Second malignancies after Ewing's sarcoma: Radiation dose-dependency of secondary sarcomas

Jr F. Kuttesch, L. H. Wexler, R. B. Marcus, D. Fairclough, L. Weaver-McClure, M. White, L. Mao, T. F. Delaney, C. B. Pratt, M. E. Horowitz, L. E. Kun

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Abstract

Background: An excess risk of second malignancies has been reported in survivors of Ewing's sarcoma. We examined a multiinstitutional data base to reevaluate the risk among survivors of Ewing's sarcoma and to identify possible causal factors. Methods: Information was derived from a data base that included 266 survivors of Ewing's sarcoma. Cumulative incidence rates of second malignancies were calculated. Contributions of clinical features, type and dose of chemotherapy, and cumulative radiation close to the risk of second malignancies were evaluated. Results: After a median follow-up duration of 9.5 years (range, 3.0 to 30), 16 patients have developed second malignancies, which included 10 sarcomas (five osteosarcomas, three fibrosarcomas, and two malignant fibrous histiocytomas) and six other malignancies (acute myeloblastic leukemia, acute lymphoblastic leukemia, meningioma, bronchioalveolar carcinoma, basal cell carcinoma, and carcinoma- in-situ of the cervix). The median latency to the diagnosis of the second malignancy was 7.6 years (range, 3.5 to 25.7). The estimated cumulative incidence rates at 20 years for any second malignancy and for secondary sarcoma were 9.2% (SD = 2.7%) and 6.5% (SD = 2.4%), respectively. The cumulative incidence rate of secondary sarcoma was radiation dose-dependent (P = .002). No secondary sarcomas developed among patients who had received less than 48 Gy, white the absolute risk of secondary sarcoma was 130 cases per 10,000 person-years of observation among patients who had received ≤ 60 Gy. Conclusion: The overall risk of second malignancies after Ewing's sarcomas is similar to that associated with treatment for other childhood cancers. The radiation dose-dependency of secondary sarcomas justifies modification in therapy to reduce radiation doses.

Original languageEnglish (US)
Pages (from-to)2818-2825
Number of pages8
JournalJournal of Clinical Oncology
Volume14
Issue number10
DOIs
StatePublished - Jan 1 1996

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Ewing's Sarcoma
Second Primary Neoplasms
Sarcoma
Radiation
Survivors
Incidence
Databases
Malignant Fibrous Histiocytoma
Fibrosarcoma
Basal Cell Carcinoma
Carcinoma in Situ
Meningioma
Osteosarcoma
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Acute Myeloid Leukemia
Cervix Uteri
Neoplasms
Observation
Carcinoma
Drug Therapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Kuttesch, J. F., Wexler, L. H., Marcus, R. B., Fairclough, D., Weaver-McClure, L., White, M., ... Kun, L. E. (1996). Second malignancies after Ewing's sarcoma: Radiation dose-dependency of secondary sarcomas. Journal of Clinical Oncology, 14(10), 2818-2825. https://doi.org/10.1200/JCO.1996.14.10.2818

Second malignancies after Ewing's sarcoma : Radiation dose-dependency of secondary sarcomas. / Kuttesch, Jr F.; Wexler, L. H.; Marcus, R. B.; Fairclough, D.; Weaver-McClure, L.; White, M.; Mao, L.; Delaney, T. F.; Pratt, C. B.; Horowitz, M. E.; Kun, L. E.

In: Journal of Clinical Oncology, Vol. 14, No. 10, 01.01.1996, p. 2818-2825.

Research output: Contribution to journalArticle

Kuttesch, JF, Wexler, LH, Marcus, RB, Fairclough, D, Weaver-McClure, L, White, M, Mao, L, Delaney, TF, Pratt, CB, Horowitz, ME & Kun, LE 1996, 'Second malignancies after Ewing's sarcoma: Radiation dose-dependency of secondary sarcomas', Journal of Clinical Oncology, vol. 14, no. 10, pp. 2818-2825. https://doi.org/10.1200/JCO.1996.14.10.2818
Kuttesch JF, Wexler LH, Marcus RB, Fairclough D, Weaver-McClure L, White M et al. Second malignancies after Ewing's sarcoma: Radiation dose-dependency of secondary sarcomas. Journal of Clinical Oncology. 1996 Jan 1;14(10):2818-2825. https://doi.org/10.1200/JCO.1996.14.10.2818
Kuttesch, Jr F. ; Wexler, L. H. ; Marcus, R. B. ; Fairclough, D. ; Weaver-McClure, L. ; White, M. ; Mao, L. ; Delaney, T. F. ; Pratt, C. B. ; Horowitz, M. E. ; Kun, L. E. / Second malignancies after Ewing's sarcoma : Radiation dose-dependency of secondary sarcomas. In: Journal of Clinical Oncology. 1996 ; Vol. 14, No. 10. pp. 2818-2825.
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abstract = "Background: An excess risk of second malignancies has been reported in survivors of Ewing's sarcoma. We examined a multiinstitutional data base to reevaluate the risk among survivors of Ewing's sarcoma and to identify possible causal factors. Methods: Information was derived from a data base that included 266 survivors of Ewing's sarcoma. Cumulative incidence rates of second malignancies were calculated. Contributions of clinical features, type and dose of chemotherapy, and cumulative radiation close to the risk of second malignancies were evaluated. Results: After a median follow-up duration of 9.5 years (range, 3.0 to 30), 16 patients have developed second malignancies, which included 10 sarcomas (five osteosarcomas, three fibrosarcomas, and two malignant fibrous histiocytomas) and six other malignancies (acute myeloblastic leukemia, acute lymphoblastic leukemia, meningioma, bronchioalveolar carcinoma, basal cell carcinoma, and carcinoma- in-situ of the cervix). The median latency to the diagnosis of the second malignancy was 7.6 years (range, 3.5 to 25.7). The estimated cumulative incidence rates at 20 years for any second malignancy and for secondary sarcoma were 9.2{\%} (SD = 2.7{\%}) and 6.5{\%} (SD = 2.4{\%}), respectively. The cumulative incidence rate of secondary sarcoma was radiation dose-dependent (P = .002). No secondary sarcomas developed among patients who had received less than 48 Gy, white the absolute risk of secondary sarcoma was 130 cases per 10,000 person-years of observation among patients who had received ≤ 60 Gy. Conclusion: The overall risk of second malignancies after Ewing's sarcomas is similar to that associated with treatment for other childhood cancers. The radiation dose-dependency of secondary sarcomas justifies modification in therapy to reduce radiation doses.",
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T1 - Second malignancies after Ewing's sarcoma

T2 - Radiation dose-dependency of secondary sarcomas

AU - Kuttesch, Jr F.

AU - Wexler, L. H.

AU - Marcus, R. B.

AU - Fairclough, D.

AU - Weaver-McClure, L.

AU - White, M.

AU - Mao, L.

AU - Delaney, T. F.

AU - Pratt, C. B.

AU - Horowitz, M. E.

AU - Kun, L. E.

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N2 - Background: An excess risk of second malignancies has been reported in survivors of Ewing's sarcoma. We examined a multiinstitutional data base to reevaluate the risk among survivors of Ewing's sarcoma and to identify possible causal factors. Methods: Information was derived from a data base that included 266 survivors of Ewing's sarcoma. Cumulative incidence rates of second malignancies were calculated. Contributions of clinical features, type and dose of chemotherapy, and cumulative radiation close to the risk of second malignancies were evaluated. Results: After a median follow-up duration of 9.5 years (range, 3.0 to 30), 16 patients have developed second malignancies, which included 10 sarcomas (five osteosarcomas, three fibrosarcomas, and two malignant fibrous histiocytomas) and six other malignancies (acute myeloblastic leukemia, acute lymphoblastic leukemia, meningioma, bronchioalveolar carcinoma, basal cell carcinoma, and carcinoma- in-situ of the cervix). The median latency to the diagnosis of the second malignancy was 7.6 years (range, 3.5 to 25.7). The estimated cumulative incidence rates at 20 years for any second malignancy and for secondary sarcoma were 9.2% (SD = 2.7%) and 6.5% (SD = 2.4%), respectively. The cumulative incidence rate of secondary sarcoma was radiation dose-dependent (P = .002). No secondary sarcomas developed among patients who had received less than 48 Gy, white the absolute risk of secondary sarcoma was 130 cases per 10,000 person-years of observation among patients who had received ≤ 60 Gy. Conclusion: The overall risk of second malignancies after Ewing's sarcomas is similar to that associated with treatment for other childhood cancers. The radiation dose-dependency of secondary sarcomas justifies modification in therapy to reduce radiation doses.

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