PURPOSE: Colorectal carcinoma (CRC) has been described as a subsequent malignant neoplasm (SMN), although little is known about associated risk factors. We aimed to quantify the long-term risk of secondary CRC and identify treatment-related risk factors. PATIENTS AND METHODS: In this nested case-control study, 19 cases of adenocarcinoma of the colon or rectum were identified from 13,048 oncology patients treated for childhood cancer at St Jude Children's Research Hospital. Group 1 controls (n = 148) were matched for age at primary malignancy and follow-up interval. Group 2 controls (n = 72) were matched on primary diagnosis in addition to group 1 criteria. Exact conditional logistic regression was performed to calculate odds ratios (ORs) for chemotherapy and radiation exposure. RESULTS: Forty-year cumulative incidence of secondary CRC was 1.4%. Standardized incidence ratio was 10.9 (95% CI, 6.6 to 17.0) compared with that in the general US population. Secondary CRC was more likely in an irradiated segment of the colon (group 1 OR, 7.7; P = .001; group 2 OR, 15.4; P = .002). Risk increased by 70% with each 10-Gy increase in radiation dose. Increasing radiation volume increased risk (group 1 OR, 1.5; P < .001; group 2 OR, 1.8; P < .001). Alkylating agent exposure was associated with an 8.8-fold increased risk of secondary CRC (P = .03). CONCLUSION: In matched analyses, radiation and alkylator exposure are associated with secondary CRC. This risk is proportional to dose and volume of radiation. Surveillance should be initiated at a young age among survivors receiving high-risk exposures.
PURPOSE:Colorectal carcinoma (CRC) has been described as a subsequent malignant neoplasm (SMN), although little is known about associated risk factors. We aimed to quantify the long-term risk of secondary CRC and identify treatment-related risk factors. PATIENTS AND METHODS: In this nested case-control study, 19 cases of adenocarcinoma of the colon or rectum were identified from 13,048 oncology patients treated for childhood cancer at St Jude Children's Research Hospital. Group 1 controls (n = 148) were matched for age at primary malignancy and follow-up interval. Group 2 controls (n = 72) were matched on primary diagnosis in addition to group 1 criteria. Exact conditional logistic regression was performed to calculate odds ratios (ORs) for chemotherapy and radiation exposure. RESULTS: Forty-year cumulative incidence of secondary CRC was 1.4%. Standardized incidence ratio was 10.9 (95% CI, 6.6 to 17.0) compared with that in the general US population. Secondary CRC was more likely in an irradiated segment of the colon (group 1 OR, 7.7; P = .001; group 2 OR, 15.4; P = .002). Risk increased by 70% with each 10-Gy increase in radiation dose. Increasing radiation volume increased risk (group 1 OR, 1.5; P < .001; group 2 OR, 1.8; P < .001). Alkylating agent exposure was associated with an 8.8-fold increased risk of secondary CRC (P = .03). CONCLUSION: In matched analyses, radiation and alkylator exposure are associated with secondary CRC. This risk is proportional to dose and volume of radiation. Surveillance should be initiated at a young age among survivors receiving high-risk exposures.
Authors: Casey L Daniel; Connie L Kohler; Kayla L Stratton; Kevin C Oeffinger; Wendy M Leisenring; John W Waterbor; Kimberly F Whelan; Gregory T Armstrong; Tara O Henderson; Kevin R Krull; Leslie L Robison; Paul C Nathan Journal: Cancer Date: 2015-02-03 Impact factor: 6.860
Authors: Crystal S Denlinger; Robert W Carlson; Madhuri Are; K Scott Baker; Elizabeth Davis; Stephen B Edge; Debra L Friedman; Mindy Goldman; Lee Jones; Allison King; Elizabeth Kvale; Terry S Langbaum; Jennifer A Ligibel; Mary S McCabe; Kevin T McVary; Michelle Melisko; Jose G Montoya; Kathi Mooney; Mary Ann Morgan; Tracey O'Connor; Electra D Paskett; Muhammad Raza; Karen L Syrjala; Susan G Urba; Mark T Wakabayashi; Phyllis Zee; Nicole McMillian; Deborah Freedman-Cass Journal: J Natl Compr Canc Netw Date: 2014-01 Impact factor: 11.908
Authors: Lois B Travis; Wendy Demark Wahnefried; James M Allan; Marie E Wood; Andrea K Ng Journal: Nat Rev Clin Oncol Date: 2013-03-26 Impact factor: 66.675
Authors: Matthew B Yurgelun; Jason L Hornick; Victoriana K Curry; Chinedu I Ukaegbu; Emily K Brown; Elaine Hiller; Anu Chittenden; Joel E Goldberg; Sapna Syngal Journal: Clin Gastroenterol Hepatol Date: 2013-12-19 Impact factor: 11.382