Published in Cancer Detection and Prevention 1996; 20(5).

Secondary tumors after chemotherapy treated sarcomas of bone

C Ferrari MSc, MS Benassi MSc, T Bohling MD, G Gamberi MSc, G Bacci MD, P Picci MD

AIM: New oncologic treatments have dramatically improved the survival of young patients with osteosarcoma and Ewing sarcoma of bone. However, the treatments are connected with severe complications, the occurrence of secondary malignancies after radiotherapy is well documented. In this study we evaluated the risk of secondary malignancies after neoadjuvant chemotherapy. METHODS: Between April 1972 and December 1990 534 osteosarcoma and 296 Ewing sarcoma patients entered neoadjuvant chemotherapy protocols. The follow-up records of all patients were analyzed, and all malignant tumors were reported. RESULTS: Of the 820 patients 8 developed another malignancy, including 4 leukemias, 1 astrocytoma, 1 lymphoma, 1 parotid and 1 breast carcinoma. All 4 leukemias were found in patients previously treated for osteosarcoma with doxorubicin, methotrexate and cisplatin, but not with radiotherapy. CONCLUSIONS: In our material there is a high incidence of leukemias, the other tumors can be explained as casual cases. Three of the leukemias, all acute lymphoblastic, appeared within two years after the treatment of the sarcoma. Treated osteosarcoma patients thus have a clear predisposition to develop leukemias, but further studies are needed to determine whether this is chemotherapy induced or due to other factors causing multiple tumors.

KEY WORDS: osteosarcoma, secondary tumor, chemotherapy, risk factor, leukemia.

Paper presented at the International Symposium on the Impact of Cancer Biotechnology on Diagnostic and Prognostic Indicators; Nice, France; October 26 - 28, 1996; in the section on Chemotherapy.

http://www.cancerprev.org/Journal/Issues/20/5/505/1552