Irradiation-Induced Secondary Tumors following Pediatric Central Nervous System Tumors: Experiences of a Single Institute in Taiwan (1975-2013)

Chu Yi Lee, Yi Wei Chen, Yi Yen Lee, Feng Chi Chang, Hsin Hung Chen, Shih Chieh Lin, Donald Ming Tak Ho, Ming Chao Huang, Sang Hue Yen, Tai-Tong Wong, Muh Lii Liang

Research output: Contribution to journalArticle

Abstract

Purpose: Complications can occur following a prolonged latency period after radiation therapy for cancer, and this is a growing concern because secondary tumors are potentially fatal. Few studies have examined secondary tumors in patients who received radiation therapy as children. Methods and Materials: This retrospective study examined 1697 pediatric patients with central nervous system tumors who received treatment at Taipei Veterans General Hospital from January 1, 1975, to December 31, 2013. Secondary tumors developed in 27 of 681 patients who received cranial irradiation. Overall survival was estimated using the Kaplan-Meier method, and the significance of differences was determined by the log-rank test. Results: The overall cumulative incidence of secondary tumors at 25 years was 3.96%, and there were similar numbers of male patients (n = 16) and female patients (n = 11). The mean age at diagnosis was 8.8 years (range, 3-16.5 years), the median dose of cranial irradiation was 52.5 Gy (mean, 53.4 Gy), the mean latency period was 14.6 years (range, 2-33 years), and the mean age at diagnosis of a secondary tumor was 23.1 years. The secondary tumors were mainly meningiomas (n = 13), sarcomas (n = 7), and high-grade gliomas (n = 6), and the mean latency periods were 19.66, 8.00, and 10.83 years, respectively. The overall survival rate from these secondary tumors was significantly different (P < .05). Age at irradiation of <7 years and craniospinal irradiation significantly increased the risk of a secondary tumor (P < .05). Secondary tumors developed in 11 of 128 patients (8.6%) with primary medulloblastomas, which was higher than the overall cumulative incidence. Conclusions: Clinicians should consider the increased risk of secondary tumors in long-term cancer survivors who received craniospinal irradiation as children. Using a selective dose de-escalation strategy or deferring radiation therapy for young patients at highest risk of secondary cancers should be studied.

Original languageEnglish
Pages (from-to)1243-1252
Number of pages10
JournalInternational Journal of Radiation Oncology Biology Physics
Volume101
Issue number5
DOIs
Publication statusPublished - Aug 1 2018

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Central Nervous System Neoplasms
central nervous system
Taiwan
tumors
Pediatrics
irradiation
Neoplasms
cancer
Craniospinal Irradiation
radiation therapy
Cranial Irradiation
Radiotherapy
incidence
rank tests
dosage
Veterans Hospitals
Medulloblastoma
Incidence
Meningioma
grade

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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Irradiation-Induced Secondary Tumors following Pediatric Central Nervous System Tumors : Experiences of a Single Institute in Taiwan (1975-2013). / Lee, Chu Yi; Chen, Yi Wei; Lee, Yi Yen; Chang, Feng Chi; Chen, Hsin Hung; Lin, Shih Chieh; Ho, Donald Ming Tak; Huang, Ming Chao; Yen, Sang Hue; Wong, Tai-Tong; Liang, Muh Lii.

In: International Journal of Radiation Oncology Biology Physics, Vol. 101, No. 5, 01.08.2018, p. 1243-1252.

Research output: Contribution to journalArticle

Lee, Chu Yi ; Chen, Yi Wei ; Lee, Yi Yen ; Chang, Feng Chi ; Chen, Hsin Hung ; Lin, Shih Chieh ; Ho, Donald Ming Tak ; Huang, Ming Chao ; Yen, Sang Hue ; Wong, Tai-Tong ; Liang, Muh Lii. / Irradiation-Induced Secondary Tumors following Pediatric Central Nervous System Tumors : Experiences of a Single Institute in Taiwan (1975-2013). In: International Journal of Radiation Oncology Biology Physics. 2018 ; Vol. 101, No. 5. pp. 1243-1252.
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abstract = "Purpose: Complications can occur following a prolonged latency period after radiation therapy for cancer, and this is a growing concern because secondary tumors are potentially fatal. Few studies have examined secondary tumors in patients who received radiation therapy as children. Methods and Materials: This retrospective study examined 1697 pediatric patients with central nervous system tumors who received treatment at Taipei Veterans General Hospital from January 1, 1975, to December 31, 2013. Secondary tumors developed in 27 of 681 patients who received cranial irradiation. Overall survival was estimated using the Kaplan-Meier method, and the significance of differences was determined by the log-rank test. Results: The overall cumulative incidence of secondary tumors at 25 years was 3.96{\%}, and there were similar numbers of male patients (n = 16) and female patients (n = 11). The mean age at diagnosis was 8.8 years (range, 3-16.5 years), the median dose of cranial irradiation was 52.5 Gy (mean, 53.4 Gy), the mean latency period was 14.6 years (range, 2-33 years), and the mean age at diagnosis of a secondary tumor was 23.1 years. The secondary tumors were mainly meningiomas (n = 13), sarcomas (n = 7), and high-grade gliomas (n = 6), and the mean latency periods were 19.66, 8.00, and 10.83 years, respectively. The overall survival rate from these secondary tumors was significantly different (P < .05). Age at irradiation of <7 years and craniospinal irradiation significantly increased the risk of a secondary tumor (P < .05). Secondary tumors developed in 11 of 128 patients (8.6{\%}) with primary medulloblastomas, which was higher than the overall cumulative incidence. Conclusions: Clinicians should consider the increased risk of secondary tumors in long-term cancer survivors who received craniospinal irradiation as children. Using a selective dose de-escalation strategy or deferring radiation therapy for young patients at highest risk of secondary cancers should be studied.",
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T1 - Irradiation-Induced Secondary Tumors following Pediatric Central Nervous System Tumors

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AU - Chen, Yi Wei

AU - Lee, Yi Yen

AU - Chang, Feng Chi

AU - Chen, Hsin Hung

AU - Lin, Shih Chieh

AU - Ho, Donald Ming Tak

AU - Huang, Ming Chao

AU - Yen, Sang Hue

AU - Wong, Tai-Tong

AU - Liang, Muh Lii

PY - 2018/8/1

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N2 - Purpose: Complications can occur following a prolonged latency period after radiation therapy for cancer, and this is a growing concern because secondary tumors are potentially fatal. Few studies have examined secondary tumors in patients who received radiation therapy as children. Methods and Materials: This retrospective study examined 1697 pediatric patients with central nervous system tumors who received treatment at Taipei Veterans General Hospital from January 1, 1975, to December 31, 2013. Secondary tumors developed in 27 of 681 patients who received cranial irradiation. Overall survival was estimated using the Kaplan-Meier method, and the significance of differences was determined by the log-rank test. Results: The overall cumulative incidence of secondary tumors at 25 years was 3.96%, and there were similar numbers of male patients (n = 16) and female patients (n = 11). The mean age at diagnosis was 8.8 years (range, 3-16.5 years), the median dose of cranial irradiation was 52.5 Gy (mean, 53.4 Gy), the mean latency period was 14.6 years (range, 2-33 years), and the mean age at diagnosis of a secondary tumor was 23.1 years. The secondary tumors were mainly meningiomas (n = 13), sarcomas (n = 7), and high-grade gliomas (n = 6), and the mean latency periods were 19.66, 8.00, and 10.83 years, respectively. The overall survival rate from these secondary tumors was significantly different (P < .05). Age at irradiation of <7 years and craniospinal irradiation significantly increased the risk of a secondary tumor (P < .05). Secondary tumors developed in 11 of 128 patients (8.6%) with primary medulloblastomas, which was higher than the overall cumulative incidence. Conclusions: Clinicians should consider the increased risk of secondary tumors in long-term cancer survivors who received craniospinal irradiation as children. Using a selective dose de-escalation strategy or deferring radiation therapy for young patients at highest risk of secondary cancers should be studied.

AB - Purpose: Complications can occur following a prolonged latency period after radiation therapy for cancer, and this is a growing concern because secondary tumors are potentially fatal. Few studies have examined secondary tumors in patients who received radiation therapy as children. Methods and Materials: This retrospective study examined 1697 pediatric patients with central nervous system tumors who received treatment at Taipei Veterans General Hospital from January 1, 1975, to December 31, 2013. Secondary tumors developed in 27 of 681 patients who received cranial irradiation. Overall survival was estimated using the Kaplan-Meier method, and the significance of differences was determined by the log-rank test. Results: The overall cumulative incidence of secondary tumors at 25 years was 3.96%, and there were similar numbers of male patients (n = 16) and female patients (n = 11). The mean age at diagnosis was 8.8 years (range, 3-16.5 years), the median dose of cranial irradiation was 52.5 Gy (mean, 53.4 Gy), the mean latency period was 14.6 years (range, 2-33 years), and the mean age at diagnosis of a secondary tumor was 23.1 years. The secondary tumors were mainly meningiomas (n = 13), sarcomas (n = 7), and high-grade gliomas (n = 6), and the mean latency periods were 19.66, 8.00, and 10.83 years, respectively. The overall survival rate from these secondary tumors was significantly different (P < .05). Age at irradiation of <7 years and craniospinal irradiation significantly increased the risk of a secondary tumor (P < .05). Secondary tumors developed in 11 of 128 patients (8.6%) with primary medulloblastomas, which was higher than the overall cumulative incidence. Conclusions: Clinicians should consider the increased risk of secondary tumors in long-term cancer survivors who received craniospinal irradiation as children. Using a selective dose de-escalation strategy or deferring radiation therapy for young patients at highest risk of secondary cancers should be studied.

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