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Cited by 765Multiple and Secondary Primary CancersSarcoma Diagnosis and TreatmentEffects of Radiation Exposure

Bone Sarcomas Linked to Radiotherapy and Chemotherapy in Children

Tucker, Margaret A., D'Angio, Giulio J., Boice, John D., Strong, Louise C., Li, Frederick P., Stovall, Marilyn, Stone, Betty J., Green, Daniel M. +5 more·1987·New England Journal of Medicine
DOI 10.1056/nejm198709033171002
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Abstract

We estimated the risk of subsequent bone cancer among 9170 patients who had survived two or more years after the diagnosis of a cancer in childhood. As compared with the general population, the patients had a relative risk of 133 (95 percent confidence interval, 98 to 176) and a mean (+/- SE) 20-year cumulative risk of 2.8 +/- 0.7 percent. Detailed data on treatment were obtained on 64 patients in whom bone cancer developed after childhood cancer. As compared with 209 matched controls who had survived cancer in childhood but who did not have bone cancer later, patients who had had radiation therapy had a 2.7-fold risk (95 percent confidence interval, 1.0 to 7.7) and a sharp dose-response gradient reaching a 40-fold risk after doses to the bone of more than 6000 rad. The relative dose-response effect among patients who had been treated for retinoblastoma resembled that among patients with all other types of initial tumors, although the cumulative risk of bone cancer in the retinoblastoma group was higher. Similar numbers of patients were treated with orthovoltage and megavoltage; the patterns of risk among categories of doses did not differ according to the type of voltage. After adjustment for radiation therapy, treatment with alkylating agents was also linked to bone cancer (relative risk, 4.7; 95 percent confidence interval, 1.0 to 22.3), with the risk increasing as cumulative drug exposure rose. We conclude that both radiotherapy and chemotherapy with alkylating agents for childhood cancer increase the subsequent risk of bone cancer.

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Crossref · 10.1056/nejm198709033171002

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20 of 20 references verified0 citation errors · 0 not checkable

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  • Radiotherapy-associated osteosarcomas tend to occur within the radiation field after a latency period of more than 10 years and are more frequent in patients with cancer predisposition syndromes such as Li-Fraumeni syndrome or hereditary retinoblastoma.

    “Radiotherapy-associated osteosarcomas tend to occur within the radiation field following a long latency period of >10 years and are more frequent in patients with cancer predisposition syndromes such as Li-Fraumeni syndrome or hereditary retinoblastoma 25 .”

    From Osteosarcoma (2022) · cites this paper as [25]

  • Exposure to alkylating chemotherapy, particularly when given with radiotherapy, is associated with an increased incidence of subsequent osteosarcoma in childhood cancer survivors.

    “Similarly, exposure to alkylating chemotherapy, particularly when given along with radiotherapy, has been associated with an increased incidence of subsequent osteosarcoma in childhood cancer survivors 25 .”

    From Osteosarcoma (2022) · cites this paper as [25]

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Authors
Tucker, M. A., D'Angio, G. J., Boice, J. D., Strong, L. C., Li, F. P., Stovall, M., Stone, B. J., Green, D. M., Lombardi, F., Newton, W., Hoover, R. N., Fraumeni, J. F., & For The Late Effects Study Group
Affiliations
National Institutes of Health (US)
ORCID
Tucker, Margaret A.
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1987-09-03
Volume
317
Issue
10
Pages
588-593
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm198709033171002
OpenAlex
W2022645679
Cited by
765
References
20
Citations by year
2026: 6 · 2025: 9 · 2024: 6 · 2023: 6 · 2022: 6 · 2021: 12 · 2020: 21 · 2019: 11 · 2018: 9 · 2017: 15 · 2016: 12 · 2015: 20 · 2014: 21 · 2013: 16 · 2012: 26
FWCI
20.55
Type
journal article
Language
en
Open access
closed
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Multiple and Secondary Primary Cancers
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Sarcoma Diagnosis and Treatment
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Effects of Radiation Exposure
Keywords
bone sarcoma, second primary malignancy, childhood cancer survivors, radiotherapy, alkylating agents, chemotherapy, retinoblastoma, radiation dose-response, cumulative risk
MeSH terms
Alkylating Agents, Bone Neoplasms, Child, Preschool, Chondrosarcoma, Dose-Response Relationship, Drug, Dose-Response Relationship, Radiation, Female, Fibrosarcoma, Humans, Male, Neoplasms, Multiple Primary, Neoplasms, Radiation-Induced, Radiotherapy, Retinoblastoma, Risk, Sarcoma, Sarcoma, Ewing, Osteosarcoma

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