Treating institution, Any RT, Higher sarcoma risk with higher RT (60 Gray) dose
NR 5% NR 9.2%
AR = 33.8/10 K PY for sarcoma AR = 54.7/10 K PY for all SMN
Fuchs, et al. (Mayo)
7.4 years
1975–1999
397
29
21 solid tumor 8 hematologic
NR
6.5% at 7.4 years
NR
Dunst, et al. (CESS)
5.1 years
1981–1991
674
8
3 solid tumor 5 hematologic
None significant, Trend toward increased solid SMN with any RT
0.7% 2.9% 4.7% NR
NR
Bacci, et al. (Rizzoli)
Range of 5–33 years
1972–1999
597
14
11 solid tumor 3 hematologic
Higher for “full dose” RT versus post-op “reduced dose”
3% 6.5% NR 12.7%
NR
Ginsberg, et al. (CCSS)
23 years (mean)
1970–1986
403
36
34 solid tumor 2 hematologic
NR
9% at 20 years
SIR = 5.9 AR = 48.1/10 K PY
Bhatia, et al. (CCG/POG)
8.03 years
1988-1992
587
16
4 solid tumor 12 hematologic
Treatment arm C
NR
SIR = 127.7 for myeloid SMN
Paulussen, et al. (EICESS)
4.6 years
1992-1999
690
6
2 solid tumor 4 hematologic
None significant, Trend toward increased risk after etoposide
0.93% NR NR NR
SIR = 30.9–33.4 for hematologic SMN (compared to Saarland & SEER registries)
Navid, et al. (SJCRH)
12.2 years
1979–2004
237
12
4 solid tumor 8 hematologic
More recent treatment protocols, Lower stage disease
3.0% 4.7% NR NR
SIR = 17.8 overall SIR = 65.1 on more recent protocols
Sultan, et al. (SEER)
6.7 years
1973–2005
1166
35
23 solid tumor 12 hematologic
Treatment era (1973–85), Any radiation (OR = 2.55)
2.1% 4.4% NR 8.0%
O/E 4.01 O/E 51.09 for myeloid SMN O/E 51.08 for OS
Abbreviations: SMN: second malignant neoplasm, NCI: National Cancer Institute, SJCRH: St Jude Children’s Research Hospital, CESS: Cooperative Ewing’s Sarcoma Study, CCG: Children’s Cancer Group, POG: Pediatric Oncology Group, EICESS: European Intergroup Cooperative Ewing’s Sarcoma Study, SEER: Surveillance, Epidemiology and End Results, RT: radiation therapy, NR: not reported, AR: absolute risk, PY: person years, OR: odds ratio, SIR: standardized incidence ratio, O/E ratio of observed to expected cases OS: osteosarcoma
