out of 26 GH-treated and 6 out of 23 GH-untreated patients; p=0.331). Age, sex and paediatric cancer type had no impact on SNs development. In our CCS, GH replacement therapy does not seem to increase the risk of SNs. Anyway, independently from replacement therapy, in these patients we observed an elevated risk of SNs, possibly related to previous radiation therapy, which suggests the need of a close long-term follow-up.

871P - Incidence and Pattern of Second Neoplasms in Patients Diagnosed with Invasive Transitional Carcinoma of the Urinary Tract

ABSTRACT Aim: Few inherited familial syndromes include transitional cell cancer; however the field carcinogenesis is a common problem for patients diagnosed of transitional cell carcinoma. Besides smoking, other risk factors are associated with developing second neoplasms such as alcohol intake and aging. While there are some published studies about secondary smoking-related tumours in this population, data about the incidence of other not-smoking related tumours is limited. The objective of this study was to analyse the cumulative incidence of second neoplasms in this population and determine the type of second neoplasms: urinary tract vs not-related urinary tract. Methods: Retrospective analysis of 629 patients diagnosed with invasive transitional cell carcinoma of the urinary tract treated in a single medical center from 1999 to 2012. Patients with a follow-up shorter than 6 months were excluded. Synchronic prostate carcinoma were not included, tumours included in our analyses were those diagnosed during the follow-up. Cumulative incidence of secondary tumours was calculated by kaplan-meier. Results: Median age of patients was 67 years (30-87). Median follow-up time was 60 months. There were 45 patients who developed a second neoplasm (8%); 32 corresponded to non-urothelial tumours (71%) and 13 urothelial tumours (29%). The actuarial cumulative incidence of a second neoplasm was 27% at 10 years. Incidence of not-urinary tumours was 19% at 10 years. There were 14 cases of lung cancer (31,1 %) (2 oat cell and 12 NSCLC) 3 colon cancers (6,7%), 2 cancers of the rectum (4,4%), 2 renal cancers (4,4%), 2 Hepatocellular carcinomas (4,2%), 2 haematological tumours (4,4%), and 1 case of each of the following tumours: GIST, prostate, parotid, biliary track, glottis, thyroid, vagina and brain. The interval between the diagnosis of urothelial cancer and the second neoplasm was on average 46,88 months. Smoking was common in all patients with second neoplasms (93,3%). Conclusions: Diagnosis of second neoplasms is a major concern for this population, which is heavily exposed to risk factors, such as smoking. Specific follow-up is required as well as programs for smoking cessation. Disclosure: All authors have declared no conflicts of interest.

Thoracic Malignancies and Other Second Neoplasms in Hodgkin Lymphoma Survivors

ABSTRACT Aim: Patients cured of Hodgkin Lymphoma (HL) have an increased risk of developing Second Neoplasms (SN). We compared characteristics of patients with Thoracic malignancies (TM), (lung cancer or mesothelioma) to other SN. Methods: 604 patients treated of HL and monitored in our hospital from 1968 to 2012 were retrospectively analyzed. Results: We found 90 (14.5%) SN: 27 (30%) patients developed TM and 63 (70%) other SN. Median age at HL diagnosis was similar in both groups (p=0.31) whereas elapsed time until SN diagnosis was 16.5 and 11.0 years respectively (p=0.004). In TM group, 85.5% of patients were men (p=0.001) and 85.2% were smokers (RR 3.4 CI95% 1.3-8.9, p=0.003). Concerning HL stage at diagnosis 25.9% in TM and 50.8% in other SN had advanced stages (p=0,029). Chemotherapy treatments received for HL were similar in both groups whereas radiotherapy when compared with combined treatment or chemotherapy was associated with an increased risk of TM (RR=2.3, CI 95% 0.9-5.9 p=0.07).The majority (59.2%) of patients with TM were diagnosed after consulting for new symptoms and had advanced stages. Adenocarcinoma was the most prevalent histology. Overall survival at 1 and 5 years in TM and other SN group was 59%/62%, and 24%/41% respectively (p=0.05). Considering the 604 patients, cumulative incidence of SN in general at ten and twenty-five years was 7.6% and 31.3% respectively and in TM group 1.5% and 9.7%. Conclusions: Smoking habit, male gender as well as radiotherapy are associated to the development of TM. Patients diagnosed of advanced stages of HL develop more frequently other SN. Moreover we found longer elapsed time until diagnosis of SN in TM group and shorter overall survival. The role of SN screening has yet to be prospectively evaluated. Disclosure: All authors have declared no conflicts of interest.

Cumulative incidence of second neoplasms over 30 years after treatment of childhood acute lymphoblastic leukemia (ALL)

8537 Background: Little is known about the long-term incidence of second neoplasm after treatment of childhood ALL. The reported cumulative incidence of second neoplasm at 10 to 15 years after ALL treatment varies from 1.2% to 3.3%, but the incidence after 20 years has not been well studied. Methods: We conducted a retrospective study of 2304 patients with ALL treated between 1962 and 1998 to assess the long-term incidence of second neoplasm. Results: The median follow-up time was 17.8 years (range, 0.3 to 39.3 years). Second neoplasms developed in 167 patients (123 in initial remission, 44 after retrieval therapy) and comprised hematologic malignancies (61 myeloid, 5 lymphoma) and solid tumors (21 meningiomas, 26 other brain tumors, 24 basal cell carcinomas, 22 other carcinomas, 7 sarcomas, and 1 melanoma). For the 123 patients in whom a second neoplasm developed as the first event, the median time between diagnosis of ALL and development of a second neoplasm was 8.6 years (range, 0.5 to 31.7 years). All myeloid malignancies, lymphomas, and CNS tumors except meningiomas occurred within 17 years after diagnosis of ALL. The cumulative incidences were 4.1% (95% confidence interval [CI], 3.2%–5.0%) at 15 years for patients in first remission and 11.9% (95% CI, 8.9%–14.9%) at 30 years. When meningioma and basal cell carcinoma were excluded, the cumulative incidences were 3.9% (95% CI, 3.0%–4.7%) at 15 years for patients in first remission and 6.5% (95% CI, 4.6%–8.3%) at 30 years. Conclusions: The overall cumulative incidence of second neoplasm increases during the first 30 years after treatment. Follow-up over multiple decades is necessary to ascertain the incidence of second neoplasm after ALL treatment. No significant financial relationships to disclose.

Incidence of Second Neoplasms in Patients with Bilateral Retinoblastoma

The cumulative incidence of second neoplasms in 215 patients with bilateral retinoblastoma was calculated using the life-table method. Second tumors developed in 4.4% of the patients during the first 10 years of follow-up, in 18.3% after 20 years, and in 26.1 % after 30 years. The 30-year cumulative incidence was 35.1 % for the 137 patients who received radiation therapy compared with an incidence rate of 5.8% for the 78 patients who did not receive radiation. In the 137 patients who received radiation, second tumors developed both inside and outside the field of therapy. There was a 30-year incidence rate of second tumors of 29.3% within the field of irradiation and 8.1 % outside the field. The rate outside the field of irradiation (8.1 %) was similar to that observed in nonirradiated patients (5.8%). Our findings indicate that carriers of the retinoblastoma gene have an increased incidence of second tumors, and that the incidence rate is further increased in patients who receive radiation therapy.

Non-ocular cancer in hereditary retinoblastoma survivors and relatives.

An epidemiological survey has been carried out to establish the incidence of second malignant neoplasms in hereditary retinoblastoma survivors in The Netherlands and the relative risk of cancer in non-affected relatives. The cumulative incidence of second neoplasms was 19% at the age of 35 years. Fathers, unaffected by retinoblastoma, were at risk for pancreatic cancer, the relative risk being 8.3.

The incidence of second neoplasms following megavoltage radiation for pediatric tumors.

From 1953 to 1975, 330 children received megavoltage for benign or malignant tumors. Fourteen subsequently developed second neoplasms. The 30-year cumulative incidence of second neoplasms was 9.6%. The incidence of second malignant neoplasms may be lower following megavoltage radiation than following orthovoltage radiation.