-Original-

Therapy-related Secondary Malignancy After Treatment of Childhood Malignancy: Cases from a Single Center

Takahiro Ueda¹, Makoto Migita¹, Toshikazu Itabashi¹, Yujiro Tanabe¹, Ryoichi Uchimura¹, Yoshihiro Gocho¹, Miho Yamanishi¹, Fumiko Kobayashi¹, Mio Yoshino¹, Atsushi Fujita², Shingo Yamanishi¹, Kiyohiko Kaizu¹, Jun Hayakawa¹, Takeshi Asano², Miho Maeda¹ and Yasuhiko Itoh¹

¹Department of Pediatrics, Nippon Medical School, Tokyo, Japan
²Department of Pediatrics, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan

Background: Therapeutic outcomes for childhood malignancy have dramatically improved. However, secondary malignancies are a major concern, as they greatly affect the quality of life of survivors. This retrospective study evaluated the cumulative incidence, clinical features, and outcomes of secondary malignancies at Nippon Medical School Hospital.
Methods: We examined data from 275 cases of primary childhood malignancy diagnosed between 1980 and 2014. Information regarding treatment of the primary malignancy, including irradiation dose, site, and cumulative dose of anticancer drugs, was assessed. We also collected data on secondary malignancy, including patient sex, age at diagnosis, malignancy site, time from primary to secondary malignancy, and outcomes.
Results: Secondary malignancies developed in 11 patients and included acute myeloid leukemia (AML) (4), meningioma (4), Ewing sarcoma (1), germ cell tumor (1), and malignant parotid gland tumor (1). The primary malignancies included acute lymphoblastic leukemia (ALL) (9), non-Hodgkin lymphoma (1) and brain tumor (1). In 7 of the 9 ALL patients, chemoradiotherapy was the primary treatment. The meningiomas and 1 solid tumor developed within the radiation field. All AMLs and meningiomas developed within 5 years and after 20 years, respectively, of the primary diagnosis. The 10- and 20-year cumulative incidence rates for secondary malignancy in our hospital were 1.9% and 5.8%, respectively.
Conclusions: Our results revealed that the type of secondary malignancy depends on the interval after the end of treatment for primary malignancy. Meningioma, notably, develops many years after completion of primary malignancy treatment. Early detection during long-term follow-up is therefore essential.

J Nippon Med Sch 2019; 86: 207-214

Keywords
secondary malignancies, childhood cancer survivors, long-term follow-up, cumulative incidence, meningioma

Correspondence to
Takahiro Ueda, MD, PhD, Department of Pediatrics, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
yuri878t@nms.ac.jp

Received, September 4, 2018
Accepted, February 12, 2019