Studies of long-term survivors of cancer treated with radiation therapy and chemotherapy have led to important insights into carcinogenesis. Last year, we reported that Italian children treated with high dose epipodophyllotoxins appeared to have an excess of promyelocytic leukemia. Promyelocytic leukemia is not the type of acute non-lymphocytic leukemia previously associated with epipodophyllotxin treatment, but it is more common in individuals of Mediterranean descent. We have initiated an investigation of childhood acute leukemia in Italy with Dr. Riccardo Haupt to begin to explore the etiology of promyelocytic leukemia in Italy. In collaboration with Dr. Bruce Johnson of the Medicine Branch, NCI, we found that among 611 two or more year survivors of small cell lung cancer, the risk of tobacco-related cancers was increased 7-fold. The most common second cancer was lung cancer. The risk of a second non small cell lung cancer was related to continued smoking which appeared synergistic with both treatment with chest irradiation and with alkylating agent chemotherapy. We have continued the field work for the study of radiation-related neural tumors in a cohort of individuals who received head and neck irradiation in childhood.
