As childhood cancer treatments continue to improve, the rate of long-term survivors increases, shining a light on post-recovery health concerns such as therapy-related secondary malignancies. According to a study published in the Journal of Nippon Medical School, there is a distinct pattern and timeline associated with the development of these secondary diseases, emphasizing the critical need for long-term follow-up and surveillance.
The research, spearheaded by Takahiro Ueda and colleagues at Nippon Medical School, set out to evaluate the cumulative incidence, clinical features, and outcomes of secondary malignancies diagnosed after the treatment of childhood cancers at their hospital. Covering cases between 1980 and 2014, they examined the data from 275 primary childhood malignancy cases.
Their findings, published with the DOI: 10.1272/jnms.JNMS.2018_86-401, indicated that out of these hundreds of cases, secondary malignancies developed in 11 patients. These included four instances each of acute myeloid leukemia (AML) and meningioma, one Ewing sarcoma, one germ cell tumor, and one malignant parotid gland tumor. Of note is that most of the patients with secondary malignancies initially had acute lymphoblastic leukemia (ALL), with one case each stemming from non-Hodgkin lymphoma and brain tumor.
Chemoradiotherapy was the primary treatment for seven of the nine patients initially diagnosed with ALL. Intriguingly, the meningiomas, along with one solid tumor, appeared within the radiation field, implicating a direct correlation between treatment location and secondary disease development.
Furthermore, this study found that all AML instances and meningiomas manifested within different time frames post-primary diagnosis: within 5 years for AML and after 20 years for meningiomas. This timeline emphasizes the importance of long-term monitoring for early detection and treatment of potential secondary malignancies.
This paper revealed that over the years, the 10- and 20-year cumulative incidence rates for secondary malignancy in their hospital were 1.9% and 5.8%, respectively. Additionally, the researchers noted that the specific type of secondary malignancy was dependent on the interval after the end of treatment for the primary malignancy. This suggests that treatment protocols should be carefully considered in terms of the long-term implications for patients.
The research team involved several prominent names from the Department of Pediatrics at Nippon Medical School, including Makoto Migita, Toshikazu Itabashi, Yujiro Tanabe, Ryoichi Uchimura, Yoshihiro Gocho, Miho Yamanishi, Fumiko Kobayashi, Mio Yoshino, Atsushi Fujita from the Nippon Medical School Chiba Hokusoh Hospital, Shingo Yamanishi, Kiyohiko Kaizu, Jun Hayakawa, Takeshi Asano, Miho Maeda, and Yasuhiko Itoh. Their collective efforts are published under the Journal Article format and were made available online on April 26, 2019.
This study guides healthcare professionals in developing long-term follow-up protocols and emphasizes the need for attention to not just the immediate eradication of the primary cancer but also the long-term health of survivors. It is critical to continue research in this area to improve the quality of life for childhood cancer survivors, making it an imperative part of oncological care.
References
1. Ueda, T. et al. (2019) ‘Therapy-related Secondary Malignancy After Treatment of Childhood Malignancy: Cases from a Single Center’, Journal of Nippon Medical School, 86(4), pp. 207-214. doi: 10.1272/jnms.JNMS.2018_86-401.
2. Bhatia, S. (2011) ‘Therapy-Related Myeloid Leukemia and Myelodysplastic Syndrome in Children: The Dark Side of Therapeutic Success’, Pediatric Blood & Cancer, 56(6), pp. 821-831. doi: 10.1002/pbc.22957.
3. Friedman, D. L., Whitton, J., Leisenring, W., Mertens, A. C., Hammond, S., Stovall, M., Donaldson, S. S., Meadows, A. T., Robison, L. L., & Neglia, J. P. (2010) ‘Subsequent Neoplasms in 5-year Survivors of Childhood Cancer: The Childhood Cancer Survivor Study’, Journal of the National Cancer Institute, 102(14), pp. 1083-1095. doi: 10.1093/jnci/djq238.
4. Armstrong, G. T., Liu, Q., Yasui, Y., Huang, S., Ness, K. K., Leisenring, W., Hudson, M. M., Donaldson, S. S., King, A. A., Stovall, M., Krull, K. R., & Robison, L. L. (2009) ‘Late Mortality Among 5-Year Survivors of Childhood Cancer: A Summary From the Childhood Cancer Survivor Study’, Journal of Clinical Oncology, 27(14), pp. 2328-2338. doi: 10.1200/JCO.2008.21.1425.
5. Meadows, A. T., Friedman, D. L., Neglia, J. P., Mertens, A. C., Donaldson, S. S., Stovall, M., Hammond, S., Yasui, Y., & Inskip, P. D. (2009) ‘Second Neoplasms in Survivors of Childhood Cancer: Findings From the Childhood Cancer Survivor Study Cohort’, Journal of Clinical Oncology, 27(14), pp. 2356-2362. doi: 10.1200/JCO.2008.21.1920.
Keywords
1. Secondary malignancies in children
2. Long-term surveillance childhood cancer
3. Therapy-related cancers after childhood treatment
4. Late effects of childhood cancer therapy
5. Childhood cancer survivorship and secondary malignancy risks