1
|
Mizumoto M, Oshiro Y, Pan H, Wang F, Kaste SC, Gajjar A, Chemaitilly W, Merchant TE. Height after photon craniospinal irradiation in pediatric patients treated for central nervous system embryonal tumors. Pediatr Blood Cancer 2020; 67:e28617. [PMID: 32715632 DOI: 10.1002/pbc.28617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND We modeled height after craniospinal irradiation (CSI) in pediatric patients with central nervous system (CNS) embryonal tumors to identify factors that impair stature. PROCEDURE During 1996-2012, 212 pediatric patients (131 male) with CNS embryonal tumors received postoperative CSI: 23.4 Gy (n = 147) or ≥36 Gy (n = 65), similar postirradiation chemotherapy, and were followed for at least 5 years without tumor progression or other event. The group was further characterized by age at CSI and hormone-replacement therapy received. Models were developed to identify factors associated with growth impairment and estimate final height. RESULTS With median follow up of 10.2 years (range 5.0-20.4 years), the mean final height z-scores at 18 years of age, compared to United States standards, were -1.3 for female and -1.5 for male survivors. Younger age at the time of CSI, higher CSI dose, and female sex were associated with height impairment. Factors associated with higher growth rates before 15 years of age were older age at CSI, male sex, CSI dose < 36 Gy, replacement therapy for growth hormone (GH) and central adrenal insufficiency, and white race. Growth after age 15 in male survivors was associated with treatment of gonadotropin deficiency. Linear mixed-effects models were developed using clinical factors to estimate final height, demonstrate the unique growth curve of this cohort, and interactions between clinical variable and radiation dose. CONCLUSIONS CSI significantly impaired height at current doses used to treat standard- or high-risk CNS embryonal tumors. Measures to reduce the impact of CSI on height should be sought, with our models serving as benchmarks.
Collapse
Affiliation(s)
- Masashi Mizumoto
- Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan
| | - Yoshiko Oshiro
- Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, Tennessee.,Department of Radiation Oncology, University of Tsukuba, Ibaraki, Japan
| | - Haitao Pan
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Fang Wang
- Department of Biostatistics, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Sue C Kaste
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Amar Gajjar
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Wassim Chemaitilly
- Department of Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Thomas E Merchant
- Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, Tennessee
| |
Collapse
|
2
|
Demoor-Goldschmidt C, Allodji RS, Journy N, Rubino C, Zrafi WS, Debiche G, Llanas D, Veres C, Thomas-Teinturier C, Pacquement H, Vu-Bezin G, Fresneau B, Berchery D, Bolle S, Diallo I, Haddy N, de Vathaire F. Risk Factors for Small Adult Height in Childhood Cancer Survivors. J Clin Oncol 2020; 38:1785-1796. [PMID: 32196392 DOI: 10.1200/jco.19.02361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Between 10% and 20% of childhood cancer survivors (CCS) experience impaired growth, leading to small adult height (SAH). Our study aimed to quantify risk factors for SAH or growth hormone deficiency among CCS. METHODS The French CCS Study holds data on 7,670 cancer survivors treated before 2001. We analyzed self-administered questionnaire data from 2,965 CCS with clinical, chemo/radiotherapy data from medical records. SAH was defined as an adult height ≤ 2 standard deviation scores of control values obtained from a French population health study. RESULTS After exclusion of 189 CCS treated with growth hormone, 9.2% (254 of 2,776) had a SAH. Being young at the time of cancer treatment (relative risk [RR], 0.91 [95% CI, 0.88 to 0.95] by year of age), small height at diagnosis (≤ 2 standard deviation scores; RR, 6.74 [95% CI, 4.61 to 9.86]), pituitary irradiation (5-20 Gy: RR, 4.24 [95% CI, 1.98 to 9.06]; 20-40 Gy: RR, 10.16 [95% CI, 5.18 to 19.94]; and ≥ 40 Gy: RR, 19.48 [95% CI, 8.73 to 43.48]), having received busulfan (RR, 4.53 [95% CI, 2.10 to 9.77]), or > 300 mg/m2 of lomustine (300-600 mg/m2: RR, 4.21 [95% CI, 1.61 to 11.01] and ≥ 600 mg/m2: RR, 9.12 [95% CI, 2.75 to 30.24]) were all independent risk factors for SAH. Irradiation of ≥ 7 vertebrae (≥ 15 Gy on ≥ 90% of their volume) without pituitary irradiation increased the RR of SAH by 4.62 (95% CI, 2.77 to 7.72). If patients had also received pituitary irradiation, this increased the RR by an additional factor of 1.3 to 2.4. CONCLUSION CCS are at a high risk of SAH. CCS treated with radiotherapy, busulfan, or lomustine should be closely monitored for growth, puberty onset, and potential pituitary deficiency.
Collapse
Affiliation(s)
- Charlotte Demoor-Goldschmidt
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Hematology Oncology Department, CHU Angers, Angers, France
| | - Rodrigue S Allodji
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Neige Journy
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Carole Rubino
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Wael Salem Zrafi
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Ghazi Debiche
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France
| | - Damien Llanas
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Cristina Veres
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Cécile Thomas-Teinturier
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France.,Department of Pediatric Endocrinology, APHP, Hôpitaux Paris-Sud, site Bicêtre, Le Kremlin Bicêtre, France
| | | | - Giao Vu-Bezin
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Brice Fresneau
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | | | - Stephanie Bolle
- Pediatric Oncology Department, Gustave Roussy, Villejuif, France
| | - Ibrahima Diallo
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Nadia Haddy
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| | - Florent de Vathaire
- Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France.,Pediatric Oncology Department, Gustave Roussy, Villejuif, France.,University Paris Saclay, Villejuif, France
| |
Collapse
|
3
|
Rodari G, Cattoni A, Albanese A. Final height in growth hormone-deficient childhood cancer survivors after growth hormone therapy. J Endocrinol Invest 2020; 43:209-217. [PMID: 31452114 DOI: 10.1007/s40618-019-01102-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/19/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Growth hormone deficiency (GHD) is the most prevalent hypothalamic-pituitary (HP) disorder found in childhood cancer survivors (CCS). The published studies assessing GHD in CCS concluded that recombinant human GH (rhGH) does not restore final height (FH) to that predicted from mid-parental height (MPH). Thus, wider analyses on final height outcomes after rhGH in CCS are needed. METHODS Retrospective study on final height (FH) in 87 CCS treated with rhGH. Patients were divided into: Group A (n =48) who underwent cranial radiotherapy or had non-irradiated tumours of HP area, and B (n =39) who were treated with craniospinal or total body irradiation (TBI). 19/87 patients with central precocious/early puberty also received GnRH analogues. RESULTS Height (HT) gain after 1 and 2 years of rhGH was 0.38 ± 0.35 SDS and 0.18 ± 0.30 SDS, respectively (P < 0.0001); mean FH was in the normal range (- 0.85 ± 1.34 SDS), though not significantly different from HT SDS at baseline. 67% overall failed to reach MPH especially in Group B (P < 0.0001). However, height loss (HT SDS-MPH SDS) at FH improved or remained stable compared to baseline in 26/45 patients (58%). On stepwise regression analysis, major determinants of FH were HT at baseline (P < 0.0001) and delay before start of rhGH (P = 0.012). There was no significant difference in FH when GnRHa was added to rhGH. CONCLUSION rhGH and GnRH analogues therapy, when indicated, though failing to induce catch-up growth, prevented further height loss leading to a FH within the normal range but still below MPH, this latter being statistically significant in children who received craniospinal and TBI.
Collapse
Affiliation(s)
- G Rodari
- Paediatric Unit, Royal Marsden NHS Foundation Trust, Sutton, UK.
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Via Francesco Sforza 28, 20122, Milan, Italy.
| | - A Cattoni
- Paediatric Unit, Royal Marsden NHS Foundation Trust, Sutton, UK
- Paediatric Department, Azienda Ospedaliera San Gerardo, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Monza, Italy
| | - A Albanese
- Paediatric Unit, Royal Marsden NHS Foundation Trust, Sutton, UK
| |
Collapse
|
4
|
Chung SY, Han JW, Kim DS, Yoon HI, Suh CO. Treatment outcomes based on radiation therapy fields for bifocal germinoma: Synchronous or disseminated disease? PLoS One 2019; 14:e0223481. [PMID: 31581215 PMCID: PMC6776334 DOI: 10.1371/journal.pone.0223481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 09/23/2019] [Indexed: 12/26/2022] Open
Abstract
Intracranial germinoma sometimes present as bifocal germinoma, and whether bifocal germinoma should be treated as a synchronous or disseminated disease remains unclear. This study aimed to determine the optimal treatment modality for bifocal germinoma. Patients with bifocal germinoma who received radiotherapy (RT) from March 1990 to August 2017 were included for analysis. A total of 21 patients were included. The median follow-up period was 76.2 months (range, 6.2-305.4 months). There were 17 patients who received cranio-spinal irradiation (CSI) with local RT; 3, whole ventricular RT (WVRT) with local RT; and 1, local RT only. Three recurrences occurred (1 patient each among those who underwent CSI, WVRT, and local RT). Recurrence in the patient who received CSI and who received WVRT occurred in the right thalamus and right frontal convexity, respectively. Meanwhile, the patient who received local RT showed not only a recurred lesion in the hypothalamus, but also cerebrospinal fluid seeding. For this patient, salvage CSI was performed and complete response was achieved after treatment. However, after 9 years and 6 months, he was diagnosed with glioblastoma and expired. As for toxicity, although 17 patients showed decrease in complete blood count levels during treatment, all patients recovered soon after treatment completion. Our findings suggest that bifocal germinoma may be considered as a disseminated disease when considering the patterns of failure according to RT fields. In addition, patients who received CSI showed low acute toxicity rates. However, further studies are necessary to confirm these findings.
Collapse
Affiliation(s)
- Seung Yeun Chung
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung Woo Han
- Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong-Seok Kim
- Department of Pediatric Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang-Ok Suh
- Department of Radiation Oncology, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, South Korea
| |
Collapse
|
5
|
Long TM, Rath SR, Wallman KE, Howie EK, Straker LM, Bullock A, Walwyn TS, Gottardo NG, Cole CH, Choong CS, Naylor LH. Exercise training improves vascular function and secondary health measures in survivors of pediatric oncology related cerebral insult. PLoS One 2018; 13:e0201449. [PMID: 30092052 PMCID: PMC6084859 DOI: 10.1371/journal.pone.0201449] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 07/16/2018] [Indexed: 11/18/2022] Open
Abstract
Adolescent and young adult (AYA) survivors of pediatric oncology related cerebral insult are vulnerable to numerous treatment-induced deficits that significantly enhance cardiovascular disease risk. Regular exercise improves endothelial function, fitness, body composition and musculoskeletal function which may reduce predisposition for cardiovascular disease. Here we assessed the feasibility and effectiveness of a 24-week exercise intervention on cardiovascular, physical and metabolic outcomes in this population. Thirteen survivors (6 male, 7 female; median age 19 y (range 16-23 y) were recruited to participate in a 48-week study consisting of a 24-week control period (regular care) followed by a 24-week exercise intervention. Outcome measures were collected at entry (week 0) and following regular care (24-week) and exercise (48-week). Assessed variables included endothelial function (flow mediated dilation, FMD), blood pressure, heart rate (HR), aerobic capacity, anthropometry, body composition, muscular strength (3 repetition maximum testing), muscular endurance (repetitions/min) and physical activity levels (accelerometry). Compared to baseline, delta diameter (p = 0.008) and FMD (p = 0.029) of the brachial artery increased following exercise. Bicep-curl strength also increased following exercise compared to baseline (p = 0.019), while submaximal (6 min mark) measures of ventilation (p = 0.012), rating of perceived exertion (p = 0.012), HR (p = 0.001), absolute (p = 0.000) and relative (p = 0.000) aerobic capacity decreased. Breaks in sedentary time increased (p = 0.043) following exercise compared to regular care. Although the sample was small and heterogeneous, this study demonstrates that exercise is achievable and has positive effects on vascular function, submaximal fitness, local strength and physical activity in a population of AYA survivors of pediatric oncology related cerebral insult.
Collapse
Affiliation(s)
- Treya M. Long
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Shoshana R. Rath
- Department of Endocrinology, Perth Children’s Hospital, Perth, Western Australia, Australia
- School of Medicine, Pediatrics, The University of Western Australia, Perth, Western Australia, Australia
| | - Karen E. Wallman
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, Australia
| | - Erin K. Howie
- School of Physiotherapy and Exercise Sciences, Curtin University, Perth, Western Australia, Australia
| | - Leon M. Straker
- School of Physiotherapy and Exercise Sciences, Curtin University, Perth, Western Australia, Australia
| | - Andrew Bullock
- Department of Cardiology, Perth Children’s Hospital, Perth, Western Australia, Australia
| | - Thomas S. Walwyn
- School of Medicine, Pediatrics, The University of Western Australia, Perth, Western Australia, Australia
- Department of Hematology and Oncology, Perth Children’s Hospital, Perth, Western Australia, Australia
| | - Nicholas G. Gottardo
- School of Medicine, Pediatrics, The University of Western Australia, Perth, Western Australia, Australia
- Department of Hematology and Oncology, Perth Children’s Hospital, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Catherine H. Cole
- School of Medicine, Pediatrics, The University of Western Australia, Perth, Western Australia, Australia
- Department of Hematology and Oncology, Perth Children’s Hospital, Perth, Western Australia, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
- Hematology, PathWest Laboratory Services, Perth, Western Australia, Australia
| | - Catherine S. Choong
- Department of Endocrinology, Perth Children’s Hospital, Perth, Western Australia, Australia
- School of Medicine, Pediatrics, The University of Western Australia, Perth, Western Australia, Australia
| | - Louise H. Naylor
- School of Human Sciences, Exercise and Sport Science, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
6
|
Sklar CA, Antal Z, Chemaitilly W, Cohen LE, Follin C, Meacham LR, Murad MH. Hypothalamic-Pituitary and Growth Disorders in Survivors of Childhood Cancer: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2018; 103:2761-2784. [PMID: 29982476 DOI: 10.1210/jc.2018-01175] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To formulate clinical practice guidelines for the endocrine treatment of hypothalamic-pituitary and growth disorders in survivors of childhood cancer. PARTICIPANTS An Endocrine Society-appointed guideline writing committee of six medical experts and a methodologist. CONCLUSIONS Due to remarkable improvements in childhood cancer treatment and supportive care during the past several decades, 5-year survival rates for childhood cancer currently are >80%. However, by virtue of their disease and its treatments, childhood cancer survivors are at increased risk for a wide range of serious health conditions, including disorders of the endocrine system. Recent data indicate that 40% to 50% of survivors will develop an endocrine disorder during their lifetime. Risk factors for endocrine complications include both host (e.g., age, sex) and treatment factors (e.g., radiation). Radiation exposure to key endocrine organs (e.g., hypothalamus, pituitary, thyroid, and gonads) places cancer survivors at the highest risk of developing an endocrine abnormality over time; these endocrinopathies can develop decades following cancer treatment, underscoring the importance of lifelong surveillance. The following guideline addresses the diagnosis and treatment of hypothalamic-pituitary and growth disorders commonly encountered in childhood cancer survivors.
Collapse
Affiliation(s)
| | - Zoltan Antal
- Memorial Sloan-Kettering Cancer Center, New York, New York
- Weill Cornell Medicine and New York Presbyterian Hospital, New York, New York
| | | | | | | | | | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
| |
Collapse
|
7
|
Pereira MC, Pereira JS, Dias D, Donato S, Salgado D. Endocrine Health Problems Detected in 764 Patients Evaluated in a Late Effects Clinic. Case Rep Oncol 2017; 10:958-963. [PMID: 29279699 PMCID: PMC5731110 DOI: 10.1159/000480494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 11/21/2022] Open
Abstract
Background Many pediatric cancer survivors have endocrine conditions. After treatment with alkylating agents, steroids, methotrexate, and radiation, several endocrine dysfunctions may appear. Surveillance for late effects is recommended by guidelines worldwide. Objective The objective of this study was to describe the endocrine outcomes of 764 patients followed during a 20 years' period in our out-patient clinic. Design We retrospectively reviewed the medical records. Patients The study included 764 patients whose oncological or hematological dangerous diseases appeared before they were 18 years old. Larger groups were constituted by leukemias, central nervous tumors, and lymphomas. Outcome Measures The frequency and types of endocrine conditions were analyzed. Results 1,091 endocrine conditions were observed in all groups. The most common types of endocrine conditions were problems with growth and the thyroid. We found puberty abnormalities and bone problems in third and fourth places of frequency. ACTH insufficiency was found in seventh place. Conclusion Endocrine dysfunctions are very common in survivor populations. Endocrinologists should be aware of international guidelines and make an effort to optimize screening and treatment of endocrine effects of cancer therapy. The crucial period is the puberty with growth spurt failure and accelerated maturity both of which can bring future social and professional difficulties.
Collapse
Affiliation(s)
- Maria Conceição Pereira
- *Maria Conceição Pereira, MD, Endocrine Department, Portuguese Cancer Institute FG, Rua Prof. Lima Basto, PT-1099-023 Lisbon (Portugal), E-Mail
| | | | | | | | | |
Collapse
|
8
|
Long TM, Rath SR, Maroni TD, Wallman KE, Atkinson HC, Gottardo NG, Cole CH, Choong CS, Naylor LH. Fitness, body composition and vascular health in adolescent and young adult survivors of paediatric brain cancer and cranial radiotherapy. Int J Adolesc Med Health 2017; 31:/j/ijamh.ahead-of-print/ijamh-2017-0082/ijamh-2017-0082.xml. [PMID: 28930627 DOI: 10.1515/ijamh-2017-0082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/19/2017] [Indexed: 06/07/2023]
Abstract
Background Survivors of paediatric brain cancer and/or cranial radiotherapy (CRT) are at an increased risk of developing serious comorbidities. Established risk factors for chronic disease include central obesity, endothelial abnormalities and diminished fitness. Objectives Here we characterised anthropometry, body composition, bone mineral density (BMD), heart rate (HR), blood pressure (BP), endothelial function, muscular strength and endurance and aerobic fitness in adolescent and young adult (AYA) survivors. Methods Twenty survivors (10 male, 10 female; 20 ± 2 years) were compared with 19 matched controls. Muscular strength was assessed using three repetition maximum tests, while muscular endurance was determined as number of repetitions performed per minute. Peak oxygen uptake (VO2 peak) was assessed on a treadmill using a modified chronotropic protocol. Anthropometric measurements, HR and BP were taken using standard clinical protocols, while body composition and BMD were determined using dual X-ray absorptiometry (DXA). Endothelial function was measured using the flow mediated dilation technique. Results Survivors demonstrated deficits in muscular strength (latissimus dorsi pull-down, p = 0.020; bicep curl, p = 0.009), muscular endurance (squats, p = 0.012; sit-ups, p = 0.030; push-ups, p = 0.013), minute ventilation at peak exericse (p = 0.002) and VO2peak (L/min, p = 0.002; mL/kg/min, p = 0.008; mL/kg LBM/min, p = 0.010). Additionally, survivors had greater waist-to-hip ratios (p = 0.032), resting HR (p = 0.048) and higher percentage of total body (p = 0.017), central (p = 0.009) and peripheral (p = 0.032) fat. Lean body mass (p = 0.004) and BMD (p = 0.005) were lower in the survivor group. Conclusion AYA survivors of paediatric brain cancer and/or CRT exhibit altered body composition, increased resting HR and reduced BMD, muscular strength, muscular endurance and cardiorespiratory fitness compared to controls.
Collapse
Affiliation(s)
- Treya M Long
- The University of Western Australia, School of Human Sciences, Exercise and Sport Science, Perth, Australia
| | - Shoshana R Rath
- Princess Margaret Hospital, Department of Endocrinology, Perth, Australia
- The University of Western Australia, School of Paediatrics and Child Health, Perth, Australia
| | - Tessa D Maroni
- The University of Western Australia, School of Human Sciences, Exercise and Sport Science, Perth, Australia
| | - Karen E Wallman
- The University of Western Australia, School of Human Sciences, Exercise and Sport Science, Perth, Australia
| | - Helen C Atkinson
- The University of Western Australia, School of Paediatrics and Child Health, Perth, Australia
| | - Nicholas G Gottardo
- The University of Western Australia, School of Paediatrics and Child Health, Perth, Australia
- Princess Margaret Hospital, Department of Haematology and Oncology, Perth, Australia
- Telethon Kids Institute, Perth, Australia
| | - Catherine H Cole
- The University of Western Australia, School of Paediatrics and Child Health, Perth, Australia
- Princess Margaret Hospital, Department of Haematology and Oncology, Perth, Australia
- Telethon Kids Institute, Perth, Australia
- Path West Laboratory Services, Department of Haematology, Perth, Australia
| | - Catherine S Choong
- Princess Margaret Hospital, Department of Endocrinology, Perth, Australia
- The University of Western Australia, School of Paediatrics and Child Health, Perth, Australia
| | - Louise H Naylor
- The University of Western Australia, School of Human Sciences, Exercise and Sport Science, Perth, Australia
| |
Collapse
|
9
|
Batra A, Patekar M, Bakhshi S. Short stature in retinoblastoma survivors: a cross-sectional study of 138 patients. Clin Transl Oncol 2015; 18:381-4. [PMID: 26286069 DOI: 10.1007/s12094-015-1380-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/05/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Short stature has been reported in pediatric cancer survivors. Data on retinoblastoma survivors are limited. We conducted a cross-sectional study to assess the height in retinoblastoma survivors. METHOD The recorded height was compared with median height for age and sex as per the Indian Academy of Pediatrics. Z-score less than -2 was considered short statured. RESULT Thirty percent of the survivors were short statured. The mean height was shorter than the mean 50th percentile height (119.7 ± 14.8 vs 128.7 ± 15 cm, p < 0.001). Previous chemotherapy showed a trend toward association (p = 0.09). CONCLUSION Short stature affects a significant number of retinoblastoma survivors.
Collapse
Affiliation(s)
- A Batra
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - M Patekar
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - S Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, India.
| |
Collapse
|
10
|
Chae HW, Kim DH, Kim HS. Growth hormone treatment and risk of malignancy. KOREAN JOURNAL OF PEDIATRICS 2015; 58:41-6. [PMID: 25774194 PMCID: PMC4357770 DOI: 10.3345/kjp.2015.58.2.41] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 11/06/2014] [Indexed: 11/27/2022]
Abstract
Growth hormone (GH) treatment has been increasingly widely used for children with GH deficiencies as the survival rate of pediatric patients with malignancies has increased. Both GH and insulin-like growth factor-I have mitogenic and antiapoptotic activity, prompting concern that GH treatment may be associated with tumor development. In this review, the authors examined the relationship between GH treatment and cancer risk in terms of de novo malignancy, recurrence, and secondary neoplasm. Although the results from numerous studies were not entirely consistent, this review of various clinical and epidemiological studies demonstrated that there is no clear evidence of a causal relationship between GH treatment and tumor development. Nonetheless, a small number of studies reported that childhood cancer survivors who receive GH treatment have a small increased risk of developing de novo cancer and secondary malignant neoplasm. Therefore, regular follow-ups and careful examination for development of cancer should be required in children who receive GH treatment. Continued surveillance for an extended period is essential for monitoring long-term safety.
Collapse
Affiliation(s)
- Hyun-Wook Chae
- Department of Pediatrics, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | | | - Ho-Seong Kim
- Department of Pediatrics, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
11
|
Wilson CL, Gawade PL, Ness KK. Impairments that influence physical function among survivors of childhood cancer. CHILDREN (BASEL, SWITZERLAND) 2015; 2:1-36. [PMID: 25692094 PMCID: PMC4327873 DOI: 10.3390/children2010001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/18/2014] [Indexed: 11/29/2022]
Abstract
Children treated for cancer are at increased risk of developing chronic health conditions, some of which may manifest during or soon after treatment while others emerge many years after therapy. These health problems may limit physical performance and functional capacity, interfering with participation in work, social, and recreational activities. In this review, we discuss treatment-induced impairments in the endocrine, musculoskeletal, neurological, and cardiopulmonary systems and their influence on mobility and physical function. We found that cranial radiation at a young age was associated with broad range of chronic conditions including obesity, short stature, low bone mineral density and neuromotor impairments. Anthracyclines and chest radiation are associated with both short and long-term cardiotoxicity. Although numerous chronic conditions are documented among individuals treated for childhood cancer, the impact of these conditions on mobility and function are not well characterized, with most studies limited to survivors of acute lymphoblastic leukemia and brain tumors. Moving forward, further research assessing the impact of chronic conditions on participation in work and social activities is required. Moreover, interventions to prevent or ameliorate the loss of physical function among children treated for cancer are likely to become an important area of survivorship research.
Collapse
Affiliation(s)
- Carmen L. Wilson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, MS-735 Memphis, TN 38105, USA; E-Mails: (P.L.G.); (K.K.N.)
| | | | | |
Collapse
|
12
|
Final height and insulin-like growth factor-1 in children with medulloblastoma treated with growth hormone. Childs Nerv Syst 2013; 29:1859-63. [PMID: 23775040 DOI: 10.1007/s00381-013-2124-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Medulloblastoma is a highly malignant childhood brain tumor. Survival from medulloblastoma is increasing. This study was performed to examine growth outcomes, insulin-like growth factor-1(IGF-1), and response to growth hormone (GH) treatment in children with medulloblastoma. METHODS Retrospective analysis of 34 children treated with GH for medulloblastoma was performed. We evaluated serum IGF-1 and insulin-like growth factor binding protein-3 concentrations. Further, we examined growth status and changes with GH treatment according to treatment modality. RESULTS GH deficiency was observed in 28 patients (82 %). The initial height at the start of GH treatment was -2.35 ± -1.53 standard deviation score (SDS) and increased to -1.85 ± -1.28 SDS by 1 year, -1.64 ± -1.46 SDS by 2 years, and -1.42 ± -1.49 SDS by 3 years after GH treatment. The final height was -1.54 ± -1.06 SDS. Gender, surgical method, tumor location, tumor size, and type of radiation did not correlate with height gain. A younger age at the initiation of GH treatment correlated with height gain. The initial serum IGF-1 concentration was -1.73 ± -0.42 and increased significantly to -0.74 ± -0.21 SDS by 1 year after GH treatment. The serum IGF-1 SDS increment correlated significantly with height gain. CONCLUSIONS Beginning GH treatment at a younger age was an important prognostic factor for growth outcome. Serum IGF-1 increment correlated with height gain during GH treatment. Thus, early GH treatment and analysis of serum IGF-1 might be helpful for improving final height or growth outcome.
Collapse
|
13
|
Berendsen AJ, Groot Nibbelink A, Blaauwbroek R, Berger MY, Tissing WJE. Second cancers after childhood cancer--GPs beware! Scand J Prim Health Care 2013; 31:147-52. [PMID: 23906108 PMCID: PMC3750436 DOI: 10.3109/02813432.2013.824152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND One of the long-term effects in childhood cancer survivors (CCS) is the development of second cancers. In a cohort of CCS, this study describes how second cancers were presented, the way they were diagnosed, and the knowledge CCS had about their increased risk to develop a second cancer. PATIENTS AND METHODS Selected participants were all adult five-year CCS (n = 1275) who were treated at the University Medical Center Groningen since 1965. Of these, 84 (6.6%) had developed a second cancer, of which 27 had died. The 57 survivors were asked to participate in a telephone interview. RESULTS Of the 57 CCS, 35 (61%) participated. Together they had developed 45 second cancers. Most participants (97%) were seen at the long-term follow-up clinic. Of all second cancers, 89% caused symptoms. Of all second cancers, the majority (56%) were first presented at the general practitioner's (GP's) office and 20% at follow-up testing. Of these CCS, only 28% were aware of their increased risk of developing a second cancer. CONCLUSIONS It is important to inform CCS continuously regarding their increased risk, as a relatively small percentage are aware of this. Since most of these patients first reported their symptoms to the GP, all GPs should be aware of this increased risk, in particular because this concerns cancer at a younger age than normally expected. A survivor care plan might be an effective way of communication with both CCS and GPs.
Collapse
Affiliation(s)
- A J Berendsen
- Department of General Practice, University of Groningen, University Medical Center Groningen, the Netherlands.
| | | | | | | | | |
Collapse
|
14
|
Sieswerda E, Mulder RL, van Dijk IWEM, van Dalen EC, Knijnenburg SL, van der Pal HJH, Mud MS, Heinen RC, Caron HN, Kremer LCM. The EKZ/AMC childhood cancer survivor cohort: methodology, clinical characteristics, and data availability. J Cancer Surviv 2013; 7:439-54. [PMID: 23625157 DOI: 10.1007/s11764-013-0283-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/25/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE Childhood cancer survivors are at high risk of late adverse effects of cancer treatment, but there are still many gaps in evidence about these late effects. We described the methodology, clinical characteristics, data availability, and outcomes of our cohort study of childhood cancer survivors. METHODS The Emma Children's Hospital/Academic Medical Center (EKZ/AMC) childhood cancer survivor cohort is an ongoing single-center cohort study of ≥5-year childhood cancer survivors, which started in 1996 simultaneously with regular structured medical outcome assessments at our outpatient clinic. RESULTS From 1966 to 2003, 3,183 eligible children received primary cancer treatment in the EKZ/AMC, of which 1,822 (57.2 %) survived ≥5 years since diagnosis. Follow-up time ranged from 5.0 to 42.5 years (median, 17.7). Baseline primary cancer treatment characteristics were complete for 1,781 (97.7 %) survivors, and 1,452 (79.7 %) survivors visited our outpatient clinic. Baseline characteristics of survivors who visited the clinic did not differ from those without follow-up. Within our cohort, 54 studies have been conducted studying a wide range of late treatment-related effects. CONCLUSIONS The EKZ/AMC childhood cancer survivor cohort provides a strong structure for ongoing research on the late effects of childhood cancer treatment and will continuously contribute in reducing evidence gaps concerning risks and risk groups within this vulnerable population. IMPLICATIONS FOR CANCER SURVIVORS Our large cohort study of childhood cancer survivors with complete baseline characteristics and unique, long-term medical follow-up decreases gaps in evidence about specific risks of late effects and high-risk groups, with the ultimate goal of improving the quality of care for childhood cancer survivors.
Collapse
Affiliation(s)
- E Sieswerda
- Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Knijnenburg S, Raemaekers S, van den Berg H, van Dijk I, Lieverst J, van der Pal H, Jaspers M, Caron H, Kremer L, van Santen H. Final height in survivors of childhood cancer compared with Height Standard Deviation Scores at diagnosis. Ann Oncol 2013; 24:1119-26. [DOI: 10.1093/annonc/mds580] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
16
|
Gnaneswaran S, Deans R, Cohn RJ. Reproductive late effects in female survivors of childhood cancer. Obstet Gynecol Int 2012; 2012:564794. [PMID: 22619680 PMCID: PMC3352687 DOI: 10.1155/2012/564794] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 12/27/2011] [Accepted: 01/25/2012] [Indexed: 01/18/2023] Open
Abstract
Childhood cancer treatments can cause female reproductive late effects. Radiation to the hypothalamic-pituitary-ovarian axis is associated with altered menarche, miscarriage, and implantation failure. Patients who receive chemotherapy and/or ovarian radiation are at risk of premature ovarian failure; the risk increases with increasing radiation dose, alkylating agent score, combination therapy, and older age at treatment. Ovarian reserve may be assessed using antimullerian hormone assay and ultrasound measurements of ovarian volume and antral follicle count; however, their efficacy is poorly established in this cohort. Fertility preservation options including cryopreservation, oophoropexy, and gonadotropin-releasing hormone analogues may be initiated prior to treatment, although most are still considered experimental. Uterine radiation has been linked to pregnancy complications including miscarriage, premature delivery, stillbirth, low-birth-weight and small-for-gestational-age infants. This paper summarises the literature on female reproductive late effects. The information should facilitate counseling and management of female survivors throughout their reproductive lives.
Collapse
Affiliation(s)
| | - Rebecca Deans
- University of New South Wales, Sydney, NSW 2052, Australia
- Royal Hospital for Women, Barker Street, Randwick, NSW 2031, Australia
- Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, High Street, Randwick, NSW 2031, Australia
| | - Richard J. Cohn
- University of New South Wales, Sydney, NSW 2052, Australia
- Centre for Children's Cancer and Blood Disorders, Sydney Children's Hospital, High Street, Randwick, NSW 2031, Australia
| |
Collapse
|
17
|
Patterson BC, Wasilewski-Masker K, Ryerson AB, Mertens A, Meacham L. Endocrine health problems detected in 519 patients evaluated in a pediatric cancer survivor program. J Clin Endocrinol Metab 2012; 97:810-8. [PMID: 22188743 DOI: 10.1210/jc.2011-2104] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Many pediatric cancer survivors have endocrine conditions. Surveillance for late effects is recommended by national guidelines. Endocrine surveillance is recommended after alkylating agents, steroids, methotrexate, and radiation. OBJECTIVE The objective of the study was to describe the endocrine outcomes in patients followed up in a program that uses national screening guidelines. DESIGN The design of the study was a medical records review. SETTING The study was conducted in the Comprehensive Cancer Survivor Program, an academic pediatric oncology program. PARTICIPANTS The study included 519 pediatric and young adult survivors of noncentral nervous system childhood malignancies between January 1, 2001, and December 15, 2005. INTERVENTION Patients were evaluated with history, physical examinations, and evaluations recommended in the Children's Oncology Group's Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers. OUTCOME MEASURES The frequency and types of endocrine conditions were measured. RESULTS Four hundred eighty endocrine conditions were observed in 299 survivors (57.6% of survivors). The most common types of endocrine conditions were problems with weight and gonadal function. In a Cox regression model, stem cell transplant, radiation, and older age at cancer diagnosis were associated with higher hazard of an endocrine condition. Radiation, stem cell transplant, and sarcoma diagnosis were associated with growth problems. CONCLUSIONS Endocrine disorders were common after pediatric cancers. Endocrinologists should be aware of national guidelines, anticipate referral of pediatric cancer survivors, and participate in further research to optimize screening for and treatment of endocrine effects of cancer therapy.
Collapse
Affiliation(s)
- Briana C Patterson
- Emory University School of Medicine, Department of Pediatrics, M.S., Emory Children's Center, 2015 Uppergate Drive, Suite 232 NE, Atlanta, Georgia 30322, USA.
| | | | | | | | | |
Collapse
|
18
|
Late effects and quality of life of childhood cancer survivors: Part 2. Impact of radiotherapy. Int J Hematol 2010; 92:95-104. [DOI: 10.1007/s12185-010-0611-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 05/21/2010] [Accepted: 05/23/2010] [Indexed: 10/19/2022]
|
19
|
Schmidt KT, Larsen EC, Andersen CY, Andersen AN. Risk of ovarian failure and fertility preserving methods in girls and adolescents with a malignant disease. BJOG 2009; 117:163-74. [DOI: 10.1111/j.1471-0528.2009.02408.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
20
|
Abstract
Over the last 4 decades, there has been a tremendous improvement in survival of children diagnosed with cancer, with 5-year survival rates now averaging 80%. The rapidly growing population of childhood cancer survivors creates an obligation to understand the health and well being of these individuals. Use of cancer therapy at an early age can produce a large burden of morbidity, as demonstrated quite conclusively by the fact that approximately two thirds of these survivors will experience at least one late effect, and approximately one third will experience a late effect, that is, severe or life threatening. Long-term complications in childhood cancer survivors, such as impairment in growth and development, neurocognitive dysfunction, cardiopulmonary compromise, endocrine dysfunction, renal impairment, gastrointestinal dysfunction, musculoskeletal sequelae, and second cancers, are related not only to the specific therapy used, but may also be determined by individual host characteristics. This review provides an update of the known late effects observed in childhood cancer survivors to provide the rationale for evaluation of specific long-term problems in this growing population of individuals at risk for chronic health conditions.
Collapse
|
21
|
Armstrong GT, Whitton JA, Gajjar A, Kun LE, Chow EJ, Stovall M, Leisenring W, Robison LL, Sklar CA. Abnormal timing of menarche in survivors of central nervous system tumors: A report from the Childhood Cancer Survivor Study. Cancer 2009; 115:2562-70. [PMID: 19309737 DOI: 10.1002/cncr.24294] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Children who receive high-dose radiotherapy to the hypothalamic-pituitary (H-P) axis may be at risk for both early and late puberty. To the authors' knowledge, data regarding the risk of altered timing of menarche after higher dose radiotherapy (RT), as used in the treatment of central nervous system (CNS) tumors, are limited. METHODS The authors evaluated 235 female survivors of CNS tumors, diagnosed between 1970 and 1986, and >1000 sibling controls who were participants in the Childhood Cancer Survivor Study, and provided self-reported data concerning age at menarche. RESULTS Survivors of CNS tumors were more likely to have onset of menarche before age 10 years compared with their siblings (11.9% vs 1.0%) (odds ratio [OR], 14.1; 95% confidence interval [95% CI], 7.0-30.9). Of the 138 survivors who received RT to the H-P axis, 20 (14.5%) had onset of menarche before age 10 years, compared with 4.3% of those who did not receive RT (OR, 3.8; 95% CI, 1.2-16.5). Age <or=4 years at the time of diagnosis was associated with an increased risk (OR, 4.0; 95% CI, 1.7-10.0) of early menarche. In addition, survivors of CNS tumors were more likely than siblings to have onset of menarche after age 16 years (10.6% vs 1.9%) (OR, 6.6; 95% CI, 3.4-11.4). Doses of RT to the H-P axis >50 gray OR, 9.0; 95% CI, 2.3-59.5) and spinal RT conferred an increased risk of late menarche, as did older age (>10 years) at the time of diagnosis (OR, 3.0; 95% CI, 1.3-7.0). CONCLUSIONS Survivors of CNS tumors are at a significantly increased risk of both early and late menarche associated with RT exposure and age at treatment.
Collapse
Affiliation(s)
- Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Sheinfeld Gorin S, McAuliffe P. Implications of childhood cancer survivors in the classroom and the school. HEALTH EDUCATION 2008. [DOI: 10.1108/09654280910923363] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
23
|
Abstract
The last four decades have seen tremendous improvements in the survival of children diagnosed with cancer, with 5-year survival rates now at 80%. The burgeoning population of childhood cancer survivors creates an obligation to understand the health and well-being of these individuals. The use of cancer therapy at an early age can produce complications that may not become apparent until years later; it has been demonstrated quite conclusively that approximately two thirds of these survivors will experience at least one late effect and about one third will experience a late effect that is severe or life threatening. Long-term complications in childhood cancer survivors, such as impairment in growth and development, neurocognitive dysfunction, cardiopulmonary compromise, endocrine dysfunction, renal impairment, gastrointestinal dysfunction, musculoskeletal sequelae, and subsequent malignancies, are not only related to the specific therapy employed, but may also be determined by individual host characteristics. This review describes some of the known late effects described in childhood cancer survivors in order to suggest reasonable starting points for evaluation of specific long-term problems in this unique and growing population.
Collapse
Affiliation(s)
- Wendy Landier
- Department of Population Sciences, City of Hope Cancer Center, Duarte, California 91010, USA
| | | |
Collapse
|
24
|
Kunos CA, Dobbins DC, Kulasekere R, Latimer B, Kinsella TJ. Comparison of Helical Tomotherapy versus Conventional Radiation to Deliver Craniospinal Radiation. Technol Cancer Res Treat 2008; 7:227-33. [DOI: 10.1177/153303460800700308] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to investigate whether helical tomotherapy would better dose-limit growing vertebral ring apophyses during craniospinal radiation as compared to conventional techniques. Four pediatric patients with M0 medulloblastoma received tomotherapy craniospinal radiation (23.4 Gy, 1.8 Gy/fx) by continuous helical delivery of 6 MV photons. Weekly blood counts were monitored. For comparison, conventional craniospinal radiation plans were generated. To assist in tomotherapy planning, a cross-sectional growth study of 52 children and young adults was completed to evaluate spine growth and maturation. Vertebral ring apophyses first fused along the posterolateral body-pedicle synostosis, proceeding circumferentially toward the anterior vertebral body such that the cervical and lumbar vertebrae fused early and mid-thoracic vertebrae fused late. For the four pediatric patients, tomotherapy resulted between 2% and 14% vertebral volume exceeding 23 Gy. Conventional craniospinal radiation predicted between 33% and 44% exceeding 23 Gy. Cumulative body radiation doses exceeding 4 Gy were between 50% and 57% for tomotherapy and between 25% and 37% for conventional craniospinal radiation. Tomotherapy radiation reduced neutrophil, platelet, and erythrocyte hemoglobin levels during treatment. Tomotherapy provides improved dose avoidance to growing vertebrae as compared to conventional craniospinal radiation. However, the long-term effects of tomotherapy dose avoidance on spine growth and large volume low dose radiation in children are not yet known.
Collapse
Affiliation(s)
- Charles A. Kunos
- Department of Radiation Oncology CASE Comprehensive Cancer Center and Case Western Reserve University 11100 Euclid Avenue Cleveland, Ohio 44106-6068, USA
- Laboratory of Physical Anthropology The Cleveland Museum of Natural History 1 Wade Oval Cleveland, Ohio 44106, USA
| | - Donald C. Dobbins
- Department of Radiation Oncology CASE Comprehensive Cancer Center and Case Western Reserve University 11100 Euclid Avenue Cleveland, Ohio 44106-6068, USA
| | - Ravi Kulasekere
- Department of Radiation Oncology CASE Comprehensive Cancer Center and Case Western Reserve University 11100 Euclid Avenue Cleveland, Ohio 44106-6068, USA
| | - Bruce Latimer
- Laboratory of Physical Anthropology The Cleveland Museum of Natural History 1 Wade Oval Cleveland, Ohio 44106, USA
| | | |
Collapse
|
25
|
Chow EJ, Friedman DL, Yasui Y, Whitton JA, Stovall M, Robison LL, Sklar CA. Timing of menarche among survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study. Pediatr Blood Cancer 2008; 50:854-8. [PMID: 17729247 DOI: 10.1002/pbc.21316] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objective of this study was to determine risk factors associated with abnormal timing of menarche among survivors of childhood acute lymphoblastic leukemia (ALL). PROCEDURE Self-reported age of menarche was determined among 949 female ALL survivors participating in the Childhood Cancer Survivor Study (CCSS), a cohort of 5-year survivors of common pediatric cancers diagnosed from 1970 to 1986, and compared with 1,128 siblings. RESULTS The majority of survivors (92%) and siblings (97%) reported menarche between the ages of 10 and 16. Survivors treated with chemotherapy alone, including those exposed to alkylating agents, experienced menarche at a similar rate to siblings. However, compared to chemotherapy alone, cranial radiotherapy was associated with early menarche (age < 10; OR 6.2, 95% CI 2.1, 18.5) while craniospinal radiotherapy was associated with both early (OR 8.6, 95% CI 1.9, 38.6) and late (age > 16; OR 4.8, 95% CI 1.4, 16.7) menarche. There were no differences in effect between <20 and >/=20 Gy radiotherapy doses. In multivariable analysis, younger age at diagnosis was an independent risk factor for early menarche. CONCLUSIONS Few female childhood ALL survivors experienced menarche outside of the normal range. Alkylating agent exposure was not associated with abnormal timing. However, those exposed to cranial and craniospinal radiotherapy, especially at a young age, should be monitored closely for abnormal timing of menarche.
Collapse
Affiliation(s)
- Eric J Chow
- Department of Pediatrics, University of Washington, Seattle, Washington, USA.
| | | | | | | | | | | | | |
Collapse
|
26
|
Ness KK, Gurney JG. Adverse Late Effects of Childhood Cancer and Its Treatment on Health and Performance. Annu Rev Public Health 2007; 28:279-302. [PMID: 17367288 DOI: 10.1146/annurev.publhealth.28.021406.144049] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
More than 12,000 newly diagnosed cases of cancer occur each year in the United States among children ages 20 years or younger, and the current 5-year survival rate is near 80%. An estimated 228,000 among adults 47 years or younger and currently living in the United States had a diagnosis of cancer during childhood or adolescence. Here, we review long-term adverse effects of childhood cancer and its treatment with an emphasis on physical performance and health. We also briefly review existing guidelines that may be used to develop appropriate exercise and diet interventions for childhood cancer survivors. We suggest that there is a need for development of evidence-based, risk-based guidelines and interventions for health promotion among long-term childhood cancer survivors, particularly for those whose physical activity limitations interfere with chances for optimizing their bodies' potential in today's society.
Collapse
Affiliation(s)
- Kirsten K Ness
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA.
| | | |
Collapse
|
27
|
Abstract
With modern therapies, most children diagnosed with cancer are expected to reach adulthood. Therefore, there are large and ever-increasing numbers of children and young adults in our population who are survivors of childhood cancer. Many of the therapies responsible for improved cancer survival rates can also damage normal cells and tissues. As more children survive cancer, the physical and emotional costs of enduring cancer therapy become increasingly important. Although most childhood cancer survivors are now expected to survive, they remain at risk for relapse, second malignant neoplasms, organ dysfunction, and a negative psychologic impact. Individual risk is quite variable and is dependent on multiple factors including the type and site of cancer, the therapy utilized, and the individual's constitution. The risks are likely to change as we learn more about the specific long-term effects of cancer therapy, develop more refined and targeted therapies, and develop and apply more effective preventative strategies or therapeutic interventions. Guidelines for long-term follow-up have been established and are available to help facilitate appropriate monitoring of and care for potential late effects.
Collapse
Affiliation(s)
- Robert E Goldsby
- Division of Pediatric Hematology/Oncology, University of California, San Francisco, USA.
| | | | | |
Collapse
|
28
|
Abstract
The past 3 decades have seen tremendous improvements in the survival of children diagnosed with cancer, with the 5-year survival rate approaching 80%. This improvement in survival has resulted in a growing population of childhood cancer survivors. Use of cancer therapy at an early age can produce complications that may not become apparent until years later. Approximately two thirds of the survivors of childhood cancer experience at least one late effect and about one fourth experience a late effect that is severe or life-threatening, although psychosocial issues in survivors and family members are often underestimated and may be more prevalent. Long-term complications in childhood cancer survivors, such as impairment in growth and development, neurocognitive dysfunction, cardiopulmonary compromise, endocrine dysfunction, renal impairment, gastrointestinal dysfunction, musculoskeletal sequelae, and subsequent malignancies, are related not only to the specific therapy used but also may be determined by individual host characteristics. We review the known late effects in survivors of childhood in order to suggest reasonable starting points for the evaluation of specific long-term problems in this unique but growing population.
Collapse
Affiliation(s)
- Smita Bhatia
- Division of Pediatric Hematology-Oncology and Hematopoietic Cell Transplantation, City of Hope Cancer Center, Duarte, California 91010, USA.
| | | |
Collapse
|
29
|
Abstract
Abstract
The last three decades have seen tremendous improvements in survival of children diagnosed with cancer, with the 5-year survival rate approaching 80%. This improvement in survival has resulted in a growing population of childhood cancer survivors. Use of cancer therapy at an early age can produce complications that may not become apparent until years later. Approximately two thirds of the survivors of childhood cancer will experience at least one late effect, and about one third will experience a late effect that is severe or life threatening. Long-term complications in childhood cancer survivors, such as impairment in growth and development, neurocognitive dysfunction, cardiopulmonary compromise, endocrine dysfunction, renal impairment, gastrointestinal dysfunction, musculoskeletal sequelae, and subsequent malignancies, are related not only to the specific therapy employed, but may also be determined by individual host characteristics. We review the known late effects of treatment in survivors of childhood cancer in order to suggest reasonable starting points for evaluation of specific long-term problems in this unique but growing population. The Children’s Oncology Group (COG) has developed risk-based, exposure-related guidelines for follow-up care that are available at www.surivorshipguidelines.org.
Collapse
Affiliation(s)
- Smita Bhatia
- City of Hope National Medical Center, Duarte, CA 91010, USA.
| |
Collapse
|
30
|
van den Bos C, Heinen RC, Sukel M, van der Pal HJH, Geenen MM. Screening for late effects in survivors of childhood cancer: growth hormone deficiency from a pediatric oncologist's point of view. Growth Horm IGF Res 2004; 14 Suppl A:S125-S128. [PMID: 15135793 DOI: 10.1016/j.ghir.2004.03.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
At the Emma Kinderziekenhuis/Academic Medical Center in Amsterdam, survivors of childhood cancer are screened annually or biennially for the occurrence of late treatment effects. The screening procedures are based on previously used treatment modalities. The data gathered at the outpatient clinic are registered in the database PLEKsys. Evaluation of the data concerning over 1000 cancer survivors screened since the start of the clinic once more illustrated the relation between cranial irradiation and the development of central endocrine abnormalities. Surprisingly, at least a proportion of the growth hormone (GH)-deficient cancer survivors were registered as not being on a replacement therapy regimen. The reasons for survivors not to be on replacement therapy are currently being evaluated. The late-effects outpatient clinic and the PLEKsys database provide a platform for additional research in fields including endocrinology, which should be aimed at improving the care for and the health status of the survivors of childhood cancer.
Collapse
Affiliation(s)
- C van den Bos
- Polikliniek Late Effecten Kindertumoren (PLEK) and Late Effects Study Group Emma Kinderziekenhuis/Academic Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
31
|
Xu W, Janss A, Packer RJ, Phillips P, Goldwein J, Moshang T. Endocrine outcome in children with medulloblastoma treated with 18 Gy of craniospinal radiation therapy. Neuro Oncol 2004; 6:113-8. [PMID: 15134625 PMCID: PMC1871981 DOI: 10.1215/s1152851703000462] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2003] [Accepted: 09/25/2003] [Indexed: 11/19/2022] Open
Abstract
Craniospinal radiation therapy (CSRT) combined with chemotherapy results in significant endocrine morbidity. Between 1987 and 1990, a trial using 18 Gy was conducted to treat 10 young children with medulloblastoma. There were 7 survivors. We compared the endocrine outcome in these children (group 18 Gy) to that of a comparable group treated with conventional doses of CSRT that ranged from 23 to 39 Gy (group CD). Both groups had an identical history of chemotherapy and tumor stage and were treated with recombinant growth hormone therapy (rhGH). The mean age of group 18 Gy at diagnosis was 4.0 years, and rhGH treatment was initiated in 6 children at age 9.2 years. Group CD (12 children) was diagnosed at a mean age of 5.8 years and rhGH started in 11 children at a mean age of 9.6 years. The dose of rhGH used in both groups was identical (0.3 mg/kg/wk). For group 18 Gy, adult heights and sitting heights (a mean standard deviation score of -1.01 +/- 1.11 and -1.62 +/- 1.16, respectively) were statistically greater (P < 0.05) than those for group CD (mean standard deviation score of -2.04 +/- 0.83 and -3.16 +/- 1.43, respectively). Moreover, adult heights of group 18 Gy were not different from midparental heights, unlike group CD, whose adult heights were less than midparental heights (P < 0.0001). Of other endocrine sequelae, 10 patients of the CD group were hypothyroid, 3 had adrenal insufficiency, 3 had hypogonadism, and 2 had early puberty. In contrast, within group 18 Gy, only 1 was hypothyroid (P = 0.006) and 1 had early puberty. We conclude that endocrine morbidity was significantly reduced with 18 Gy CSRT in young children with medulloblastoma.
Collapse
Affiliation(s)
- Weizhen Xu
- Divisions of Endocrinology (W.X., T.M.) and Neurology and Oncology (A.J., P.P.) and Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104; Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104 (J.G.); and Department of Neurology and Oncology, Children’s National Medical Center, The George Washington University, Washington, DC 20010 (R.J.P.); USA
| | - Anna Janss
- Divisions of Endocrinology (W.X., T.M.) and Neurology and Oncology (A.J., P.P.) and Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104; Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104 (J.G.); and Department of Neurology and Oncology, Children’s National Medical Center, The George Washington University, Washington, DC 20010 (R.J.P.); USA
| | - Roger J. Packer
- Divisions of Endocrinology (W.X., T.M.) and Neurology and Oncology (A.J., P.P.) and Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104; Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104 (J.G.); and Department of Neurology and Oncology, Children’s National Medical Center, The George Washington University, Washington, DC 20010 (R.J.P.); USA
| | - Peter Phillips
- Divisions of Endocrinology (W.X., T.M.) and Neurology and Oncology (A.J., P.P.) and Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104; Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104 (J.G.); and Department of Neurology and Oncology, Children’s National Medical Center, The George Washington University, Washington, DC 20010 (R.J.P.); USA
| | - Joel Goldwein
- Divisions of Endocrinology (W.X., T.M.) and Neurology and Oncology (A.J., P.P.) and Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104; Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104 (J.G.); and Department of Neurology and Oncology, Children’s National Medical Center, The George Washington University, Washington, DC 20010 (R.J.P.); USA
| | - Thomas Moshang
- Divisions of Endocrinology (W.X., T.M.) and Neurology and Oncology (A.J., P.P.) and Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104; Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104 (J.G.); and Department of Neurology and Oncology, Children’s National Medical Center, The George Washington University, Washington, DC 20010 (R.J.P.); USA
| |
Collapse
|
32
|
Ronckers CM, Land CE, Hayes RB, Verduijn PG, Stovall M, van Leeuwen FE. Late health effects of childhood nasopharyngeal radium irradiation: nonmelanoma skin cancers, benign tumors, and hormonal disorders. Pediatr Res 2002; 52:850-8. [PMID: 12438660 DOI: 10.1203/00006450-200212000-00007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nasopharyngeal radium irradiation (NRI) was widely used from 1940 through 1970 to treat otitis serosa in children and barotrauma in airmen and submariners. We assessed whether NRI-exposed individuals were at higher risk for benign tumors, nonmelanoma skin cancer, thyroid disorders, and conditions related to regulatory control of anterior pituitary hormones, such as growth and reproductive characteristics. We conducted a retrospective cohort study in 3,440 NRI-exposed and 3,088 nonexposed subjects, who as children were treated at nine ear, nose and throat clinics in The Netherlands between 1945 and 1981. Based on information from original medical records, we traced vital status through follow-up at municipal population registries. Disease status (including medical confirmation) and indicators of pituitary gland radiation damage were assessed from a self-administered questionnaire in 1997. The average radiation doses were 11, 7, and 1.5 cGy for pituitary, parotid, and thyroid gland, respectively, and 3.2 cGy for the facial skin. Among exposed subjects, 23 benign head and neck tumors were observed, compared with 21 among nonexposed subjects. Elevated risk of basal cell carcinoma of the head and neck area was observed in exposed subjects (odds ratio = 2.6; 95% confidence interval: 1.0-6.7). Exposed and nonexposed groups did not differ substantially with regard to thyroid disorders, height, and reproductive characteristics, although exposed males more frequently reported a history of fertility problems compared with nonexposed males (odds ratio = 1.4; 95% confidence interval: 1.0-2.1). We found no evidence of highly elevated risk of benign head and neck tumors, nonmelanoma skin cancer, thyroid disorders, or indicators of pituitary radiation damage after childhood NRI in The Netherlands.
Collapse
Affiliation(s)
- Cécile M Ronckers
- Department of Ear, Nose and Throat Medicine, Reinaert Kliniek, Maastricht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
33
|
Abstract
Chemotherapy and irradiation to the hypothalamic-pituitary-gonadal axis given for childhood cancer carry with them a risk of endocrine late effects. These treatment modalities are part of the treatment of common oncological diseases in childhood such as acute lymphoblastic leukaemia, brain tumours, Hodgkins lymphoma and solid tumours outside the central nervous system. Cranial irradiation of a prepubertal child can induce early or even precocious puberty, particularly in girls. Hypogonadotrophic hypogonadism may develop at a later stage. Irradiation of the gonads, as e.g. part of total body irradiation before bone marrow transplantation, will most likely cause gonadal failure and late, incomplete or absent puberty in girls. Many boys will experience a normal pubertal development except for small testes. Alkylating agents given for a variety of childhood cancers, are gonadotoxic. After high doses of these drugs, girls are at great risk of developing ovarian failure, whereas boys will usually go through puberty normally. Many children receive a combination of several treatment modalities, which complicates the prediction of pubertal development. Control and management of children with cancer at risk of having a disturbance of puberty is difficult and requires detailed knowledge of endocrinology as well as oncology. This chapter reviews the common treatments for the most frequent childhood cancers, the known effects of the therapy on pubertal development and provides outlines of control and management.
Collapse
Affiliation(s)
- Jørn Müller
- Department of Growth and Reproduction GR 5064, Rigshospitalet, 9 Blegdamsvej, DK-2100 Copenhagen Ø, Denmark
| |
Collapse
|