Second cancers after medulloblastoma: population-based results from the United States and Sweden |
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Authors: | Alisa M Goldstein Jonathan Yuen Margaret A Tucker |
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Institution: | (1) Genetic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, USA;(2) Department of Cancer Epidemiology, University Hospital, Uppsala, Sweden |
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Abstract: | Medulloblastoma, one of the most common central nervous system(CNS)tumors in children, requires aggressive multimodality therapy
including surgery, radiation therapy, and occasionally chemotherapy. Given its intensive treatment regimen and improved survival
during the past 20 years, it is likely that a cohort of survivors will result who may incur consequences of therapy, including
a second cancer. We used population-based data from the United States and Sweden to estimate risks of second neo plasms in
patients with histologically confirmed medulloblastoma (n = 1,262).Overall, there was a 5.4-fold excess of second neoplasms
(95 percent confidence interval = 3.3-8.4) based on 20 observed and 3.7 expected cancers. The second cancers occurred eight
to 432 months after initial diagnosis(median, 73 months) with significantly elevated ratios for all intervals examined except
for less than one year after initial diagnosis. Significantly elevated risks were seen for cancers of the salivary glands,
cervix uteri, brain and CNS, thyroid gland, and acute lymphoblastic leukemia. Of the 15second cancers with treatment data,
seven occurred in the radiation field or within areas of scatter while two others may have been radiation-related. Although
based on small numbers of second cancers, the results suggest that as survival increases, some patients with medulloblastoma
will have an increased risk of a second cancer, particularly a radiation-related cancer. Thus, as survival improves, late-occurring
consequences of diagnosis and treatment will need to be carefully assessed. Identification of patients hypersensitive to radiation
therapy, such as those with Gorlin Syndrome, should also be attempted in order to reduce the sequelae from intensive radiation
exposure.
This revised version was published online in July 2006 with corrections to the Cover Date. |
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Keywords: | Medulloblastoma radiation second cancers survival Sweden United States |
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