Armstrong GT, Chen Y, Yasui Y, Leisenring W, Gibson TM, Mertens AC, Stovall M, Oeffinger KC, Bhatia S, Krull KR, Nathan PC, Neglia JP, Green DM, Hudson MM, Robison LL. Reduction in Late Mortality among 5-Year Survivors of Childhood Cancer. N Engl J Med. 2016 Jan 13. [Epub ahead of print]

In this study, Armstrong et al abstracted data of 34,033 patients in the Childhood Cancer Survivor Study cohort who survived at least 5 years after childhood cancer (i.e., cancer diagnosed before the age of 21 years) for which treatment was initiated during the period from 1970 through 1999. Of the 3958 deaths that occurred during the study period, 1618 (41%) were attributable to health-related causes, including 746 deaths from subsequent neoplasms, 241 from cardiac causes, 137 from pulmonary causes, and 494 from other causes. A reduction in 15-year mortality was observed for death from any cause (from 12.4% in the early 1970s to 6.0% in the 1990s, P<0.001 for trend) and from health-related causes (from 3.5% to 2.1%, P<0.001 for trend). These reductions were attributable to decreases in the rates of death from subsequent neoplasm (P<0.001), cardiac causes (P<0.001), and pulmonary causes (P=0.04). Changes in therapy according to decade included reduced rates of cranial radiotherapy for acute lymphoblastic leukemia, of abdominal radiotherapy for Wilms' tumor, of chest radiotherapy for Hodgkin's lymphoma, and of anthracycline exposure. The changes in treatment protocols not only decrease acute tretment related toxicities, but also decrease the late effects and related deaths in pediatric cancer survivors.(Summarized by Şule Ünal,M.D.)