2ND MALIGNANT-TUMORS FOLLOWING TREATMENT DURING CHILDHOOD AND ADOLESCENCE FOR CANCER

Many pediatric and adolescent cancer patients are treated with carcino genic chemotherapeutic agents and radiation therapy to achieve permane nt control of their malignancy. These modalities may induce a new canc er in the successfully treated patient. To identify disease and treatm ent factors which increased the risk of occurrence of a second maligna nt tumor following modern treatment for cancer during childhood or ado lescence, we reviewed the courses of 1,406 previously untreated patien ts who were less than 20 years of age at diagnosis and were treated at Roswell Park Cancer Institute between January 1, 1960 and December 31 , 1989. Eighteen patients developed a second malignant tumor, includin g two meningiomas, 2.65-25.65 years after diagnosis of the first cance r. The actuarial risk of a second malignant tumor was 5.6% at 25 years after diagnosis. Using Cox proportional hazards modelling, we identif ied prior therapy with BCNU (P = 0.0055) and doxorubicin (P = 0.0254) as the only factors that were significantly associated with the risk o f a second malignant tumor. Three second malignant tumors of the centr al nervous system occurred following treatment with a nitrosourea. Suc cessfully treated patients must be carefully followed to identify trea tment related malignant tumors at an early stage. (C) 1994 Wiley-Liss, Inc.