Secondary Gastrointestinal Cancer in Childhood Cancer Survivors

The Children's Hospital of Philadelphia, Filadelfia, Pennsylvania, United States
Annals of internal medicine (Impact Factor: 17.81). 06/2012; 156(11):757-66, W-260. DOI: 10.1059/0003-4819-156-11-201206050-00002
Source: PubMed


Childhood cancer survivors develop gastrointestinal cancer more frequently and at a younger age than the general population, but the risk factors have not been well-characterized.
To determine the risk and associated risk factors for gastrointestinal subsequent malignant neoplasms (SMNs) in childhood cancer survivors.
Retrospective cohort study.
The Childhood Cancer Survivor Study, a multicenter study of childhood cancer survivors diagnosed between 1970 and 1986.
14 358 survivors of cancer diagnosed when they were younger than 21 years of age who survived for 5 or more years after the initial diagnosis.
Standardized incidence ratios (SIRs) for gastrointestinal SMNs were calculated by using age-specific population data. Multivariate Cox regression models identified associations between risk factors and gastrointestinal SMN development.
At median follow-up of 22.8 years (range, 5.5 to 30.2 years), 45 cases of gastrointestinal cancer were identified. The risk for gastrointestinal SMNs was 4.6-fold higher in childhood cancer survivors than in the general population (95% CI, 3.4 to 6.1). The SIR for colorectal cancer was 4.2 (CI, 2.8 to 6.3). The highest risk for gastrointestinal SMNs was associated with abdominal radiation (SIR, 11.2 [CI, 7.6 to 16.4]). However, survivors not exposed to radiation had a significantly increased risk (SIR, 2.4 [CI, 1.4 to 3.9]). In addition to abdominal radiation, high-dose procarbazine (relative risk, 3.2 [CI, 1.1 to 9.4]) and platinum drugs (relative risk, 7.6 [CI, 2.3 to 25.5]) independently increased the risk for gastrointestinal SMNs.
This cohort has not yet attained an age at which risk for gastrointestinal cancer is greatest.
Childhood cancer survivors, particularly those exposed to abdominal radiation, are at increased risk for gastrointestinal SMNs. These findings suggest that surveillance of at-risk childhood cancer survivors should begin at a younger age than that recommended for the general population.
National Cancer Institute.

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    • "Advances in dose delivery techniques as conformal and modulated beams and other newer modalities such as ion and radionuclide targeted therapy have been implemented and many investigations are in progress [10]. But the risk of secondary cancer after radiotherapy particularly in children because of their high radiosensitivity is high and finding newer treatment techniques is in thought of radiation scientists [11] [12]. "
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    ABSTRACT: Ionization radiation (IR) is a main part of modern technologies with a double-edge sword manner. Finding the most feasible therapies to reduce adverse effects of IR and also enhancing radiotherapy effectiveness is a debating issue that has been challenged and studied for years. The main aim of the present hypothetical research was to theorize and suggest a new biological radiation protection approach and also increasing radiotherapy outcomes based on cellular autofluorescence following IR. In this hypothesis, we suggested that this cellular autofluorescence can activate some synthetic drugs called photo-activated agents that are injected in human body after radiation exposures scenarios. Photo activated agents can activate biological pathways such as DNA repair and immunostimulation pathways, bystander signals blocking, and so survive cells and tissues. In the other hand, light emitted by cellular response to radiation can be used as like as photodynamic therapy and therefore more cancer cells killing via apoptosis and necrosis. These ideas can be performed in future using more animal and in vivo/in vitro studies and clinical trials. In conclusion, cellular autofluorescence after radiation exposure can be used as a source for activation specific drugs for radiation protection and also radiation therapy effectiveness. These hypothetical therapeutic approaches can be served as personalized therapy based on individual radiosensitivity.
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    • "The use of radiation increased the RR of SMN including glioma and colorectal cancer. Similar to the findings in the BCCSS, Henderson et al. found an increased number of GI cancers in childhood cancer survivors as compared to the general population [69]. Eighty-seven percent of the childhood cancer survivors who later developed a GI SMN received radiotherapy for treatment of the primary cancer [69]. "
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    ABSTRACT: Childhood cancer survivors are at risk for developing second malignant neoplasms. Very-low-dose therapeutic radiation therapy (RT) may be used to treat infants with Stage 4S neuroblastoma. We report a case of a patient who subsequently developed clear cell sarcoma of the gastrointestinal tract nearly 15 years after treatment with very low-dose therapeutic RT (4.5 Gy) for Stage 4S neuroblastoma.
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