PMID- 7636528
OWN - NLM
STAT- MEDLINE
DCOM- 19950911
LR  - 20170210
IS  - 0732-183X (Print)
IS  - 0732-183X (Linking)
VI  - 13
IP  - 8
DP  - 1995 Aug
TI  - Second malignant neoplasms following treatment for Wilm's tumor: a report from 
      the National Wilms' Tumor Study Group.
PG  - 1851-9
AB  - PURPOSE: The study was undertaken to determine the incidence of second malignant 
      neoplasms (SMNs) in patients treated for Wilms' tumor and demonstrate how the 
      incidence varied with the initial treatment protocol. PATIENTS AND METHODS: 
      Between October 1969 and December 1991, 5,278 assessable patients were enrolled 
      onto the National Wilms' Tumor Study (NWTS) and by the end of 1993 had 
      contributed 39,461 person-years to a follow-up study. Expected numbers of second 
      cancers were calculated by applying national incidence rates to person-years 
      classified by age, sex, and calendar year. RESULTS: Forty-three SMNs were 
      observed, whereas only 5.1 were expected (standardized incidence ratio [SIR], 
      8.4; 95% confidence interval [CI], 6.1 to 11.4). Fifteen years after the Wilms' 
      tumor diagnosis, the cumulative incidence of a SMN was 1.6% and increasing 
      steadily. Abdominal irradiation received as part of the initial therapy increased 
      the risk of a SMN (SIR, 1.43/10 Gy; 95% CI, 1.13 to 1.81). Doxorubicin 
      potentiated the radiation effect. Among 234 patients who received doxorubicin and 
      greater than 35 Gy of abdominal radiation, eight SMNs were observed, whereas only 
      0.22 were expected (SIR, 36; 95% CI, 16 to 72). Treatment for relapse further 
      increased the SMN risk by a factor of 4 to 5. CONCLUSION: These results 
      demonstrate the importance of current efforts to limit the use of intensive 
      chemotherapy and radiation therapy, which are now applied only to patients with 
      the most aggressive disease. Continuing close surveillance of the great majority 
      of Wilms' tumor patients who become long-term survivors is essential for early 
      diagnosis of SMNs and other late sequelae of therapy.
FAU - Breslow, N E
AU  - Breslow NE
AD  - Department of Biostatistics, University of Washington, Fred Hutchinson Cancer 
      Research Center, Seattle 98195-7232, USA.
FAU - Takashima, J R
AU  - Takashima JR
FAU - Whitton, J A
AU  - Whitton JA
FAU - Moksness, J
AU  - Moksness J
FAU - D'Angio, G J
AU  - D'Angio GJ
FAU - Green, D M
AU  - Green DM
LA  - eng
GR  - R01 CA054498/CA/NCI NIH HHS/United States
GR  - R01CA54498/CA/NCI NIH HHS/United States
GR  - U01CA42326/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - J Clin Oncol
JT  - Journal of clinical oncology : official journal of the American Society of 
      Clinical Oncology
JID - 8309333
RN  - 80168379AG (Doxorubicin)
SB  - IM
MH  - Adolescent
MH  - Child
MH  - Child, Preschool
MH  - Combined Modality Therapy
MH  - Doxorubicin/adverse effects
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Incidence
MH  - Infant
MH  - Kidney Neoplasms/drug therapy/radiotherapy/*therapy
MH  - Male
MH  - Neoplasms, Second Primary/*epidemiology/etiology
MH  - Poisson Distribution
MH  - Radiotherapy/adverse effects
MH  - Regression Analysis
MH  - Risk Factors
MH  - United States
MH  - Wilms Tumor/drug therapy/radiotherapy/*therapy
EDAT- 1995/08/01 00:00
MHDA- 1995/08/01 00:01
CRDT- 1995/08/01 00:00
PHST- 1995/08/01 00:00 [pubmed]
PHST- 1995/08/01 00:01 [medline]
PHST- 1995/08/01 00:00 [entrez]
AID - 10.1200/JCO.1995.13.8.1851 [doi]
PST - ppublish
SO  - J Clin Oncol. 1995 Aug;13(8):1851-9. doi: 10.1200/JCO.1995.13.8.1851.