Second malignancies

Acute myelogenous leukemia with specific abnormalities in chromosome 11q23 may occur 2 to 3 years after treatment with etoposide [30]. The risk for leukemia seems to be cumulative and dose-dependent. Studies generally report the risk break point is a cumulative etoposide dose less than or equal to 2 g/m2 versus greater than 2 g/m2. Fortunately, the risk for leukemia for most patients who have GCT is low, with a cumulative incidence at 5 years of less than 0.6%.

Travis and colleagues [31] have recently reported a population-based registry study examining the risk for secondary solid malignancies in long-term survivors of GCT. Based on 14 registries, 40,576 1-year survivors of GCT were identified with a median follow-up of 11.3 years. In this cohort, 2285 second solid cancers were identified for an observed-to-expected ratio of 1.41 (95% CI, 1.35-1.47). The risk increased with increasing age of the patient at diagnosis of GCT and continued for 35 years. Increased risk for second solid cancers was observed in patients treated with radiation therapy alone (relative risk [RR] = 2.0; 95% CI, 1.9-2.2), chemotherapy alone (RR = 1.8; 95% CI, 1.3-2.5), and both (RR = 2.9; 95% CI, 1.94.2). The finding that patients treated with chemotherapy alone are at statistically increased risk for second solid cancers has not previously been demonstrated. The underlying mechanism associated with this risk is unknown.

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