Risk of a Second Kidney Carcinoma Following Childhood Cancer: Role of Chemotherapy and of Radiation Dose to Kidneys (original) (raw)

The Journal of Urology, 2015

Abstract

Kidney carcinoma (KC) is a rare second malignant carcinoma following childhood cancer. In order to quantify the risk of KC following childhood cancer treatment, and to assess its risk factors, we followed over 27 years on average, a cohort of 4,350 5-year childhood cancer survivors treated between 1943 and 1985, in France and UK. Radiation dose received to the two kidneys during radiotherapy was estimated with dedicated software whatever the site of the childhood cancer. Thirteen patients had developed a KC. The cumulative incidence of KC was 0.62% (95%CI: 0.27% - 1.45%), 40 years after diagnosis, i.e. 13.3-fold higher (95%CI: 7.1-22.3) than that expected in the general population. The absolute excess risk strongly increased (p<0.0001) with longer duration of follow-up. Compared to the general population, the incidence of KC was 5.7-fold higher (95%CI: 1.4-14.7) if no radiation therapy or less than 1 Gy had been absorbed by the kidney, but 66.3-fold higher (95%CI: 23.8-142.5) if the radiation dose to the kidneys was between 10 and 19 Gy, and 14.5-fold greater (95%CI: 0.8-63.9) for higher radiation doses to the kidney. Treatment with chemotherapy increased the risk of KC (RR=5.1, 95%CI: 1.1-22.7), but we were not able to identify a specific drug or drug category responsive for this increase. Moderate radiation dose to the kidneys during childhood cancer treatment increased the risk of a second KC whose incidence will be on the increase when childhood cancer survivors reach old ages.

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