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Gan HW, Morillon P, Albanese A, Aquilina K, Chandler C, Chang YC, Drimtzias E, Farndon S, Jacques TS, Korbonits M, Kuczynski A, Limond J, Robinson L, Simmons I, Thomas N, Thomas S, Thorp N, Vargha-Khadem F, Warren D, Zebian B, Mallucci C, Spoudeas HA. National UK guidelines for the management of paediatric craniopharyngioma. Lancet Diabetes Endocrinol 2023; 11:694-706. [PMID: 37549682 DOI: 10.1016/s2213-8587(23)00162-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 08/09/2023]
Abstract
Although rare, craniopharyngiomas constitute up to 80% of tumours in the hypothalamic-pituitary region in childhood. Despite being benign, the close proximity of these tumours to the visual pathways, hypothalamus, and pituitary gland means that both treatment of the tumour and the tumour itself can cause pronounced long-term neuroendocrine morbidity against a background of high overall survival. To date, the optimal management strategy for these tumours remains undefined, with practice varying between centres. In light of these discrepancies, as part of a national endeavour to create evidence-based and consensus-based guidance for the management of rare paediatric endocrine tumours in the UK, we aimed to develop guidelines, which are presented in this Review. These guidelines were developed under the auspices of the UK Children's Cancer and Leukaemia Group and the British Society for Paediatric Endocrinology and Diabetes, with the oversight and endorsement of the Royal College of Paediatrics and Child Health using Appraisal of Guidelines for Research & Evaluation II methodology to standardise care for children and young people with craniopharyngiomas.
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Affiliation(s)
- Hoong-Wei Gan
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK.
| | - Paul Morillon
- King's College Hospital NHS Foundation Trust, London, UK
| | - Assunta Albanese
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Kristian Aquilina
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Chris Chandler
- King's College Hospital NHS Foundation Trust, London, UK
| | - Yen-Ching Chang
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Evangelos Drimtzias
- St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sarah Farndon
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Thomas S Jacques
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK
| | - Márta Korbonits
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Adam Kuczynski
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jennifer Limond
- Department of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Louise Robinson
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ian Simmons
- St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Nick Thomas
- King's College Hospital NHS Foundation Trust, London, UK
| | - Sophie Thomas
- Nottingham Children's Hospital, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicola Thorp
- The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, UK
| | - Faraneh Vargha-Khadem
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK
| | - Daniel Warren
- St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Bassel Zebian
- King's College Hospital NHS Foundation Trust, London, UK
| | - Conor Mallucci
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Maciel J, Dias D, Cavaco D, Donato S, Pereira MC, Simões-Pereira J. Growth hormone deficiency and other endocrinopathies after childhood brain tumors: results from a close follow-up in a cohort of 242 patients. J Endocrinol Invest 2021; 44:2367-2374. [PMID: 33683662 DOI: 10.1007/s40618-021-01541-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Brain tumors are the most common solid tumor in children. The prevalence of survivors from these cancers has been increasing, presenting endocrine sequelae in more than 40% of the cases. Our aim was to characterize the endocrinopathies diagnosed in this population, exploring the outcomes of growth hormone treatment. METHODS We have performed a retrospective analysis of the survivors that were followed-up through a close protocol at our endocrine late-effects clinic. RESULTS 242 survivors, followed during 6.4 (0-23.4) years, were considered. The median age at tumor diagnosis was 6.7 (0-18) years and pilocytic astrocytoma was the most frequent neoplasm (33.5%). The prevalence of endocrinopathies was of 71.5%, with growth hormone deficiency being the most frequent (52.9%). An indirect correlation between the age at the beginning of somatropin and growth velocity in the first year of treatment was observed. Those treated with craniospinal radiotherapy presented a smaller final upper/lower segments ratio comparing with those that only received cranial radiotherapy. However, their final height was not compromised when compared to their family height target. We found pubertal delay in 12%; accelerated/precocious puberty in 13.2%; central and primary hypogonadism in 21.9% and 3.3%, respectively; primary and central hypothyroidism in 23.6% and 14.5%, respectively; thyroid nodules in 7.4%; ACTH deficiency in 10.3% and diabetes insipidus in 12%. CONCLUSION This study reveals a higher prevalence of endocrinopathies in brain tumors survivors and explores the influence of craniospinal irradiation in the adult body proportions. It reinforces the importance of routine follow-up among survivors.
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Affiliation(s)
- J Maciel
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
| | - D Dias
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - D Cavaco
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - S Donato
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - M C Pereira
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - J Simões-Pereira
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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DeWire M, Fuller C, Hummel TR, Chow LML, Salloum R, de Blank P, Pater L, Lawson S, Zhu X, Dexheimer P, Carle AC, Kumar SS, Drissi R, Stevenson CB, Lane A, Breneman J, Witte D, Jones BV, Leach JL, Fouladi M. A phase I/II study of ribociclib following radiation therapy in children with newly diagnosed diffuse intrinsic pontine glioma (DIPG). J Neurooncol 2020; 149:511-522. [PMID: 33034839 DOI: 10.1007/s11060-020-03641-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/01/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Cyclin-dependent kinase-retinoblastoma (CDK-RB) pathway is dysregulated in some diffuse intrinsic pontine gliomas (DIPG). We evaluated safety, feasibility, and early efficacy of the CDK4/6-inhibitor ribociclib, administered following radiotherapy in newly-diagnosed DIPG patients. METHODS Following radiotherapy, eligible patients received ribociclib in 28-day cycles (350 mg/m2; 21 days on/7 days off). Feasibility endpoints included tolerability for at least 6 courses, and a less than 2-week delay in restarting therapy after 1 dose reduction. Early efficacy was measured by 1-year and median overall survival (OS). Patient/parent-by-proxy reported outcomes measurement information system (PROMIS) assessments were completed prospectively. RESULTS The study included 10 evaluable patients, 9 DIPG and 1 diffuse midline glioma (DMG)-all 3.7 to 19.8 years of age. The median number of courses was 8 (range 3-14). Three patients required dose reduction for grade-4 neutropenia, and 1 discontinued therapy for hematological toxicity following course 4. The most common grade-3/4 toxicity was myelosuppression. After 2 courses, MRI evaluations in 4 patients revealed increased necrotic volume, associated with new neurological symptoms in 3 patients. The 1-year and median OS for DIPG was 89% and 16.1 months (range 10-30), respectively; the DMG patient died at 6 months post-diagnosis. Five patients donated brain tissue and tumor; 3 were RB+ . CONCLUSIONS Ribociclib administered following radiotherapy is feasible in DIPG and DMG. Increased tumor necrosis may represent a treatment effect. These data warrant further prospective volumetric analyses of tumors with necrosis. Feasibility and stabilization findings support further investigation of ribociclib in combination therapies. TRIAL REGISTRATION NCT02607124.
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Affiliation(s)
- Mariko DeWire
- Division of Oncology, Department of Pediatrics College of Medicine, Brain Tumor Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7015, Cincinnati, OH, 45209, USA.
| | - Christine Fuller
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Trent R Hummel
- Division of Oncology, Department of Pediatrics College of Medicine, Brain Tumor Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7015, Cincinnati, OH, 45209, USA
| | - Lionel M L Chow
- Department of Hematology/Oncology, Dayton Children's Hospital, Dayton, OH, USA
| | - Ralph Salloum
- Division of Oncology, Department of Pediatrics College of Medicine, Brain Tumor Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7015, Cincinnati, OH, 45209, USA
| | - Peter de Blank
- Division of Oncology, Department of Pediatrics College of Medicine, Brain Tumor Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7015, Cincinnati, OH, 45209, USA
| | - Luke Pater
- Department of Radiation Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sarah Lawson
- Department of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Xiaoting Zhu
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Phil Dexheimer
- Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Adam C Carle
- Department of Pediatrics, Department of Psychology, College of Medicine University of Cincinnati, College of Arts and Sciences University of Cincinnati, Anderson Center Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shiva Senthil Kumar
- Division of Oncology, Department of Pediatrics College of Medicine, Brain Tumor Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7015, Cincinnati, OH, 45209, USA
| | - Rachid Drissi
- Division of Oncology, Department of Pediatrics College of Medicine, Brain Tumor Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7015, Cincinnati, OH, 45209, USA
| | - Charles B Stevenson
- Division of Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Adam Lane
- Department of Biostatistics, Cincinnati, OH, USA
| | - John Breneman
- Department of Radiation Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David Witte
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Blaise V Jones
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James L Leach
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Maryam Fouladi
- Division of Oncology, Department of Pediatrics College of Medicine, Brain Tumor Center, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7015, Cincinnati, OH, 45209, USA
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Quality of survival assessment in European childhood brain tumour trials, for children below the age of 5 years. Eur J Paediatr Neurol 2020; 25:59-67. [PMID: 31753708 DOI: 10.1016/j.ejpn.2019.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 10/03/2019] [Accepted: 10/12/2019] [Indexed: 11/23/2022]
Abstract
The highest incidence rate of childhood brain tumours is in children below the age of five years, who are particularly vulnerable to the effects of treatments. The assessment of quality of survival (QoS) in multiple domains is essential to compare the outcomes for different tumour types and treatment regimens. The aim of this position statement is to present the domains of health and functioning to be assessed in children from birth to five years, to advance the collection of a common QoS data set in European brain tumour trials. The QoS group of the European Society of Paediatric Oncology (SIOP-E) Brain Tumour group conducted consensus discussions over a period of six years to establish domains of QoS that should be prioritised in clinical trials involving children under 5 years. The domains of health and functioning that were agreed to affect QoS included: medical outcomes (e.g. vision, hearing, mobility, endocrine), emotion, behaviour, adaptive behaviour, and cognitive functioning. As for children aged five years and older, a 'core plus' approach is suggested in which core assessments are recommended for all clinical trials. The core component for children from birth to three years includes indirect assessment which, in this age-group, requires proxy assessment by a parent, of cognitive, emotional and behaviour variables and both direct and indirect endocrine measures. For children from four years of age direct cognitive assessment is also recommended as 'core'. The 'plus' components enable the addition of assessments which can be selected by individual countries and/or by, age-, treatment-, tumour type- and tumour location-specific trials.
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Yamane T, Kuji I, Seto A, Matsunari I. Quantification of osteoblastic activity in epiphyseal growth plates by quantitative bone SPECT/CT. Skeletal Radiol 2018; 47:805-810. [PMID: 29327129 DOI: 10.1007/s00256-017-2861-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/03/2017] [Accepted: 12/19/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Quantifying the function of the epiphyseal plate is worthwhile for the management of children with growth disorders. The aim of this retrospective study was to quantify the osteoblastic activity at the epiphyseal plate using the quantitative bone SPECT/CT. MATERIALS AND METHODS We enrolled patients under the age of 20 years who received Tc-99m hydroxymethylene diphosphonate bone scintigraphy acquired by a quantitative SPECT/CT scanner. The images were reconstructed by ordered subset conjugate-gradient minimizer, and the uptake on the distal margin of the femur was quantified by peak standardized uptake value (SUVpeak). A public database of standard body height was used to calculate growth velocities (cm/year). RESULTS Fifteen patients (6.9-19.7 years, 9 female, 6 male) were enrolled and a total of 25 legs were analyzed. SUVpeak in the epiphyseal plate was 18.9 ± 2.4 (average ± standard deviation) in the subjects under 15 years and decreased gradually by aging. The SUVpeak correlated significantly with the age- and sex-matched growth velocity obtained from the database (R2 = 0.83, p < 0.0001). CONCLUSION The SUV measured by quantitative bone SPECT/CT was increased at the epiphyseal plates of children under the age of 15 years in comparison with the older group, corresponding to higher osteoblastic activity. Moreover, this study suggested a correlation between growth velocity and the SUV. Although this is a small retrospective pilot study, the objective and quantitative values measured by the quantitative bone SPECT/CT has the potential to improve the management of children with growth disorder.
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Affiliation(s)
- Tomohiko Yamane
- Department of Nuclear Medicine, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, 350-1298, Japan.
| | - Ichiei Kuji
- Department of Nuclear Medicine, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, 350-1298, Japan
| | - Akira Seto
- Department of Nuclear Medicine, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, 350-1298, Japan
| | - Ichiro Matsunari
- Division of Nuclear Medicine, Department of Radiology, Saitama Medical University Hospital, Moroyama, Japan
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Lee J, Kim J, Yang A, Cho SY, Jin DK. Etiological trends in male central precocious puberty. Ann Pediatr Endocrinol Metab 2018; 23:75-80. [PMID: 29969878 PMCID: PMC6057022 DOI: 10.6065/apem.2018.23.2.75] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/24/2017] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In the present study, the etiological trends in male central precocious puberty (CPP) were examined, and annual distribution was evaluated. METHODS Seventy-one male CPP subjects who started puberty before 9 years of age were included in this study. All individuals were diagnosed as having CPP at Samsung Medical Center between 2001 and 2016. Chronological age at puberty onset, diagnosis of CPP, bone age, weight (kg), height (cm), puberty stage, brain magnetic resonance imaging findings, testosterone level, basal gonadotropin level, and gonadotropin level after gonadotropin releasing hormone stimulation were analyzed. RESULTS The 71 patients were divided into 2 groups: idiopathic (group I) and organic (group II) when the lesion was identified as associated with the central nervous system (CNS) or when the patient received chemotherapy for non-CNS tumors before CPP diagnosis, respectively. Forty-four cases (62%) were idiopathic, and 27 (38%) were organic. The proportion of idiopathic CPP was higher than that of organic CPP during the study period. In 51.9% of organic cases, puberty started before 8 years of age, whereas it started after that age in 93.2% of the idiopathic cases. CONCLUSION In the present study, among all male CPP cases, 62% were idiopathic. The probability of idiopathic CPP prevalence was higher in males when the puberty onset was after 8 years of age with no history of cranial radiotherapy or chemotherapy.
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Affiliation(s)
| | | | | | - Sung Yoon Cho
- Address for correspondence: Sung Yoon Cho, MD, PhD Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-6190-5227 Fax: +82-2-3410-0043 E-mail:
| | - Dong-Kyu Jin
- Address for correspondence: Sung Yoon Cho, MD, PhD Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-6190-5227 Fax: +82-2-3410-0043 E-mail:
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Bordbar MR, Haghpanah S, Dabbaghmanesh MH, Omrani GR, Saki F. Bone mineral density in children with acute leukemia and its associated factors in Iran: a case-control study. Arch Osteoporos 2016; 11:36. [PMID: 27785744 DOI: 10.1007/s11657-016-0290-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/18/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED Acute leukemia is the most common malignancy in children. We showed that low bone mass is prevalent among children with leukemia, especially in femur. Serum calcium, exercise, chemotherapy protocol, and radiotherapy are the main contributing factors. We suggest that early diagnosis and treatment of this problem could improve bone health in them. INTRODUCTION Acute leukemia is the most common malignancy in children and has been reported to be associated with low bone mass. Due to lack of sufficient data about the bone mineral density of children with leukemia in the Middle East, and inconsistencies between possible associated factors contributing to decreasing bone density in these children, we aimed to conduct a case-control study in Iran. MATERIALS AND METHODS This case-control study was conducted on 60 children with acute leukemia and 60 age- and sex-matched healthy controls. Anthropometric data, sun exposure, puberty, physical activity, and mineral biochemical parameters were assessed. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DEXA). Data analysis was done by SPSS software v. 21. RESULTS Serum calcium was higher in the control group (P = 0.012) while serum phosphorous, alkaline phosphatase, and serum 25(OH)D3 were higher in children with leukemia with P values of 0.04, 0.002, and 0.036, respectively. Sun exposure and physical activity were more in healthy controls (P values <0.001 and 0.003, respectively). Prevalence of vitamin D deficiency in case and control groups was 57.8 and 79.4 %, respectively. This prevalence was higher in healthy controls (P value = 0.007). Both lumbar and femoral neck bone mineral apparent density (BMAD) were higher in the control group (P value <0.001). Serum calcium, physical activity, and radiotherapy were the most relevant factors associated with lumbar BMAD. Femoral neck BMAD was associated with chemotherapy protocol. CONCLUSION Low bone mass for chronological age is prevalent among children with leukemia, especially in the femoral neck. Serum calcium, physical activity, chemotherapy protocol, and radiotherapy are the main contributing factors.
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Affiliation(s)
| | - Sezaneh Haghpanah
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Forough Saki
- Shiraz Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Lollert A, Gies C, Laudemann K, Faber J, Jacob-Heutmann D, König J, Düber C, Staatz G. Ultrasound Evaluation of Thyroid Gland Pathologies After Radiation Therapy and Chemotherapy to Treat Malignancy During Childhood. Int J Radiat Oncol Biol Phys 2015; 94:139-146. [PMID: 26545453 DOI: 10.1016/j.ijrobp.2015.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/01/2015] [Accepted: 09/14/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of this study was to evaluate correlations between treatment of malignancy by radiation therapy during childhood and the occurrence of thyroid gland pathologies detected by ultrasonography in follow-up examinations. METHODS AND MATERIALS Reductions of thyroid gland volume below 2 standard deviations of the weight-specific mean value, occurrence of ultrasonographically detectable thyroid gland pathologies, and hypothyroidism were retrospectively assessed in 103 children and adolescents 7 months to 20 years of age (median: 7 years of age) at baseline (1997-2013) treated with chemoradiation therapy (with the thyroid gland dose assessable) or with chemotherapy alone and followed by ultrasonography and laboratory examinations through 2014 (median follow-up time: 48 months). RESULTS A relevant reduction of thyroid gland volume was significantly correlated with thyroid gland dose in univariate (P<.001) and multivariate analyses for doses above 2 Gy. Odds ratios were 3.1 (95% confidence interval: 1.02-9.2; P=.046) for medium doses (2-25 Gy) and 14.8 (95% confidence interval: 1.4-160; P=.027) for high doses (>25 Gy). Thyroid gland dose was significantly higher in patients with thyroid gland pathologies during follow-up (P=.03). Univariate analysis revealed significant correlations between hypothyroidism and thyroid gland dose (P<.001). CONCLUSIONS Ultrasonographically detectable changes, that is, volume reductions, pathologies, and hypothyroidism, after malignancy treatment during childhood are associated with thyroid gland dose. Both ultrasonography and laboratory follow-up examinations should be performed regularly after tumor therapy during childhood, especially if the treatment included radiation therapy.
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Affiliation(s)
- André Lollert
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany.
| | - Christina Gies
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Katharina Laudemann
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Jörg Faber
- Department of Pediatrics and Adolescent Medicine, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Dorothee Jacob-Heutmann
- Department of Radio-oncology and Radiotherapy, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Jochem König
- Institute for Medical Biostatistics, Epidemiology and Informatics, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Gundula Staatz
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Barnes N, Chemaitilly W. Endocrinopathies in survivors of childhood neoplasia. Front Pediatr 2014; 2:101. [PMID: 25295241 PMCID: PMC4172013 DOI: 10.3389/fped.2014.00101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/06/2014] [Indexed: 01/26/2023] Open
Abstract
Advancements in cancer treatments have increased the number of survivors of childhood cancers. Endocrinopathies are common complications following cancer therapy and may occur decades later. The objective of the current review is to address the main endocrine abnormalities detected in childhood cancer survivors including disorders of the hypothalamic-pituitary axis, thyroid, puberty, gonads, bone, body composition, and glucose metabolism.
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Affiliation(s)
- Nicole Barnes
- Division of Pediatric Endocrinology, Department of Pediatric Medicine, St. Jude Children's Research Hospital , Memphis, TN , USA
| | - Wassim Chemaitilly
- Division of Pediatric Endocrinology, Department of Pediatric Medicine, St. Jude Children's Research Hospital , Memphis, TN , USA ; Epidemiology and Cancer Control, St. Jude Children's Research Hospital , Memphis, TN , USA
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Radiation Fibrosis Syndrome: Neuromuscular and Musculoskeletal Complications in Cancer Survivors. PM R 2011; 3:1041-54. [DOI: 10.1016/j.pmrj.2011.08.535] [Citation(s) in RCA: 125] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 07/13/2011] [Accepted: 08/18/2011] [Indexed: 11/16/2022]
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Baronio F, Battisti L, Radetti G. Central hypothyroidism following chemotherapy for acute lymphoblastic leukemia. J Pediatr Endocrinol Metab 2011; 24:903-6. [PMID: 22308840 DOI: 10.1515/jpem.2011.407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It has been suggested that chemotherapy per se might impair the hypothalamus-pituitary-thyroid axis of childhood cancer survivors. OBJECTIVE We examined six patients treated for acute lymphoblastic leukemia (ALL) with chemotherapy alone, with suspicious central hypothyroidism (CH). SUBJECTS AND METHODS ALL was diagnosed at a mean age of 3.8 years (range 0.3-6 years), the mean follow-up is 6 years (range 6-13 years). Auxological data were recorded, and thyroid function, autoimmunity and ultrasonography (US) were evaluated. Three individuals underwent a thyrotropin-releasing hormone (TRH) test and a magnetic resonance imaging (MRI) scan of the hypothalamic-pituitary region. RESULTS All study participants showed negative thyroid autoimmunity, normal thyroid ultrasound, and thyroid-stimulating hormone (TSH) above the normal range; free T4 (fT4) was abnormally low in two patients. After TRH infusion all patients showed TSH increase and slow TSH decline. CONCLUSIONS Our study shows that CH could arise at any time after childhood leukemia following only chemotherapy treatment. Although overt hypothyroidism was detected in only two patients, a careful follow-up of thyroid function is also recommended for ALL survivors not treated by irradiation.
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Affiliation(s)
- Federico Baronio
- Department of Pediatrics, Regional Hospital of Bolzano, Bolzano, Italy
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Zaletel LZ, Bratanic N, Jereb B. Gonadal Function in Patients Treated for Leukemia in Childhood. Leuk Lymphoma 2009; 45:1797-802. [PMID: 15223638 DOI: 10.1080/1042819042000219458] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ovarian and testicular function were assessed in 67 long-term survivors (37 females, 30 males) treated for leukemia between 1973 and 1992. At diagnosis they were 1-16 (median 5) years old and had evaluation of gonadal function 4-25 (median 13) years later at the age of 13-31 (median 19). All had been treated with various combinations of chemotherapy (ChT) (including cyclophosphamide (CYC) and cytarabine in 32 patients), 62 patients had received prophylactic cranial irradiation with 12-49 (median 18) Gy, 2 patients had had craniospinal irradiation with 24 and 10 Gy respectively. Nine patients were treated for relapse; 2 boys had testicular irradiation (RT) with 12 Gy in 3 fractions and 1 girl whole-abdomen RT with 20 Gy as a part of this treatment. Three patients were treated for second malignancies. Gonadal function was assessed by clinical examination and measurement of serum concentrations of estradiol and testosterone. Serum levels of LH and FSH were determined in basal state and after stimulation. Primary hypogonadism was found in 6 (9%) patients. Five (16,5%) males had primary hypogonadism with evidence of damage to the germinal epithelium, 2 of them, treated with testicular RT, had evidence of damage to the Leydig cells and 2 had evidence of dysfunction of Leydig cells as well. Primary hypogonadism was found in 1 female, who was heavily treated for relapse (ChT containing CYC, abdominal RT and craniospinal RT). She was amenorrhoic and needed substitutional estrogen therapy but delivered a child anyway. Five females had early puberty after cranial RT. One female had secondary hypogonadism and hyposomatotropism after cranial RT with 30 Gy, one male had hyposomatotropism after receiving cranial RT twice (49 Gy total). Primary treatment for leukemia does not produce primary hypogonadism in girls, but it does in boys. Alkylating agents and gonadal RT are the most damaging factors. Not only RT to gonads but also alkylating agents alone cause dysfunction of Leydig cells.
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Rohrer TR, Beck JD, Grabenbauer GG, Fahlbusch R, Buchfelder M, Dörr HG. Late endocrine sequelae after radiotherapy of pediatric brain tumors are independent of tumor location. J Endocrinol Invest 2009; 32:294-7. [PMID: 19636193 DOI: 10.1007/bf03345714] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Irradiation of brain tumors (BT) in children can lead to the loss of pituitary function, predominantly manifesting as deficiencies in GH and ACTH. OBJECTIVE To assess the incidence and nature of pituitary deficiency in relation to initial tumor location in children after radiotherapy of BT. METHODS Twenty survivors (16 males and 4 females) of radiation-treated BT aged 1.4-10.9 (median 3.6) yr at diagnosis were studied, 10 with supratentorial and 10 with infratentorial BT. Radiation doses to the hypothalamus- pituitary (HP) area ranged from 30 to 54 (median 45) Gray. Follow-up was 9.4-16.9 (median 12.2) yr. Basal pituitary hormone levels were measured every 6 months. When growth failure became evident or pituitary deficiency was suspected, provocation tests of the HP axis were performed to assess GH, ACTH, and TSH function. RESULTS GH deficiency (GHD) developed in 17/20 (85%) children. In 10 patients, it occurred 4 yr after radiotherapy and in 2, 11 and 12 yr after radiotherapy. Six (30%) patients developed secondary hypothyroidism and 4 (20%) developed ACTH deficiency. Precocious puberty occurred in 2 girls. The course of development and the severity of hormone deficiencies were similar for supratentorial and infratentorial tumors. CONCLUSION The major hormonal effect of BT irradiation in children is GHD, which may sometimes take more than 10 yr to manifest. We confirm findings by others that ACTH insufficiency occurs less frequently in children than reported for adults. Tumor location has no prognostic significance regarding the loss of HP function.
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Affiliation(s)
- T R Rohrer
- Department of Paediatrics and Adolescent Medicine, Saarland University Hospital, Homburg/Saar, Germany
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Thomas IH, Donohue JE, Ness KK, Dengel DR, Baker KS, Gurney JG. Bone mineral density in young adult survivors of acute lymphoblastic leukemia. Cancer 2009; 113:3248-56. [PMID: 18932250 DOI: 10.1002/cncr.23912] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The purpose of the current study was to determine the prevalence of low bone mineral density (BMD) (ie, osteopenia) and identify factors associated with low BMD in young adult survivors of childhood acute lymphoblastic leukemia (ALL). METHODS Dual energy x-ray absorptiometry was used to evaluate BMD in 74 randomly selected, long-term childhood ALL survivors initially treated in Minneapolis/St. Paul, Minnesota. Growth hormone (GH)-releasing hormone-arginine stimulation testing was conducted to evaluate peak GH level, and insulin-like growth factor I (IGF-I) and other markers of endocrine functioning were also evaluated in relation to BMD. RESULTS The mean age at the time of interview was 30 years, and the mean time since diagnosis was 24 years. Low BMD (Z-score, < or = -1) was present in 24% of subjects, including 1 with osteoporosis. Low BMD was substantially more prevalent in men than in women and was strongly associated with short height. The mean height Z-score for those with low BMD was -1.44, compared with a height Z-score of -0.39 (P < .01) for those with normal BMD. GH insufficiency, low IGF-I Z-score, and current smoking were also suggestive risk factors for low BMD. CONCLUSIONS In this long-term follow-up study of childhood ALL survivors, low BMD was found to be more prevalent than expected based on population normative data, specifically in men. The health consequences of early-onset BMD problems in childhood ALL survivors need to be carefully monitored.
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Affiliation(s)
- Inas H Thomas
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
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Madanat LMS, Lähteenmäki PM, Hurme S, Dyba T, Salmi TT, Sankila R. Hypothyroidism among pediatric cancer patients: A nationwide, registry-based study. Int J Cancer 2007; 122:1868-72. [DOI: 10.1002/ijc.23277] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Madanat LMS, Lähteenmäki PM, Alin J, Salmi TT. The natural history of thyroid function abnormalities after treatment for childhood cancer. Eur J Cancer 2007; 43:1161-70. [PMID: 17391953 DOI: 10.1016/j.ejca.2007.01.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Accepted: 01/15/2007] [Indexed: 12/01/2022]
Abstract
The aim of the study was to find out which of childhood cancer survivors are at higher risk of thyroid dysfunction, and the timeframe for its development. The consequences of different treatments, particularly chemotherapy, were of interest. Follow-up data for 291 patients from a cohort of 360 patients were available and analysed in this retrospective study. Impaired thyroid function occurred in 71/291 (24%) patients: brain tumours 30/65 (46%), Hodgkin's disease (HD) 10/21 (48%), leukaemia/non Hodgkin's lymphoma (NHL) 19/140 (14%) and others 12/65 (18%). Patients with brain tumours had a higher hazard ratio (HR) over leukaemia/NHL (HR 7.47) but not over HD (HR 1.57). These patients also developed thyroid hypofunction earlier than patients with HD or leukaemia/NHL. Age at diagnosis did not have an effect on the occurrence or timeframe of development of thyroid hypofunction. Radiotherapy (HR 4.68) and radiotherapy combined with chemotherapy (HR 2.90) were associated with a higher risk than chemotherapy alone. Chemotherapy added to radiotherapy tended to increase risk (HR 2.42 95% confidence interval (CI) 1.00-5.87). Craniospinal irradiation did not differ significantly from total body irradiation (TBI) (HR 1.09 95%CI 0.25-4.76) or direct thyroid irradiation (HR 0.81 95%CI 0.32-2.06), but cranial irradiation (CIR) (HR 0.18 95%CI 0.08-0.38) was less harmful to thyroid function. Girls were more prone to effects of irradiation (HR 2.10 95%CI 1.15-3.82). All treatments, excluding surgery, predispose to thyroid dysfunction. Suggestions for follow-up of thyroid function are made.
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Neville KA, Cohn RJ, Steinbeck KS, Johnston K, Walker JL. Hyperinsulinemia, impaired glucose tolerance, and diabetes mellitus in survivors of childhood cancer: prevalence and risk factors. J Clin Endocrinol Metab 2006; 91:4401-7. [PMID: 16954158 DOI: 10.1210/jc.2006-0128] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT Hyperinsulinism and its associated metabolic abnormalities, including diabetes mellitus (DM), have been reported in long-term survivors of childhood cancer, mainly after bone marrow transplant (BMT); however, the predisposing factors are unclear, and early markers have not been identified. METHODS The prevalence of overweight/obesity, abdominal adiposity and hyperinsulinemia (HI), impaired glucose tolerance (IGT), or DM was examined prospectively in 248 survivors of childhood cancer (36 prepubertal, 88 pubertal, and 124 adult subjects; 67 BMT) at a median of 12.9 yr (2.3-33.6) after diagnosis and compared with healthy controls. Potential risk factors for the development of HI, IGT, or DM were sought. RESULTS Overweight/obesity was not increased when comparing subjects with controls; however, the prevalence of abdominal adiposity in prepubertal and pubertal subjects was roughly doubled (P < or = 0.04). Fasting insulin concentrations were higher in prepubertal and pubertal subjects compared with their controls (P < 0.001) and were similar in adult and pubertal subjects. HI, IGT, or DM was detected in 39 of 212 (18%) pubertal or adult subjects (23 BMT). Ten of 88 (11%) pubertal and 14 of 124 (11%) adult subjects had IGT/DM (vs. 0 and 4.9% controls, respectively; P < 0.001). Total body irradiation, untreated hypogonadism, and abdominal adiposity emerged as independent risk factors for the development of HI, IGT, or DM in multivariate regression analysis. CONCLUSIONS The risk factors identified suggest the need for reconsideration of BMT protocols and regular screening of survivors. The increased prevalence of abdominal adiposity among prepubertal subjects, none of whom had developed HI/IGT/DM, suggests that a waist to height ratio greater than 0.5 has potential as a clinical screening tool.
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Affiliation(s)
- Kristen A Neville
- Department of Endocrinology, Sydney Children's Hospital, High Street Randwick, New South Wales 2031, Australia.
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19
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Abstract
In the past three decades, the survival for patients with medulloblastoma has improved remarkably. Contemporary "standard" therapy for children with medulloblastoma consists of maximal surgical resection followed by craniospinal irradiation with a boost to the posterior fossa, combined with adjuvant chemotherapy. The use of such multimodal therapeutic approaches results in progression-free survival (PFS) rates of 75% to 80% for patients with average-risk disease and approximately 60% for high-risk patients. However, despite the marked improvements in survival, many therapeutic challenges remain. Children with macroscopic metastatic disease (M2/M3) at presentation continue to fare poorly, with the best reports only attaining PFS rates up to 40%. Furthermore, despite intensive multimodal therapy, some patients have disease progression or recurrence, which for most remains incurable. The early recognition of these patients is imperative in order to institute treatment modifications, such as intensification and/or the use of novel experimental therapies. Additionally, the price for cure is clearly evident in survivors, who suffer from significant, often debilitating long-term neurocognitive and neuroendocrine sequela. Using the current clinical stratification system, a significant number of patients are overtreated and unnecessarily subjected to these long-term toxicities. This group of patients would benefit from reductions in therapy. Refinements in patient stratification and further improvement in outcome are unlikely to be achieved without improved knowledge of tumor biology. Several molecular alterations have already been identified, many of which appear to have prognostic significance. Furthermore, the disruption of molecular alterations in signaling pathways involved in the development and maintenance of medulloblastoma using novel molecularly targeted therapies promises to improve outcomes and reduce toxicity for patients with medulloblastoma. It is envisaged that in the near future children diagnosed with medulloblastoma will be more accurately stratified based on a combination of clinical variables and molecular profiles. Improved risk stratification will permit delivery of individualized therapy using conventional treatment modalities in conjunction with novel targeted therapeutic approaches.
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Affiliation(s)
- Nicholas G Gottardo
- Division of Neuro-oncology, Department of Hematology-Oncology, St. Jude Children's Research Hospital, 332 North Lauderdale Street, Memphis, TN 38105, USA
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Absolom K, Greenfield D, Ross R, Horne B, Davies H, Glaser A, Simpson A, Waite H, Eiser C. Predictors of clinic satisfaction among adult survivors of childhood cancer. Eur J Cancer 2006; 42:1421-7. [PMID: 16759851 DOI: 10.1016/j.ejca.2006.01.053] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Revised: 12/02/2005] [Accepted: 01/03/2006] [Indexed: 11/26/2022]
Abstract
Childhood cancer survivors experience a wide range of late-effects. As survival rates improve, follow-up in paediatric clinics becomes less feasible, and alternative models of care have been proposed. In this study, satisfaction among those attending a traditional paediatric late-effects clinic was compared with a multi-disciplinary clinic in an adult setting. Survivors (adult clinic n=93, paediatric clinic n=105, age 16-39 years) completed measures of symptoms, understanding of vulnerability to late-effects, purpose of follow-up, satisfaction and number of topics discussed. Predictors of satisfaction were: number of topics discussed, greater understanding of the purpose of follow-up and sex. Females, and those reporting longer waiting time were less satisfied. Aspects of clinic organisation, including shorter waiting times and opportunities to discuss health concerns, are more important in determining patient satisfaction than clinic type. Survivors' understanding of the purpose of follow-up is also integral in determining satisfaction.
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Affiliation(s)
- Kate Absolom
- Department of Psychology, Western Bank, University of Sheffield, Child and Family Research Group, Sheffield, S10 2TP, UK
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Sheppard L, Eiser C, Davies HA, Carney S, Clarke SA, Urquhart T, Ryder MJ, Stoner A, Wright NP, Butler G. The Effects of Growth Hormone Treatment on Health-Related Quality of Life in Children. Horm Res Paediatr 2006; 65:243-9. [PMID: 16582566 DOI: 10.1159/000092455] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Accepted: 12/08/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The effects of growth hormone deficiency (GHD) on linear growth in children are well documented, but there is less convincing evidence regarding the impact on health-related quality of life (QOL). We examined QOL in children aged 8-16 years with acquired GHD following treatment for malignancy (AGHD) or idiopathic GHD (IGHD) on commencing growth hormone treatment (GHT) over 6 months. We adopted a longitudinal design involving consecutive patients and their families attending clinic over an 18-month period. Mothers and children were invited to complete questionnaires before GHT (T1) and 6 months later (T2). METHODS Mothers of 22 children (AGHD n = 14; IGHD n = 8) completed standardized measures of child QOL and behaviour. Children completed parallel measures of QOL, short-term memory tasks and fitness either in clinic or at the family home. RESULTS For children with AGHD, QOL was significantly below population norms at T1 and improved over time. For children diagnosed with IGHD, QOL at T1 was below, but comparable with population norms. QOL improved over time, though not significantly. CONCLUSION GHT is potentially valuable for improving QOL in children, especially in cases of AGHD. We conclude that benefits of GHT for QOL need to be evaluated independent of different diagnostic groups.
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Affiliation(s)
- L Sheppard
- CR-UK Child and Family Health Group, Department of Psychology, University of Sheffield, Sheffield, UK.
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Curry HL, Parkes SE, Powell JE, Mann JR. Caring for survivors of childhood cancers: the size of the problem. Eur J Cancer 2006; 42:501-8. [PMID: 16406574 DOI: 10.1016/j.ejca.2005.11.003] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Revised: 09/28/2005] [Accepted: 11/07/2005] [Indexed: 11/16/2022]
Abstract
Many survivors of childhood cancer have significant health problems due to their illness or treatment. This population-based study examines the number of long-term survivors, their disabilities and consequent long-term care needs. Survival rates for children diagnosed with cancer between 1960 and 1999 in the West Midlands, United Kingdom (UK), were used to estimate future long-term survivor numbers. Treatment and late effects data on a cohort of patients surviving for more than 5 years were used to consider continuing care needs. Between the 1960s and 1990s, 5-year survival increased from 23% to 70%. There were 98 5-year survivors in 1970, and numbers may exceed 2,100 by the end of 2005. Most (at least 61%) survivors in the West Midlands Region have one or more chronic medical problems and may require multidisciplinary care. We conclude that, in order to determine how to provide cost-effective care for this increasing population, protocol delivered management with audit is needed.
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Affiliation(s)
- H L Curry
- Department of Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK
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Skowronska-Gardas A, Pedziwiatr K, Chojnacka M. Evaluation of quality of life in long-term survivors of paediatric brain stem tumors, treated with radiotherapy. Radiother Oncol 2004; 70:269-73. [PMID: 15064012 DOI: 10.1016/j.radonc.2004.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2003] [Revised: 01/14/2004] [Accepted: 01/29/2004] [Indexed: 11/27/2022]
Abstract
The quality of life in long-term survivors of paediatric brain stem tumors, treated with radiotherapy is evaluated. They suffer predominantly from pre-treatment neurological impairments, which seriously influence their quality of life. The most often observed treatment sequelae are pituitary insufficiency and hearing loss.
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Affiliation(s)
- Anna Skowronska-Gardas
- Department of Radiotherapy, M. Sklodowska-Curie Memorial Cancer Centre, Institute of Oncology, ul. Wawelska 15, Warsaw 00-973, Poland
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Abstract
Inactivation of p53 function is a common event in cancer. Approximately 50% of human tumours express mutant p53 and there is evidence that in others, including many childhood tumours, p53 function is impaired in other ways. These defects in p53 function may be due to the alteration of cellular factors that modulate p53 or to the expression of viral oncoproteins. Radiotherapy and many of the chemotherapeutic drugs currently used in cancer treatment are potent activators of p53. However, most of these therapies have a serious drawback, and that is the long-term consequences of their DNA damaging effects. Here, we review the discoveries in p53 research that are most significant to the development of new therapies based on the induction of the transcriptional activity of p53 in a non-genotoxic way and discuss the situations in which this type of approach may be most beneficial.
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Affiliation(s)
- S Lain
- Department of Surgery and Molecular Oncology, University of Dundee, Ninewells Hospital, Scotland, UK.
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Ellison DW, Clifford SC, Gajjar A, Gilbertson RJ. What's new in neuro-oncology? Recent advances in medulloblastoma. Eur J Paediatr Neurol 2003; 7:53-66. [PMID: 12697428 DOI: 10.1016/s1090-3798(03)00014-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- David W Ellison
- The Northern Institute for Cancer Research, University of Newcastle upon Tyne, The Medical School, Newcastle upon Tyne, UK.
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