Published in Cancer Detection and Prevention 1999; 23(5):368-374.

Secondary Tumors in Bone Sarcomas After Treatment with Chemotherapy

C. Ferrari, M.S.,a T. Bohling, M.D.,d M. S. Benassi, M.S.,a A. Ferraro, M.D.,b G. Gamberi, M.S.,a G. Bacci, M.D.,c A. Brach del Prever, M.D.,e L. Sangiorgi, M.D.,a P. Ragazzini, M.S.,a M. B. Sollazzo, M.S.,a A. Balladelli, B.A.,a and P. Picci, M.D.a

a Laboratory of Oncologic Research, b V Orthopedic Departement, and c Department of Chemotherapy, Rizzoli Orthopedic Institute, Bologna, Italy; d Department of Pathology, Haartman Institute, University of Helsinki, Finland; e Pediatric Clinic of Torino University, Torino, Italy

Address all correspondence and reprint requests to: Cristina Ferrari. Laboratorio di Ricerca Oncologica, Istituto di Ricerca Codivilla-Putti, Via di Barbiano 1/10, 40136 Bologna, Italy.

ABSTRACT: New oncologic treatments have improved survival in osteosarcoma and Ewing’s sarcoma. However, these treatments may cause secondary malignancies after radiotherapy. This study evaluated the incidence of secondary malignancies after neoadjuvant chemotherapy. Between April 1972 and December 1990, 518 osteosarcoma and 299 Ewing's sarcoma patients entered neoadjuvant chemotherapy protocols. Follow-up records of all patients were analyzed and malignant tumors were reported. Nine patients developed another malignancy, including 5 leukemias, 1 astrocytoma, 1 liposarcoma, 1 parotid, and 1 breast carcinoma. Four leukemias were found in patients treated for osteosarcoma with chemotherapy, but not radiotherapy. Only one leukemia developed after Ewing’s sarcoma treated with chemotherapy and radiotherapy. The incidence of leukemias is high, while the other tumors can be explalned as unrelated cases. Incidence densities for leukemia were calculated for both groups of patients. Treated osteosarcoma patients seem to have a predisposition to develop leukemias, but whether this is chemotherapy induced needs to be investigated.

KEY WORDS: chemotherapy, Ewing's sarcoma, leukemia, osteosarcoma, secondary tumor.