Format

Send to

Choose Destination
Neuro Oncol. 2015 Mar;17(3):448-56. doi: 10.1093/neuonc/nou279. Epub 2014 Nov 13.

Subsequent neoplasms in survivors of childhood central nervous system tumors: risk after modern multimodal therapy.

Author information

1
Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee (K.T., A.B., A.G., C.W.); Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee (C.L., D.S.); Department of Radiological Sciences, St Jude Children's Research Hospital, Memphis, Tennessee (L.E.K., T.E.M.); Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee (D.W.E., B.A.O.); Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee (F.A.B., P.K.); Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee (F.A.B., P.K.); Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee (F.A.B., P.K.); University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee (J.R.); Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee (L.L.R., G.T.A.).

Abstract

BACKGROUND:

Multimodal therapy has improved survival for some childhood CNS tumors. However, whether risk for subsequent neoplasms (SNs) also increases is unknown. We report the cumulative incidence of, and risk factors for, SNs after a childhood primary CNS tumor and determine whether treatment that combines radiation therapy (RT) with chemotherapy increases risk for SNs.

METHODS:

Analyses included 2779 patients with a primary CNS tumor treated at St Jude Children's Research Hospital between 1985 and 2012. Cumulative incidence and standardized incidence ratios (SIRs) were estimated for SNs confirmed by pathology report. Cumulative incidence among the 237 five-year medulloblastoma survivors treated with multimodal therapy (RT + chemotherapy) was compared with a historical cohort of 139 five-year survivors treated with RT but no chemotherapy in the Childhood Cancer Survivor Study.

RESULTS:

Eighty-one survivors had 97 SNs. The cumulative incidence of first SN was 3.0% (95% CI: 2.3%-3.9%) at 10 years, and 6.0% (95% CI: 4.6%-7.7%) at 20 years from diagnosis. Risks were highest for subsequent glioma, all grades (SIR = 57.2; 95% CI: 36.2-85.8) and acute myeloid leukemia (SIR = 31.8; 95% CI: 10.2-74.1). Compared with RT alone, RT + chemotherapy did not increase risk for SNs (hazard ratio: 0.64; 95% CI: 0.38-1.06). Among five-year survivors of medulloblastoma treated with multimodal therapy, cumulative incidence of SN was 12.0% (95% CI: 6.4%-19.5%) at 20 years, no different than survivors treated with RT alone (11.3%, P = .44).

CONCLUSION:

The cumulative incidence of SNs continues to increase with time from treatment with no obvious plateau, but the risk does not appear to be higher after exposure to multimodal therapy compared with RT alone. Continued follow-up of survivors as they age is essential.

KEYWORDS:

chemotherapy; childhood CNS tumor survivors; medulloblastoma; radiation; subsequent neoplasms

PMID:
25395462
PMCID:
PMC4483102
DOI:
10.1093/neuonc/nou279
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center