Nazmiye YUKSEK, Ceyhun BOZKURT, Gurses SAHİN, Sule TOPRAK, Sibel AKPINAR TEKGÜNDÜZ, Mehmet Onur CANDİR, Ulya ERTEM, Sule YESİL, Hikmet Gulsah TANYİLDİZ

Pediatrik Onkoloji Hastalarında İkincil Kanserler: Tek Merkez Deneyimi

Amaç.Son yıllarda kanser tedavisinde kullanılmaya başlanılan yeni ve yoğun tedavi modalitelerinin katkısı ile çocukluk çağı malinitelerinde sağkalım oranlarının arttığı görülmektedir. Bununla ilişkili olarak kanser tanısı alan çocuklarda yaklaşık %70 oranında 5 yılın üzerinde yaşam şansı beklenmektedir. Ancak tedavideki yüz güldürücü sonuçların yanısıra sekonder tümör oranlarında da artış olduğu bir gerçektir. Çocukluk çağı kanserlerinde primer tümörün tedavisi kadar hastanın hayat kalitesi, geç dönem yan etkiler ve ilerleyen süreçte karşılaşılabilecek sekonder malignensilerinin önlenebilmesinin de önemli olduğunu düşünmekteyiz. Yöntemler. Bu amaçla 1985-2012 yılları arasında kliniğimizde tanı alan toplam 2100 çocukluk çağı kanser olgusunun dosyası retrospektif olarak incelendi. Bulgular. Toplam 11 sekonder tümör olgusunun olduğu görüldü. Erkek kız oranı 6/5, median tanı yaşı 7 olarak saptandı (1 yaş 3 ay-11 yaş 6 ay). Sekonder tümör olarak 5 olguda AML, 1 olguda paraganglioma, 1 olguda liposarkom, 1 olguda rabdomiyosarkom, 1 olguda papiller tiroid karsinomu,1 olguda malign fibröz histiositoma ve 1 olguda dilde skuamöz hücreli karsinom görüldü. AML en sık görülen sekonder malignite olarak gözlendi. Sonuç. Daha az toksik etkili sistemik kemoterapi ve azaltılmış doz radyoterapi uygulamasının hedefe yönelik tedavi modalitelerinin gündeme gelmesi ile önem kazanacağını ve sekonder malinite riskini azaltacağını düşünmekteyiz

Second Malignant Neoplasms in Pediatric Oncology Patients: A Single Center Experience

Objective: The pediatric malignancy survival rate has increased with new andintensive treatment modality advancements. This has led to anapproximately 70% chance of surviving more than 5 years in childrendiagnosed with cancer. However, the secondary tumor incidence has alsoincreased with these advances. The patient’s quality of life, late side effects,and prevention of secondary malignancies in the future are as important astreating the primary tumor in pediatric cancer patients.Methods: We retrospectively evaluated the charts of 2100 pediatric cancerpatients who were diagnosed in our clinic between 1985 and 2012.Results: There were 11 secondary tumors. Male-to-female ratio was 6:5 andmedian age at diagnosis was 7 years (range, 1 year 3 months–11 years 6months). Secondary tumor diagnosis was AML in five patients,paraganglioma in one patient, liposarcoma in one patient,rhabdomyosarcoma in one patient, papillary thyroid carcinoma in onepatient, malignant fibrous histiocytoma in one patient, and squamous cellcarcinoma of the tongue in one patient. AML was the most commonlydetected secondary malignancy.Conclusion: We suggest that using less toxic systemic chemotherapy andreduced-dose radiotherapy is increasingly important with targeted treatmentmodalities to decrease the risk of secondary malignancy.

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Gold DG, Neglia JP, Dusenbery KE. Second neoplasms after megavoltage radiation for pediatric tumors. Cancer 2003;97:2588-96.
Bhatia S, Sklar C. Second cancers in survivors of childhood cancer. Nat Rev Cancer 2002;2:124-32.
Gow KW, Lensing S, Hill DA, Krasin MJ, McCarville MB, Rai SN, et al. Thyroid carcinoma presenting in childhood or after treatment of childhood malignancies: an institutional experience and review of the literature. J Pediatr Surg 2003;38:1574-80.
Smith MB, Xue H, Strong L, Takahashi H, Jaffe N, Ried H, et al. Forty-year experience with second malignancies after treatment of childhood cancer: analysis of outcome following the development of the second malignancy. J Pediatr Surg 1993;28:1342-8.
Robison LL, Mertens AC, Boice JD, Breslow NE, Donaldson SS, Green DM, et al. Study design and cohort characteristics of the Childhood Cancer Survivor Study: a multi-institutional collaborative project. Med Pediatr Oncol 2002;38:229-39.
Neglia JP, Friedman DL, Yasui Y, Mertens AC, Hammond S, Stovall M, et al. Second malignant neoplasms in five-year survivors of childhood cancer: childhood cancer survivor study. J Natl Cancer Inst 2001;93-618- 29.
Kowalczyk JR, Nurzynska J, Armata J, Bogusławska-Jaworska J, RokickaMilewska R, Sońta-Jakimczyk D, et al. International note: second malignant neoplasms in children: a multicenter study of the Polish Pediatric Leukemia/Lymphoma Group. Med Pediatr Oncol 2002;38:421- 3.
Davies SM. Therapy-related leukemia associated with alkylating agents. Med Pediatr Oncol 2001;36:536-40.
Rich DC, Corpron CA, Smith MB, Black CT, Lally KP, Andrassy RJ. Second malignant neoplasms in children after treatment of soft tissue sarcoma. J Pediatr Surg 1997;32:369-72.
Neglia JP. Childhood cancer survivors. Past, present, and future. Cancer 1994;73:2883-5.
Travis LB. Therapy-associated solid tumors. Acta Oncol 2002; 41: 323-33.
Berger C, Trombert-Paviot B, Casagranda L, Mialou V, Frappaz D, Plantaz D, et al. Second malignant neoplasms following childhood cancer: a study of a recent cohort (1987-2004) from the childhood cancer registry of the Rhône-Alpes region (ARCERRA) in France. Pediatr Hematol Oncol 2011; 28:364-79.
Rihani R, Bazzeh F, Faqih N, Sultan I. Secondary hematopoietic malignancies in survivors of childhood cancer: an analysis of 111 cases from the Surveillance, Epidemiology, and End Result-9 registry. Cancer 2010;116:4385-94.
Vega-Stromberg T. Chemotherapy-induced secondary malignancies. J Infus Nurs 2003;26: 353-61.
Garber JE, Offit K. Hereditary cancer predisposition syndromes. J Clin Oncol 2005;23:276-92.
Robson ME, Storm CD, Weitzel J, Wollins DS, Offit K; American Society of Clinical Oncology. American Society of Clinical Oncology policy statement update: Genetic and genomic testing for cancer susceptibility. J Clin Oncol 2010;28:893-901.
Hampel H, Sweet K, Westman JA, Offit K, Eng C. Referral for cancer genetics consultation: A review and complication of risk assessment criteria. J Med Genet 2004;41:81-91.
Vasen HF, Watson P, Mecklin JP, Lynch HT. New critical criteria for hereditary nonpolyposis colorectal cancer proposed by the international Collaborative group on HNPCC. Gastroenterology 1999;116:1453-6.
Metcalfe K, Gershman S, Lynch HT, Ghadirian P, Tung N, Kim-Sing C, et al. Predictors of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. Br J Cancer 2011;104:1384-92.
Mertens AC, Liu Q, Neglia JP, Wasilewski K, Leisenring W, Armstrong GT, et al. Cause-specific late mortality among 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study. J Natl Cancer Inst 2008;100:1368-79.
Thirman MJ, Larson RA. Therapy-related myeloid leukemia. Hematol Oncol Clin N Am 1996;10:293-320.
Hijiya N, Ness KK, Ribeiro RC, Hudson MM. Acute leukemia as a secondary malignancy in children and adolescents: current findings and issues. Cancer 2009;115:23-35.
Hijiya N, Hudson MM, Lensing S, Zacher M, Onciu M, Behm FG, et al. Cumulative incidence of secondary neoplasms as at first event after childhood acute lymphoblastic leukemia. JAMA 2007; 297:1207-15.
Le Deley MC, Leblanc T, Shamsaldin A, Raquin MA, Lacour B, Sommelet D, et al. Risk of secondary leukemia after a solid tumor in childhood according to the dose of epipodophyllotoxins and anthracyclines: a casecontrol study by the Societe Francaise d’Oncologie Pediatrique. J Clin Oncol 2003;21:1074-81.
Goldsby R, Burke C, Nagarajan R, Zhou T, Chen Z, Marina N, et al. Second solid malignancies among children, adolescents, and young adults diagnosed with malignant bone tumors after 1976: follow up of a Children’s Oncology Group cohort. Cancer 2008;113:2597-604.
Choi D.K, Helenowski I, Hijiya N. Secondary malignancies in pediatric cancer survivors: Perspectives and review of the literature . Int J Cancer 2014;135:1764-73.
Robison LL, Green DM, Hudson M, Meadows AT, Mertens AC, Packer RJ, et al. Long-term Outcomes of Adult Survivors of Childhood Cancer. Cancer Supplement 2005;104:2557-64.
de Vathaire F, Hawkins M, Campbell S, Oberlin O, Raquin MA, Schlienger JY, et al. Second malignant neoplasms after a first cancer in childhood: temporal pattern of risk according to type of treatment. Br J Cancer 1999 ;79:1884-93.
Pui CH, Pei D, Sandlund JT, Ribeiro RC, Rubnitz JE, Raimondi SC, et al. Long-term results of St. Jude Total Therapy studies 11,12,13A,13B and 14 for childhood acute lymphoblastic leukemia. Leukemia 2010;24:371- 82.
Bhatia S, Yasui Y, Robison LL, Birch JM, Bogue MK, Diller L, et al. High risk of subsequent neoplasm countries with extended follow up childhood Hodgkin’s disease: report from Late Effects Study Group. J Clin Oncol 2003;21:4386-94.
Hudson MM, Onciu M, Donaldson SS. Hodgkin lymphoma. In: Pizzo PA, Poplack DG, eds. Principles and Practice of Pediatric Oncology. Philadelphia, PA: Lippincott Williams and Wilkins, 2011:638-62.
Schellong G, Pötter R, Brämswig J, Wagner W, Prott FJ, Dörffel W, et al. High cure rates, and reduced long-term toxicity in pediatric Hodgkin’s disease. The German-Austrian multicenter trial DAL-HD-90. The GermanAustrian Pediatric Hodgkin’s Disease Group. J Clin Oncol 1999;17:3736- 44.
Olweny CL, Katongole-Mbidde E, Kiire C, Lwanga SK, Magrath I, Ziegler JL. Childhood Hodgkin’s disease in Uganda: a ten year experience. Cancer 1978;42:787-92.
Sackmann-Muriel F, Zubizarreta P, Gallo G, Scopinaro M, Alderete D, Alfaro E, et al. Hodgkin’s disease in children: results of a prospective randomised trial in a single institution in Argentina. Med Pediatr Oncol 1997;29:544-52.
van den Berg H, Zsiros J, Behrendt H. Treatment of childhood Hodgkin’s disease without radiotherapy. Ann Oncol 1997;8:15-7.
Capra M, Hewitt M, Radford M, Hayward J, Weston CL, Machin D. Long term outcome in Children with Hodgkin’s lymphoma: The United Kingdom Children’s Cancer Group HD82 trial. Eur J Cancer 2007;43:1171- 9.
Hutchinson RJ, Fryer CJ, Davis PC, Nachman J, Krailo MD, O'Brien RT, et al. MOPP or irradiation in addition to ABVD in the treatment of pathologically staged advanced Hodgkin’s disease in children: results of Children Cancer Group on Phase III Trial. J Clin Oncol 1998; 16:897-906.
Weiner MA, Leventhal B, Brecher ML, Marcus RB, Cantor A, Gieser PW, et al. Randomized study of intensive MOPP-ABVD with or without lowdose total-nodal radiation therapy in the treatment of stages IIB, IIIA, IIIB, and IV Hodgkin’s disease in pediatric patients: a Pediatric Oncology Group study. J Clin Oncol 1997;15:2769-79.
Cağlar K, Varan A, Akyüz C, Selek U, Kutluk T, Yalçin B, et al. Second neoplasms in Pediatric Patients Treated for Cancer: A Center’s 30-year Experience. J Pediatr Hematol Oncol 2006;28:374-8.