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Genito-Urinary (GU) Second Malignant Neoplasms (SMN) In Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study (CCSS)

Saturday, October 20, 2012: 11:15 AM
Grand Ballroom A/B (Hilton Riverside)
Margarett Shnorhavorian, MD, MPH1, Wendy Leisenring, ScD2, Pamela Goodman, MS2, Debra L. Friedman, MD, MS3, Marilyn Stovall, MD4, Lillian Meacham, MD5, Eric Chow, MD6, Charles Sklar, MD7, Lisa Diller, MD8, Fernando A. Ferrer Jr., MD, FAAP9, Greg Armstrong, MD10, Joseph Neglia, MD, MPH11 and Leslie Robison, PhD10, (1)Urology, Seattle Children's Hospital, Seattle, WA, (2)Clinical Statistics and Cancer Prevention Programs, Fred Hutchinson Cancer Research Center, Seattle, WA, (3)Pediatric Oncology, Vanderbilt Ingram Cancer Center, Nashville, TN, (4)Department of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, (5)Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, (6)Department of Pediatrics, University of Washington, Seattle, WA, (7)Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY, (8)Department of Pediatric Oncology, Dana Farber Cancer Institute, Boston, MA, (9)Division of Urology, Connecticut Children's Medical Center, Hartford, CT, (10)Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, (11)Department of Pediatrics, University of Minnesota


To describe the occurrence of GU SMNs among five year survivors in the CCSS cohort.


Among 14,358 five-year survivors, cumulative incidence of first GU SMN was calculated using death as a competing risk. Standardized Incidence Ratios (SIRs) were calculated using age- sex- year- specific rates from the SEER program.


A total of 72 GU SMNs were identified among 68 subjects. Median age at diagnosis of first GU SMN was 31.0 years (range 9.0-51.0), occurring a median of 21.9 years (range 6.3-35.7) after primary cancer. Among GU SMN cases, 68.4% had received radiation therapy (RT) involving the GU system. Sites of first GU SMN included: 27 female reproductive (13.2% ovary, 11.8% endometrium, 7.4% cervix, 2.9 % uterus,2.9% vulva), 24 kidney (35.3%), 10  bladder (14.7%) and 7 male reproductive (5.9% testes, 4.4% prostate). Most common histologies included:  24 renal cell carcinoma (24.3%), 7 adenocarcinoma (9.7%), 5 transitional cell carcinoma (6.9%), and 5 endometrioid carcinoma (6.9%).The overall cumulative incidence at 30 years post diagnosis was 0.6% (95% CI: 0.4-0.8%) and SIR was 11.6 (95% CI: 9.1-14.7).  Cumulative incidence was significantly higher for females (0.7%; 95% CI: 0.5-1.0%) as compared to males (0.5%; 95% CI 0.2%-0.7%) (p=0.01) as were SIRs (females: 20.9; 95%CI 15.4-28.4; males: 6.5; 95% CI: 4.3-9.6; p<0.001). Cumulative incidence did not significantly differ between exposure levels of GU RT and risk was elevated in comparison to the general population among those with no GU RT (SIR 12.1; 95% CI: 7.5-19.6), <2000 cGY (SIR 8.4; 95% CI: 5.6-12.7), and RT ≥2000 (SIR 20.6; 95%CI 11.7-36.2)


Although the absolute cumulative incidence is low, survivors of childhood cancer are at significantly increased risk for a GU SMN. In particular, female survivors and survivors with GU RT ≥ 2000 cGy have highest elevated risk for a GU SMN.