Changes to This Summary (01/24/2014)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Added text to state that standardized incidence ratios reported for subsequent central nervous system (CNS) neoplasms after treatment for childhood cancer range from 8.1 to 52.3 across studies. Also added that the current literature is insufficient to evaluate the potential harms and benefits of routine screening for subsequent CNS neoplasms among childhood cancer survivors treated with cranial irradiation (cited Bowers et al. as reference 38).
Added text to state that the reported overall absolute risk of 8.4 per 105 person-years indicates that these cases are relatively rare.
Added text to state that radiation has been hypothesized to predispose to renal carcinoma among children with high-risk neuroblastoma (cited Fleitz et al. as reference 52). Added that cases of secondary renal carcinoma associated with Xp11.2 translocations and TFE3 gene fusions have also been reported and suggest that cytotoxic chemotherapy may contribute to renal carcinogenesis (cited Hedgepeth et al. and Argani et al. as references 53 and 54, respectively). Also added that underlying genetic predisposition may play a role because rare cases of renal carcinoma have been observed in children with tuberous sclerosis.
Added text to state that a retrospective cohort study of 325 survivors of pediatric cancer treated with cranial irradiation or cervical irradiation at an age that was younger than 18 years determined that cranial irradiation puts childhood cancer survivors at a high risk of first and recurrent strokes. In this study, stroke was defined by physician diagnosis and symptoms consistent with stroke. The cumulative incidence of first stroke was 2% at 5 years and 4% at 10 years after irradiation. The stroke hazard increased by 5% with each 1 Gy increase in the radiation dose. The cumulative incidence of recurrent stroke was 38% at 5 years and 59% at 10 years after the first stroke (cited Mueller, Sear, et al. as reference 71).
Added text to state that a follow-up Childhood Cancer Survivors Study (CCSS) investigation evaluated whether increased stroke risk conferred by childhood cranial radiation therapy persists into adulthood by comparing stroke risk among 14,358 5-year survivors and 4,023 sibling controls. Survivors treated with cranial radiation therapy exhibited a dose-dependent increased stroke risk for 30 to 49 Gy of cranial radiation and 11.0 for 50 or more Gy of cranial radiation. The cumulative stroke incidence in survivors treated with 50 or more Gy of cranial radiation was 1.1% at 10 years after diagnosis. Atherosclerotic risk factors increased stroke risk because hypertension advanced stroke hazard by fourfold (cited Mueller, Fullerton, et al. as reference 72).
Revised text to include postsurgery mutism as a risk factor for adverse neurocognitive effects (cited Ris et al. as reference 8).
Added text to state that survivors of developmental or embryonal tumors treated with abdominal irradiation are also at an increased risk for developing components of the metabolic syndrome. Added that in a prospective study of 164 long-term survivors, nephroblastoma and neuroblastoma survivors had more components of the metabolic syndrome than did controls; compared with nonirradiated survivors, survivors treated with abdominal irradiation had higher blood pressure, triglycerides, low-density lipoprotein cholesterol, and total fat percentage, which were assessed by dual energy X-ray absorptiometry (cited van Waas et al. as reference 65).
Updated reference to include chapter on Immunization in Special Circumstances, Red Book: 2012 Report of the Committee on Infectious Diseases (cited the American Academy of Pediatrics as reference 1).
Added Thomas-Teinturier et al. as reference 50.
Added text to state that a French cohort study of 1,109 female survivors of childhood solid cancer identified the following as risk factors for nonsurgical menopause: exposure to and dose of alkylating agents, especially during adolescence; radiation dose to the ovaries; and oophorectomy. Added that women treated with alkylating agents after the onset of puberty, either alone or associated with even a low dose of radiation to the ovaries, had the highest risk ratio for nonsurgical menopause. Also added that exposure to unilateral oophorectomy was associated with a 7-year-earlier age at menopause; and, by age 40 years, the overall rate of nonsurgical menopause was only 2.1% and substantially lower than the CCSS and European Organization for Research and Treatment of Cancer cohort studies that include survivors of hematological malignancies.
This summary is written and maintained by the PDQ Pediatric Treatment Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ NCI's Comprehensive Cancer Database pages.