Second malignant neoplasms after treatment of childhood cancer

The aim of this study was to determine therapy-related risk factors for the development of second malignant neoplasm (SMN) after childhood cancer. The German Childhood Cancer Registry (GCCR) registers all childhood malignancies since 1980 including SMN. A nested case-control study with 238 SMN cases and 450 controls was conducted. A confirmatory, as well as an explorative, analysis was performed. Radiotherapy showed a small effect on the risk of SMN for doses greater than or equal to 65 Gy. Regarding the chemotherapeutical agents, we saw increased Odds Ratios (OR) for high doses of cyclophosphamide (CP > 8000 mg/m(2) OR 6.3 (95% Confidence Interval (Cl): 1.3-30.2)), cisplatinum (DDP > 435 mg/m(2) OR = 2.8 (95% CI: 1.1-6.7)) and mercaptopurine (MP > 5000 mg/m(2) OR = 4.5 (95% Cl: 1.1-18.9)). Patients jointly receiving high doses of NIP (> 5000 mg/m(2)) and dexamethasone (DEXA greater than or equal to 1200 mg/m(2)) had an OR = 6.9 (95% CI: 1.2-40.3). Our results could be added to those of other investigations to give indications for modifying future therapeutic strategies for childhood cancer. (C) 2003 Elsevier Science Ltd. All rights reserved.