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Post-Radiation Grade 3 Neuroendocrine Carcinoma: A New Entity?

Authors
  • Hadoux, Julien
  • Blanchard, Pierre
  • Scoazec, Jean-Yves
  • Burtin, Pascal
  • Planchard, David
  • Malka, David
  • Berdelou, Amandine
  • Boige, Valérie
  • Duvillard, Pierre
  • Leboulleux, Sophie
  • Faron, Matthieu
  • Tselikas, Lambros
  • Deutsch, Eric
  • Ducreux, Michel
  • Baudin, Eric
Type
Published Article
Journal
Neuroendocrinology
Publisher
S. Karger AG
Publication Date
Oct 22, 2019
Volume
111
Issue
1-2
Pages
139–145
Identifiers
DOI: 10.1159/000504255
PMID: 31639792
Source
Karger
Keywords
License
Green
External links

Abstract

Background: Cancer survivors have a 14% increased risk of developing a malignancy compared with the general population. Second radiation-induced malignancies with different histologies have been described in different organs. Based on individual observations, we hypothesized that neuroendocrine carcinoma (NEC) could arise in irradiated organs. Methods: In a retrospective analysis of Gustave Roussy database of NEC patients (small cell lung cancer excluded) diagnosed as a second cancer, we looked for the frequency of grade 3 NEC that arose in patients who had received previous radiation therapy for a first cancer. Radiation therapy for the first cancer, dose, location of radiation therapy, pathological characteristics, overall survival, and response to treatment of secondary NEC were analyzed. Results: From January 1995 to December 2017, 847 cases of NEC were seen at Gustave Roussy. Among them, 95 (11.2%) patients had a history of previous malignancy of which 36 (4%) had been treated with radiation therapy. Out of these 36 patients, 12 (1.4% of all NEC patients) developed a NEC within the previous irradiated organ (median dose of 50 Gy, range 36–67.5). Most frequent first cancers were breast cancer (n = 4) and Hodgkin lymphoma (n = 3). NEC arose within a median time of 21.7 years (range 5.1–36.4) from radiation in the thorax (n = 5), digestive tract (n = 3), and other sites. Five large cell NEC, 3 small cell NEC, 1 mixed neuroendocrine neoplasm and 3 not otherwise specified NEC were diagnosed. Ten patients had stage IV disease at diagnosis; median overall survival was 37.8 months (95% CI [17.6 to NA]). Three patients (25%) achieved complete response with multimodal treatment. Conclusions: NEC can arise from previously irradiated organs and may have a better outcome in this setting. Other risk factors should be investigated to explain the high rate of previous cancer in this population of neuroendocrine neoplasm.

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