Abstract
Background
Additive chemotherapeutic treatment of UICC-stage -III / IV colon cancer with fluorouracil,
leucovorin and oxaliplatin is widely accepted as current standard of treatment after
R0-resection. However, as patients.. survival is increasing, long-term side effects
of chemotherapeutic agents such as second cancer development are becoming increasingly
important.
Patients
We therefore investigated a total of 2 856 Patients with UICC-stage III / IV colon
cancer, 223 of whom (7.8%) had developed a subsequent second cancer.
Results
Median follow-up was 73.2 months (range 209.9 months, 95%-CI 69.8-76.9). Most frequent
second cancers were prostate cancer (18.4%), colon cancer (16.1%), breast cancers
(8.1%), lung cancer (8.1%), rectal cancer (4.9%) and uterine cancer (4.9%). However,
in comparison to non-treated patients this did not represent a significantly increased
risk for subsequent second cancer in patients after treatment with additive chemotherapy.
Of interest, our data suggest a significantly decreased second cancer rate in patients
treated with FOLFOX compared to FUFOL for additive treatment.
Conclusions
Second cancer development was not increased after additive chemotherapy for colon
cancer, which is a novel aspect in the ongoing discussions on reduction of adjuvant
treatment to 3 months or treatment of lymph node negative patients.
Novelty and Impact Statement
To our knowledge, this is the first population-based study analyzing second cancer
development after additive chemotherapy in patients with UICC III-IV colon cancer.
The results have an important impact on the surveillance and long-term follow-up of
cancer patients.
Keywords
Abbreviations:
CI (confidence interval), CRC (colorectal cancer), CTx (chemotherapy), FOLFOX (folinic acid, fluorouracil and oxaliplatin), 5-FU (5-fluoruracil), HR (hazard ratio), ICD (International Classification of Diseases), Ox (oxaliplatin), UICC (Union Internationale Contre le Cancer)To read this article in full you will need to make a payment
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References
Ferlay J, Ervik M, Lam F et al. Cancer Today (powered by GLOBOCAN 2018) IARC CancerBase No. 15. 2018.
Robert Koch-Institut (Hrsg.) & Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V.(Hrsg.). Krebs in Deutschland für 2015 /2016 Krebs in Deutschland. 2019.
- Adjuvant radiotherapy for rectal cancer: a systematic overview of 8,507 patients from 22 randomised trials.Lancet. 2001; 358: 1291-1304
- Screening colonoscopy for colorectal cancer prevention: results from a German online registry on 269000 cases.Eur J Gastroenterol Hepatol. 2009; 21: 650-655
- Colorectal cancer.Lancet. 2019; 394: 1467-1480
- Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer.N Engl J Med. 2004; 350: 2343-2351
- Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer.J Clin Oncol. 2000; 18: 2938-2947
- Phase III multicenter randomized trial of oxaliplatin added to chronomodulated fluorouracil-leucovorin as first-line treatment of metastatic colorectal cancer.J Clin Oncol. 2000; 18: 136-147
- The secondary leukemias: challenges and research directions.J Natl Cancer Inst. 1996; 88: 407-418
- Therapy-associated solid tumors.Acta Oncol. 2002; 41: 323-333
- Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment.Hematology Am Soc Hematol Educ Program. 2016; 2016: 323-330
- A case-control study of screening sigmoidoscopy and mortality from colorectal cancer.N Engl J Med. 1992; 326: 653-657
- Second cancers after breast cancer treatment.Semin Oncol. 2003; 30: 740-748
- Myeloid malignancies after treatment for solid tumours.Best Pract Res Clin Haematol. 2019; 32: 40-46
- The risk of subsequent primary malignant diseases after cancers of the colon and rectum. A nationwide cohort study.Cancer. 1990; 65: 2091-2100
- Cumulative incidence of metachronous colorectal cancer.Dis Colon Rectum. 1993; 36: 388-393
- What is the risk factor for metachronous colorectal carcinoma?.Dis Colon Rectum. 1997; 40: 935-938
- Second primary colorectal cancers (SPCRCs): experiences from a large Australian Cancer Registry.Ann Oncol. 2010; 21: 92-97
- Second primary colorectal cancer after the initial primary colorectal cancer.BMC Cancer. 2018; 18: 931
- 5-Fluorouracil treatment induces characteristic T>G mutations in human cancer.Nat Commun. 2019; 10: 4571
- Surveillance for second primary colorectal cancer after adjuvant chemotherapy: an analysis of Intergroup 0089.Ann Intern Med. 2002; 136: 261-269
- Rapid onset of myelodysplastic syndrome after treatment for anal cancer: a case report.J Gastrointest Oncol. 2010; 1: 120-121
- Myelodysplastic syndrome/acute myelogenous leukaemia related to adjuvant chemotherapy with oral pyrimidine anti-metabolites.Br J Haematol. 2000; 111: 712-713
Article Info
Publication History
Published online: July 15, 2022
Accepted:
July 3,
2022
Received in revised form:
December 18,
2021
Received:
February 7,
2021
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
