Survivors Of Childhood Central Nervous System Cancer Face Persistent Risks As Adults

It was known that survivors of childhood CNS malignancies faced long-term side effects, but this large, 30-year study is one of the first to examine their long-term risks of subsequent cancers and debilitating medical conditions, as well as sociodemographic outcomes into adulthood.

To address these risks, Gregory Armstrong, M.D., M.S.C.E., at St. Jude Children's Research Hospital in Memphis, Tenn., and colleagues collected information on treatment, mortality, chronic medical conditions, and neurocognitive functioning from patients who had been diagnosed between 1970 and 1986 within the Childhood Cancer Survivor Study and had survived for 5 or more years after diagnosis.

The researchers found that these survivors had a risk of death that was 13 times that of the general population. Recurrence or progression of primary disease was the most common cause of death in the first 30 years after diagnosis. The risk of developing a subsequent cancer was associated with radiation exposure during initial treatment, and this risk continues to increase over time in this population. For patients with certain tumor types, increased radiation therapy was also associated with neurocognitive impairment. Radiation of the frontal/temporal lobes was associated with lower levels of employment and marriage.

"Continued follow-up will help determine temporal patterns in incidence and late effects as this cohort ages," the authors write. "Modern therapeutic regimens that increasingly use chemotherapy to reduce [radiation therapy] dose or use limited [radiation therapy] fields will likely improve long-term outcomes and minimize the risk of adverse late effects."

This research was published in the Journal of the National Cancer Institute on June 17, 2009.