2ND MALIGNANT NEOPLASMS OCCURRING IN SURVIVORS OF OSTEOSARCOMA

BACKGROUND. Second malignant neoplasms have been noted infrequently in survivors of osteosarcoma treated before 1970. METHODS. For the above reason, the authors surveyed their patients to determine the actuaria l incidence and relative risk of second malignancies among patients tr eated with adjuvant chemotherapy for osteosarcoma. RESULTS. Between Ma rch 1962 and March 1996, 334 patients received chemotherapy for newly diagnosed primary or metastatic osteosarcoma. Of these patients, 47 pr esented with metastases, 14 had multifocal osteosarcoma, and 273 had l ocalized disease. Nine patients developed second malignant neoplasms 0 .45-17.8 years (median, 6.3 years) after receiving definitive surgery and adjuvant chemotherapy for primary osteosarcoma; 2 of these patient s had pulmonary metastasectomies before receiving adjuvant chemotherap y. The second neoplasms comprised two cases of malignant fibrous histi ocytoma and one case each of melanoma, glioblastoma multiforme, chondr osarcoma, and carcinoma of the breast: stomach, colon, rectum. The ove rall 10-year cumulative incidence of second malignancies was 2% +/- 1% ; by comparison, this rate was 2% +/- 1% for patients with localized o steosarcoma but was 8% +/- 5% (P = 0.15) for those who presented with metastatic disease. CONCLUSIONS. Since the advent of successful adjuva nt chemotherapy, more patients are surviving primary osteosarcoma; the refore, the number of osteosarcoma patients who develop second maligna ncies can be expected to increase. Recognition of osteosarcoma patient s who are members of families with Li-Fraumeni syndrome may lead to ea rlier intervention for these individuals. (C) 1997 American Cancer Soc iety.