Multinational case-control study of risk factors for primary bone cancer after childhood cancer

A case-control study in 12 European countries investigated the risks of subsequent primary bone cancer among childhood cancer survivors by different levels of cumulative radiation exposure and the dose-response relationships according to different specific types of chemotherapy. Among these patients, the risk of bone cancer was 5- to 10-fold increased after exposure of bone tissue to cumulative radiation doses of 1-9 Gy, indicating that the risk at these doses is far greater than previous studies suggested. Exposure to alkylating agents exceeding 10,000 mg/m² increased the risk of bone cancer 7- to 8-fold, particularly following procarbazine, ifosfamide, and cyclophosphamide.