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. 2013 Mar 1;85(3):776-83.
doi: 10.1016/j.ijrobp.2012.06.006. Epub 2012 Jul 24.

Risk of salivary gland cancer after childhood cancer: a report from the Childhood Cancer Survivor Study

Houda Boukheris  1 , Marilyn Stovall, Ethel S Gilbert, Kayla L Stratton, Susan A Smith, Rita Weathers, Sue Hammond, Ann C Mertens, Sarah S Donaldson, Gregory T Armstrong, Leslie L Robison, Joseph P Neglia, Peter D Inskip
Affiliations

Risk of salivary gland cancer after childhood cancer: a report from the Childhood Cancer Survivor Study

Houda Boukheris et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: To evaluate effects of radiation therapy, chemotherapy, cigarette smoking, and alcohol consumption on the risk of second primary salivary gland cancer (SGC) in the Childhood Cancer Survivor Study (CCSS).

Methods and materials: Standardized incidence ratios (SIR) and excess absolute risks (EAR) of SGC in the CCSS were calculated using incidence rates from Surveillance, Epidemiology, and End Results population-based cancer registries. Radiation dose to the salivary glands was estimated based on medical records. Poisson regression was used to assess risks with respect to radiation dose, chemotherapy, smoking, and alcohol consumption.

Results: During the time period of the study, 23 cases of SGC were diagnosed among 14,135 childhood cancer survivors. The mean age at diagnosis of the first primary cancer was 8.3 years, and the mean age at SGC diagnosis was 24.8 years. The incidence of SGC was 39-fold higher in the cohort than in the general population (SIR = 39.4; 95% CI = 25.4-57.8). The EAR was 9.8 per 100,000 person-years. Risk increased linearly with radiation dose (excess relative risk = 0.36/Gy; 95% CI = 0.06-2.5) and remained elevated after 20 years. There was no significant trend of increasing risk with increasing dose of chemotherapeutic agents, pack-years of cigarette smoking, or alcohol intake.

Conclusion: Although the cumulative incidence of SGC was low, childhood cancer survivors treated with radiation experienced significantly increased risk for at least 2 decades after exposure, and risk was positively associated with radiation dose. Results underscore the importance of long-term follow up of childhood cancer survivors for the development of new malignancies.

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Conflict of interest statement

Conflict of Interest Notification: Actual or potential conflicts of interest do not exist.

Figures

Figure 1
Figure 1
Cumulative incidence of salivary gland cancers among childhood cancer survivors by time (years) since first cancer diagnosis, overall and separately for those who did and did not receive radiotherapy.
Figure 2
Figure 2
Risk of subsequent primary salivary gland cancer among five year survivors of childhood cancer with respect to radiation dose to the salivary glands. The sloped dashed line is the fitted dose-response relationship. The horizontal dotted line is a reference line corresponding to relative risk=1.
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