Objectives

• Establish a pan-European cohort of survivors of childhood cancer for whom the occurrence of second primary sarcomas and second primary “adult-type” carcinomas has been systematically ascertained and validated.
• Within the cohort compare observed and expected numbers of second primary cancers (sarcomas of bone and soft tissue and carcinomas of digestive tract and genito-urinary organs) sites, particularly among survivors who are aged over 40 years.
• Undertake a nested case-control study of subsequent primary sarcomas developing within the cohort as these are the most frequent solid cancer observed in existing cohorts to determine aspects of radiotherapy and chemotherapy most strongly associated with increased risk. Investigate the nature of the dose-response relationship between cumulative dose of radiation from radiotherapy, cumulative dose of specific anti-cancer drugs and the risk of subsequent primary sarcoma.
• Undertake a nested case-control study of the subsequent primary “adult-type” carcinomas most frequently observed within the cohort to determine aspects of radiotherapy and chemotherapy most strongly associated with increased risk. Investigate the nature of the dose-response relationship between cumulative dose of radiation from radiotherapy, cumulative dose of specific anti-cancer drugs and the risk of subsequent primary
• adult-type carcinoma.
• Provide a reliable and unbiased evidence base useful for:
  • counselling, educating and empowering survivors;
  • educating health care professionals;
  • reviewing and updating standardised guidelines for the clinical follow-up of survivors;
  • evaluating alternative proposals for future treatment protocols from a risk as well as benefit perspective;
  • assessing proposals for screening tests among particular groups;
  • evaluating potential intervention studies aimed at reducing the risk of specific adverse outcomes.