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Bowers DC, Verbruggen LC, Kremer LCM, Hudson MM, Skinner R, Constine LS, Sabin ND, Bhangoo R, Haupt R, Hawkins MM, Jenkinson H, Khan RB, Klimo P, Pretorius P, Ng A, Reulen RC, Ronckers CM, Sadighi Z, Scheinemann K, Schouten-van Meeteren N, Sugden E, Teepen JC, Ullrich NJ, Walter A, Wallace WH, Oeffinger KC, Armstrong GT, van der Pal HJH, Mulder RL. Surveillance for subsequent neoplasms of the CNS for childhood, adolescent, and young adult cancer survivors: a systematic review and recommendations from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Oncol 2021; 22:e196-e206. [PMID: 33845037 DOI: 10.1016/s1470-2045(20)30688-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/28/2020] [Accepted: 11/06/2020] [Indexed: 11/17/2022]
Abstract
Exposure to cranial radiotherapy is associated with an increased risk of subsequent CNS neoplasms among childhood, adolescent, and young adult (CAYA) cancer survivors. Surveillance for subsequent neoplasms can translate into early diagnoses and interventions that could improve cancer survivors' health and quality of life. The practice guideline presented here by the International Late Effects of Childhood Cancer Guideline Harmonization Group was developed with an evidence-based method that entailed the gathering and appraisal of published evidence associated with subsequent CNS neoplasms among CAYA cancer survivors. The preparation of these guidelines showed a paucity of high-quality evidence and highlighted the need for additional research to inform survivorship care. The recommendations are based on careful consideration of the evidence supporting the benefits, risks, and harms of the surveillance interventions, clinical judgment regarding individual patient circumstances, and the need to maintain flexibility of application across different health-care systems. Currently, there is insufficient evidence to establish whether early detection of subsequent CNS neoplasms reduces morbidity and mortality, and therefore no recommendation can be formulated for or against routine MRI surveillance. The decision to start surveillance should be made by the CAYA cancer survivor and health-care provider after careful consideration of the potential harms and benefits of surveillance for CNS neoplasms, including meningioma.
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Affiliation(s)
- Daniel C Bowers
- Division of Pediatric Hematology/Oncology, Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | | | | | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology and Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Louis S Constine
- Department of Radiation Oncology, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Noah D Sabin
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Ranjeev Bhangoo
- Neurosurgical Department, King's College Hospital Foundation Trust, London, UK
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit and DOPO Clinic, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Mike M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Helen Jenkinson
- Department of Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Raja B Khan
- Department of Pediatrics, Division of Neurology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee, Memphis, TN, USA
| | - Pieter Pretorius
- Department of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Antony Ng
- Department of Paediatric Oncology, Royal Hospital for Children, Bristol, UK
| | - Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Cécile M Ronckers
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands; Institute for Biostatistics and Registry Research, Brandenburg Medical School, Neuruppin, Germany
| | - Zsila Sadighi
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katrin Scheinemann
- Division of Oncology-Hematology, Department of Pediatrics, Kantonsspital Aarau, Switzerland; Division of Hematology & Oncology, University Children's Hospital Basel, University of Basel, Switzerland; Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | | | | | - Jop C Teepen
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Nicole J Ullrich
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew Walter
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Wilmington, DE, USA; Department of Pediatrics, A I duPont Hospital for Children, Wilmington, DE, USA
| | - W Hamish Wallace
- Department of Paediatric Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Kevin C Oeffinger
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Gregory T Armstrong
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA; Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Renée L Mulder
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
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Nguyen TH, Makena MR, Yavvari S, Kaur M, Pham T, Urias E, Panapitiya N, Al-Rahawan MM. Sarcoma as Second Cancer in a Childhood Cancer Survivor: Case Report, Large Population Analysis and Literature Review. ACTA ACUST UNITED AC 2020; 56:medicina56050224. [PMID: 32392854 PMCID: PMC7279476 DOI: 10.3390/medicina56050224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 12/25/2022]
Abstract
The majority of pediatric patients are cured of their primary cancer with current advanced developments in pediatric cancer therapy. However, survivors often experience long-term complications from therapies for primary cancer. The delayed mortality rate has been decreasing with the effort to reduce the therapeutic exposure of patients with pediatric cancers. Our study investigates the incidence of sarcoma as second cancer in pediatric cancer survivors. We present a 9-year-old male who survived embryonal hepatoblastoma diagnosed at 22 months of age. At 4.5 years of age, he presented with a non-metastatic primitive neuroectodermal tumor (PNET) of the left submandibular area. He has no evidence of recurrence of either cancer for 51 months after finishing all chemotherapy and radiotherapy. We used the Surveillance, Epidemiology, and End Results (SEER) database to identify the current rate of second sarcomas in pediatric cancer survivors. Our literature review and large population analysis emphasize the impact of sarcoma as a second malignancy and provide help to physicians caring for pediatric cancer survivors.
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Affiliation(s)
- Thinh H. Nguyen
- Department of Pediatrics, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX 79430, USA; (T.H.N.); (M.K.); (T.P.); (E.U.); (N.P.)
| | - Monish Ram Makena
- Department of Physiology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA;
| | - Siddhartha Yavvari
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, Usual;
| | - Maninder Kaur
- Department of Pediatrics, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX 79430, USA; (T.H.N.); (M.K.); (T.P.); (E.U.); (N.P.)
| | - Teresia Pham
- Department of Pediatrics, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX 79430, USA; (T.H.N.); (M.K.); (T.P.); (E.U.); (N.P.)
| | - Eduardo Urias
- Department of Pediatrics, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX 79430, USA; (T.H.N.); (M.K.); (T.P.); (E.U.); (N.P.)
| | - Narendra Panapitiya
- Department of Pediatrics, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX 79430, USA; (T.H.N.); (M.K.); (T.P.); (E.U.); (N.P.)
| | - Mohamad M. Al-Rahawan
- Department of Pediatrics, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX 79430, USA; (T.H.N.); (M.K.); (T.P.); (E.U.); (N.P.)
- Correspondence:
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