Bone sarcomas as second malignant neoplasms following childhood cancer

Article Abstract:

There are several reasons why an individual might develop two distinct, different cancers. One, of course, is random chance. However, the development of two tumors might indicate that the tumors resulted from exposure to the same agent; it might also indicate that the two cancers arose from the presence of the same genetic defect. A patient may also develop a second cancer as a result of radiation and chemotherapy used in the treatment of the first. In children, the most common second cancer is bone sarcoma. A study was undertaken, therefore, of 91 children in whom bone sarcoma was a second malignant neoplasm. The second cancers occurred an average of 9.6 years after the diagnosis of the primary cancer. The type of primary cancer affected the interval until the second tumor; the interval was shortest among patients with leukemia or lymphomas, while it was longest among those who had retinoblastoma. A major factor affecting the development of a second cancer is radiation therapy. In the present series of patients, 77 percent had received radiation therapy; in 69 cases the bone cancer developed within the irradiated area. Among the patients who did not receive radiotherapy, the bone cancers developed in the areas most commonly associated with bone cancer, for example the long bones around the knee. Chemotherapy contributed to the rapidity with which the second cancer developed; this effect seemed to be most strongly associated with the use of drugs of the anthracycline class. Treatment with anthracyclines was associated with an average decrease of four years in the time elapsed before the development of the second tumor. About one fourth of the patients had retinoblastoma as their primary tumor. Since retinoblastoma is an inherited cancer, it strongly suggests a possible genetic contribution to the second cancers as well. In addition, there seemed to be a predisposition to multiple cancers within the families of some of the patients. Unfortunately, it was not possible to obtain sufficiently detailed information to document the familial contributions to the observed second cancers of the bone. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Postirradiation sarcoma: analysis of a nationwide cancer registry material

Article Abstract:

Radiation therapy for cancer carries with it the risk of causing another cancer. Although the risks are small, they are not negligible. Scandinavian countries maintain especially good records of cancer patients, and these records may be used to glean important insights into the causes and treatments of cancer. The Finnish cancer registry has been used to evaluate postirradiation sarcoma, a form of cancer most often affecting bones and muscle. Examination of these records, which are essentially complete as far back as 1933, revealed 380 cases of sarcoma occurring in patients who had previously had a different cancer. Many cases were excluded from consideration, most often because the sarcoma did not occur in the same tissue that had been exposed to radiation, and, therefore, could not be attributed to radiation. A total of 33 cases were identified that could confidently be termed postirradiation sarcoma. The patients who developed postirradiation sarcoma were not exposed to particularly high doses of radiation therapy. The average (median) dose of radiation was 3,600 cGy. (A Gy, or Gray, is a dose of radiation equivalent to one joule of energy absorbed per kilogram of tissue. It is equal to 100 rads.) No patient developed a sarcoma earlier than 3.4 years after the radiotherapy, and the median delay was 13.2 years. In one case, the sarcoma followed treatment for the initial cancer by 22.8 years. The most common postirradiation sarcomas were osteosarcoma, a bone cancer, and malignant fibrous histiocytoma, a connective tissue cancer; 10 cases of each were found. Overall, the five-year survival rate was 29 percent. However, survival was considerably better for the patients who were treated aggressively. For patients treated with radical surgery or modified marginal surgery with radiation, a five-year survival of 67 percent was observed, suggesting that postirradiation sarcoma is quite treatable. This report underscores the importance of maintaining long-term follow-up of cancer patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Cancer

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Osteosarcoma of the maxilla in Hong Kong Chinese postirradiation for nasopharyngeal carcinoma: a report of four cases

Article Abstract:

Osteosarcoma is a malignant cancer of the bone, which may develop after exposure to radiation. Four cases or radiation-related osteosarcoma of the maxilla are described in patients who were treated with radiation for cancer of the nasopharynx, a common malignancy among Chinese from Hong Kong. The maxilla is a rare site of osteosarcoma, accounting for 2.9 to 3.5 percent of all osteosarcomas. This head bone forms the skeletal base of the upper face, roof of the mouth, sides of nasal cavity, and floor of the orbit, the bony cavity containing the eyeball. Because a portion of the maxilla called the alveolar process supports the teeth, the maxilla is often called the upper jaw. The four cases of osteosarcoma of the maxilla accounted for nine percent of osteosarcomas at all sites in 1,000 patients treated with radiation for nasopharyngeal carcinoma between 1979 and 1989. The osteosarcoma developed 8 to 11 years after the completion of radiation treatment. Three of the patients received a radiation dose of 6,000 to 6,280 cGy; the dose for the fourth was unknown. These cases fulfilled the criteria for diagnosis of osteosarcoma. Osteosarcoma of the maxilla developing after radiation treatment for nasopharyngeal carcinoma has not been previously reported. Since nasopharyngeal carcinoma is common in Hog Kong Chinese, and radiation therapy is the treatment of choice for this cancer, the occurrence of osteosarcoma of the maxilla may be more frequent in this population. However, the risk of developing osteosarcoma of the maxilla after radiation treatment is small and should not preclude the use of radiation therapy for nasopharyngeal carcinoma. (Consumer Summary produced by Reliance Medical Information, Inc.)

Mouth cancer

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