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Survivors of osteosarcoma at increased risk for second malignant neoplasms
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Survivors of osteosarcoma demonstrated an increased risk for second malignant neoplasms, and the risk persisted long after the conclusion of osteosarcoma treatment, according to study results.
Researchers also observed elevated risks among patients treated in more recent time periods.
“Patients should be monitored indefinitely for second malignant neoplasms after the completion of their treatment for osteosarcoma,” Jean S. Lee, MD, of the department of pediatrics at Benioff Children’s Hospital at University of California, San Francisco, and colleagues wrote. “The findings … may help to direct the type of surveillance screening for second malignant neoplasms in this population, with an emphasis on breast and blood cancers.”
Lee and colleagues used SEER data from 1973 to 2010 to assess the incidence, characteristics and outcomes of secondary malignant neoplasms (SMN) in 3,379 patients with osteosarcoma. Median age at diagnosis was 16 years, and median follow-up was 4.2 years (range, 0-38).
Researchers determined 89 patients (2.6%) developed a SMN. The median time from primary diagnosis of osteosarcoma to diagnosis of SMN was 6 years. The cumulative incidence of SMNs was 2.1% (95% CI, 1.6-2.7) at 10 years, 4% (95% CI, 3.1-5.1) at 20 years, and 7.4% (95% CI, 5.6-9.5) at 30 years.
Compared with the general population, the standardized incidence ratio for SMN was 1.6 (95% CI, 1-2.5) among those diagnosed with osteosarcoma between 1973 and 1985, and 4.7 (95% CI, 3.3-6.4) among those diagnosed between 1986 and 2010. Researchers observed a 34-fold increase in risk for leukemia among those diagnosed with osteosarcoma during the more recent era.
Researchers reported 5-year OS of 44.5% (95% CI, 29.2-55.1) among all patients who developed a SMN. Five-year OS was 24.2% (95% CI, 9.1-43.2) among those who developed a hematologic SMN (n=34) and 51.6% (95% CI, 33.9-66.7) among those who developed a solid tumor SMN (n=55).
Nine patients in the study population subsequently developed a third malignancy. Types included adenocarcinoma of the colon, melanoma, breast cancer and squamous cell carcinoma of the esophagus. One patient developed a fourth malignancy, papillary adenocarcinoma of the thyroid gland.
“Further studies evaluating genetic risks need to be conducted to determine whether these patients harbor a genetic predisposition toward an SMN via altered DNA stability or altered chemotherapy metabolism,” Lee and colleagues wrote. “Additional studies are needed to identify targeted therapeutics that enable the successful treatment of osteosarcoma without the potential genotoxic side effects.”
Disclosure: The study was funded by Swim Across America, the National Center for Advancing Translational Sciences and the NIH.