Secondary gastrointestinal cancer in childhood cancer survivors: A cohort study Journal Article

Authors: Henderson, T. O.; Oeffinger, K. C.; Whitton, J.; Leisenring, W.; Neglia, J.; Meadows, A.; Crotty, C.; Rubin, D. T.; Diller, L.; Inskip, P.; Smith, S. A.; Stovall, M.; Constine, L. S.; Hammond, S.; Armstrong, G. T.; Robison, L. L.; Nathan, P. C.
Article Title: Secondary gastrointestinal cancer in childhood cancer survivors: A cohort study
Abstract: Background: Childhood cancer survivors develop gastrointestinal cancer more frequently and at a younger age than the general population, but the risk factors have not been well-characterized. Objective: To determine the risk and associated risk factors for gastrointestinal subsequent malignant neoplasms (SMNs) in childhood cancer survivors. Design: Retrospective cohort study. Setting: The Childhood Cancer Survivor Study, a multicenter study of childhood cancer survivors diagnosed between 1970 and 1986. Patients: 14 358 survivors of cancer diagnosed when they were younger than 21 years of age who survived for 5 or more years after the initial diagnosis. Measurements: Standardized incidence ratios (SIRs) for gastrointestinal SMNs were calculated by using age-specific population data. Multivariate Cox regression models identified associations between risk factors and gastrointestinal SMN development. Results: At median follow-up of 22.8 years (range, 5.5 to 30.2 years), 45 cases of gastrointestinal cancer were identified. The risk for gastrointestinal SMNs was 4.6-fold higher in childhood cancer survivors than in the general population (95% CI, 3.4 to 6.1). The SIR for colorectal cancer was 4.2 (CI, 2.8 to 6.3). The highest risk for gastrointestinal SMNs was associated with abdominal radiation (SIR, 11.2 [CI, 7.6 to 16.4]). However, survivors not exposed to radiation had a significantly increased risk (SIR, 2.4 [CI, 1.4 to 3.9]). In addition to abdominal radiation, high-dose procarbazine (relative risk, 3.2 [CI, 1.1 to 9.4]) and platinum drugs (relative risk, 7.6 [CI, 2.3 to 25.5]) independently increased the risk for gastrointestinal SMNs. Limitation: This cohort has not yet attained an age at which risk for gastrointestinal cancer is greatest. Conclusion: Childhood cancer survivors, particularly those exposed to abdominal radiation, are at increased risk for gastrointestinal SMNs. These findings suggest that surveillance of at-risk childhood cancer survivors should begin at a younger age than that recommended for the general population. Primary Funding Source: National Cancer Institute. © 2012 American College of Physicians.
Keywords: adolescent; adult; cancer chemotherapy; child; controlled study; leukemia; retrospective studies; young adult; major clinical study; cancer risk; liver cell carcinoma; antineoplastic agents; united states; cancer radiotherapy; pancreas cancer; drug megadose; follow up; colorectal cancer; adenocarcinoma; proportional hazards models; radiotherapy; incidence; risk factors; stem cell transplantation; angiosarcoma; medical record review; retrospective study; risk factor; cancer mortality; procarbazine; childhood cancer; hodgkin disease; cancer survivor; risk assessment; survivors; digestive system cancer; neuroendocrine tumor; colorectal neoplasms; gastrointestinal neoplasms; nonhodgkin lymphoma; neuroblastoma; colon cancer; family history; soft tissue sarcoma; stomach cancer; brain cancer; platinum derivative; neoplasms, second primary; platinum compounds; leiomyosarcoma; anus cancer; esophagus cancer; population surveillance; rectum cancer; canada; hepatobiliary disease; klatskin tumor; nephroblastoma; bone cancer; small intestine cancer; pancreas islet cell carcinoma; gastrinoma
Journal Title: Annals of Internal Medicine
Volume: 156
Issue: 11
ISSN: 0003-4819
Publisher: American College of Physicians  
Date Published: 2012-01-01
Start Page: 757
End Page: 766
Language: English
PROVIDER: scopus
PUBMED: 22665813
PMCID: PMC3554254
DOI: 10.1059/0003-4819-156-11-201206050-00002
Notes: --- - "Export Date: 2 July 2012" - "CODEN: AIMEA" - "Source: Scopus"
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MSK Authors
  1. Kevin Oeffinger
    294 Oeffinger