Chemotherapy Shows Little Added Risk of Second Cancers
A study of 1,633 pediatric rhabdomyosarcoma patients found maintenance chemotherapy did not significantly raise cumulative secondary malignancy risk.
Updated on Nov. 3, 2026 in Cancer
Maintenance chemotherapy did not significantly increase cumulative risk for secondary malignancies among pediatric rhabdomyosarcoma survivors, according to an analysis of the EpSSG RMS 2005 trial published in Cancer. Of 1,633 patients, 27 (1.7%) developed a secondary malignancy after a median follow-up of 9.3 years.
Why it matters
Rhabdomyosarcoma is a childhood cancer where survival has improved, making long-term treatment side effects a growing concern for clinicians and families. The findings suggest maintenance therapy may not carry a meaningfully higher late-cancer risk, though the authors call for longer follow-up.
The trial's 8-year cumulative incidence was 1.3%, with 1.6% of patients on alkylating agents alone and 1.9% on maintenance chemotherapy developing a secondary malignancy. Researchers note that longer follow-up will be needed to determine whether these rates change over time.
The players
EpSSG (European Pediatric Soft Tissue Sarcoma Study Group)
A European research consortium that conducts clinical trials on pediatric soft tissue sarcomas, including rhabdomyosarcoma.
The details
Researchers assessed secondary malignancy incidence in the EpSSG RMS 2005 randomized trial, dividing patients into low, standard, high, and very high risk treatment groups. Osteosarcoma was the most frequent secondary cancer, and a predisposing cancer syndrome such as Li-Fraumeni syndrome or neurofibromatosis type 1 was identified in 29.6% of patients who developed one.
Timeline
Median follow-up in the cohort was 9.3 years.
Secondary malignancies developed a median of 56.7 months after primary diagnosis.
The study was published online in Cancer on October 27, 2026.
Health Landscape
Long-term safety data from the EpSSG RMS 2005 trial extends its earlier efficacy reporting into late-effects territory. As survival for pediatric rhabdomyosarcoma improves, such survivorship data increasingly shapes how maintenance regimens are weighed against late-cancer risk.
For families of children treated for rhabdomyosarcoma, the findings suggest maintenance chemotherapy does not appear to substantially raise the chance of a later second cancer. Families should still discuss long-term monitoring and screening plans with their oncology teams.
The takeaway
Survivors of childhood cancer benefit from long-term follow-up that tracks late effects like second cancers. Patients and families should ask their care teams how their individual risk, including any inherited cancer syndrome, shapes monitoring.
Further reading
For broader context on long-term cancer outcomes, explore more in Cancer.
