Trends in treatment of childhood cancer and subsequent primary neoplasm risk release_xjgk622uj5cbnem7t4gnduhyk4

Abstract

<jats:title>Abstract</jats:title> <jats:sec id="j_raon-2022-0027_s_006"> <jats:title>Background</jats:title> The aim of the study was to investigate long-term risk and spectrum of subsequent neoplasm (SN) in childhood cancer survivors and to identify how trends in therapy influenced cumulative incidence of SN. </jats:sec> <jats:sec id="j_raon-2022-0027_s_007"> <jats:title>Patients and methods</jats:title> The population-based cohort comprises 3271 childhood cancer patients diagnosed in Slovenia aged ≤ 18 years between 1st January 1961 and 31st December 2013 with a follow-up through 31st December 2018. Main outcome measures are standardised incidence ratios (SIRs), absolute excess risks (AERs), and cumulative incidence of SN. </jats:sec> <jats:sec id="j_raon-2022-0027_s_008"> <jats:title>Results</jats:title> After median follow-up time of 21.5 years for 5-year survivors, 230 patients experienced 273 SN, including 183 subsequent malignant neoplasm (SMN), 34 meningiomas and 56 nonmelanoma skin cancers. 10.5% patients received radiotherapy only, 31% chemotherapy only, 26.9% a combination of chemotherapy and radiotherapy and 16.1% surgery only. The overall SIR was almost 3 times more than expected (SIR 2.9), with survivors still at 2-fold increased risk after attained age 50 years. The observed cumulative incidence of SMN at 30-year after diagnosis was significantly lower for those diagnosed in 1960s, compared with the 1970s and the 1980s (P heterogeneity &lt; 0.001). Despite reduced use of radiotherapy over time, the difference in cumulative incidence for the first 15 years after diagnosis was not significant for patients treated before or after 1995 (p = 0.11). </jats:sec> <jats:sec id="j_raon-2022-0027_s_009"> <jats:title>Conclusions</jats:title> Risks of developing a SMN in this study are similar to other European population-based cohorts. The intensity of treatment peaked later and use of radiotherapy declined slower compared to high income countries, making continuous surveillance even more important in the future. </jats:sec>
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