Bone sarcomas as second malignant neoplasms following childhood cancer

This study explores the relationship between histologic variants of bone sarcomas and previous therapy in patients in whom an unrelated malignant neoplasm had been diagnosed during childhood. Sarcomas of bone were the most common second malignant neoplasm (SMN) reported to the Late Effects Study Group, a 13institution consortium consisting of pediatric oncology centers from western Europe, Canada, and the United States. The authors attempted to relate the histologic subtypes of the 91 bone tumors to clinical factors such as previous therapy and genetic predisposition because morphologic variants have been shown to have biologic significance in other tumors and may have etiologic import. The literature concerning the subtypes of bone tumors, clinical and experimental, is also reviewed. The authors also investigated the effect of several factors on the time interval from the first diagnosis to the SMN (ie., the bone sarcoma). Anthracyclines significantly shortened the interval by about 3 years. The primary diagnosis also significantly affected the interval, with leukemia/lymphomas having the shortest interval and retinoblastoma the longest. The authors could not demonstrate any significant relationship between morphologic characteristics of the osteosarcoma and predisposing conditions. However, lesions diagnosed as chondrosarcoma and malignant fibrous histiocytoma occurred almost exclusively in patients who had received radiation therapy to the site in which the SMN developed. Cancer 67:193-201,1991, HEN MORE THAN ONE cancer occurs in a person, W the opportunity arises to investigate etiologic factors for carcinogenesis. Usually environmental agents are implicated, some of them being associated with therapy for the first cancer. The possibility that genetic factors may play a role should also be considered. Genetics is especially important for one childhood neoplasm, retinoblastoma, in which the association with osteogenic sarcoma in those with the genetic form is well known.’ Osteogenic sarcoma, however, is most often seen after ra