NEW YORK (Reuters Health) - Ovarian cancer in childhood and adolescence increases the risk of second primary tumors and lymphoma, according to a new study.
Dr. Giovanni Sisti, from the University of Florence in Italy, and colleagues conducted a retrospective study of ovarian cancer patients with a malignant tumor diagnosed at 19 years old or younger between 1973 and 2011. They used the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database to identify and follow the cohort.
Out of a total of 806 patients, 28 (3.47%) developed a second primary tumor after the diagnosis of malignant ovarian cancer. The cohort had a higher risk of solid tumors (standardized incident ratio 1.85) and lympho-hematologic malignancies (SIR 5.28) compared with the general population.
Following initial diagnosis of ovarian malignancy during childhood or adolescence, incidences of lymphoma (SIR 4.25) and acute non-lymphocytic leukemia (SIR 19.65) were also higher, the authors report in an article published online March 25 in the Journal of Pediatric & Adolescent Gynecology.
The highest SIRs were for oropharyngeal cancers, endocrine tumors, lymphoma, and leukemia. The calculated excess risk was greatest for all lympho-hematologic cancers (4.55), and specifically, lymphoma (2.46) and acute non-lymphocytic leukemia (2.29).
Significant SIRs of solid primary tumors in the 2-11-month and 5-9-year intervals after diagnosis of ovarian cancer were 17.13 (p<0 .05="" 10="" 6.63="" 7.03="" after="" all="" and="" at="" cancer="" cases="" diagnosis="" identified="" initial="" least="" lymphoma="" of="" ovarian="" p="" respectively.="" the="" were="" years="">
The authors reported a two-fold increase in the risk of secondary solid tumors, a five-fold greater risk of lymphatic and hematologic malignancies, a 20-fold higher risk of acute non-lymphocytic leukemia, a four-fold significantly increased risk of any type of lymphoma, and a three-fold rise in the risk of an endocrine malignancy.
They wrote that the etiology of second primary malignancies is multifactorial, and may not be solely attributable to previous cancer treatments. However, exposure to chemotherapy may be the primary driver behind the development of a second primary tumor, they add.
"This study spans over 40 years of pediatric ovarian cancer," Dr. Jamie Bakkum-Gamez, from the Mayo Clinic in Rochester, Minnesota, told Reuters Health by email. She noted that the study is retrospective and that SEER does not include data to confirm the authors' hypothesis on the role of chemotherapy in the development of second primary tumors.
According to Dr. Bakkum-Gamez, who was not involved in the study, today's standard of care is very different from that of earlier years. "Most germ cell cancers of the ovary are stage I," she said, noting that research has shown that some stage I cases can simply be observed after surgery without chemotherapy.
This wasn't always the case, she said. Until the late 1970s, only one in five young women or girls who developed ovarian cancer survived it. "Chemotherapy increased survival to greater than 90% and was the standard of care for decades," Dr. Bakkum-Gamez said.
Today, fewer young women need chemotherapy, but among those who do, the current standard of care includes etoposide, which is known to increase the risk of hematologic malignancies. These patients, Dr. Bakkum-Gamez said, are already monitored according to guidelines.
Corresponding author Dr. Sisti told Reuters Health in an e-mail that surveillance can be strengthened by screening for certain types of second primary malignancies, such as endocrine tumors and lymphoma. "These are usually overlooked because previous studies did not find their occurrence," he said.
According to Dr. Sisti, another approach is to individualize the type of treatment before giving chemotherapy by using genetic/molecular characteristics of the patient and the risk of a second primary tumor related to that particular genotype.
He noted that surveillance should start early and be continued for many years. "Our study found a significant occurrence of second primary tumors more than a decade after treatment," he said.
The authors reported no commercial funding or disclosures.
SOURCE: http://bit.ly/1ygehNy
J Pediatr Adolesc Gynecol 2015.
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