Second malignant neoplasms following treatment for hepatoblastoma: an
international report and review of the literature
Abstract
Background: Treatment intensification has improved survival in patients
with hepatoblastoma (HB); however, these treatments are associated with
an increased risk of late effects including second malignant neoplasms
(SMNs). Data is limited regarding SMNs following HB treatment. Methods:
Cases of SMNs following treatment for HB reported in the literature and
from personal communication were analyzed to further assess this late
effect. Results: Thirty-eight patients were identified. Median age at
diagnosis of HB was 16 months (range: 3 to 168 months). All patients had
received a platinum agent, and almost all had anthracycline exposure. Of
12 patients with a known history of liver transplantation for primary
resection of their HB, the majority had post-transplant
lymphoproliferative disorder (PTLD) (n=7). The most common SMNs reported
were non-PTLD hematopoietic malignancies (n=19). Solid tumors were seen
in 12 patients: peripheral neuroectodermal tumor/Ewing sarcoma (3); and
one each for renal cell carcinoma, nephroblastoma, colorectal carcinoma,
thyroid carcinoma, medulloblastoma, clear cell sarcoma-like tumor,
hepatocellular carcinoma, osteosarcoma, and malignant schwannoma. Of 36
patients with data, nineteen survived. Conclusions: SMNs following HB
treatment were seen in patients with anthracycline (and cisplatin)
exposure, hereditary tumor predisposition syndromes, and/or history of
liver transplantation. Hematopoietic malignancies were the most common
SMN reported in this cohort and were diagnosed earlier than other SMNs.
Prospective collection of data via a companion late effects study or
international registry could be used to further evaluate rates and risks
of SMNs as well as tumor predisposition syndromes in patients treated
for HB.