1
|
Pradhan KR, Chen Y, Moustoufi-Moab S, Krull K, Oeffinger KC, Sklar C, Armstrong GT, Ness KK, Robison L, Yasui Y, Nathan PC. Endocrine and Metabolic Disorders in Survivors of Childhood Cancers and Health-Related Quality of Life and Physical Activity. J Clin Endocrinol Metab 2019; 104:5183-5194. [PMID: 31287545 PMCID: PMC6763277 DOI: 10.1210/jc.2019-00627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/02/2019] [Indexed: 12/17/2022]
Abstract
CONTEXT Childhood cancer survivors experience chronic health conditions that impact health-related quality of life (HRQOL) and participation in optimal physical activity. OBJECTIVE The study aimed to determine independent effects of endocrine and metabolic disorders on HRQOL and physical activity. DESIGN, SETTING, AND PATIENTS Retrospective cohort with longitudinal follow-up of survivors of childhood cancer enrolled in the North American Childhood Cancer Survivor Study. MAIN OUTCOME MEASURES Medical Outcomes Short Form-36 estimated HRQOL, and participation in physical activity was dichotomized as meeting or not meeting recommendations from the Centers for Disease Control and Prevention. Log binomial regression evaluated the association of each endocrine/metabolic disorder with HRQOL scales and physical activity. RESULTS Of 7287 survivors, with a median age of 32 years (range, 18 to 54 years) at their last follow-up survey, 4884 (67%) reported one or more endocrine/metabolic disorders. Survivors with either disorder were significantly more likely to be male, older, have received radiation treatment, and have experienced other chronic health conditions. After controlling for covariates, survivors with any endocrine/metabolic disorder were more likely to report poor physical function risk ratio (RR, 1.25; 95% CI, 1.05 to 1.48), increased bodily pain (RR, 1.27; 95% CI, 1.12 to 1.44), poor general health (RR, 1.49; 95% CI, 1.32 to 1.68), and lower vitality (RR, 1.21; 95% CI, 1.09 to 1.34) compared with survivors without. The likelihood of meeting recommended physical activity was lower among survivors with growth disorders (RR, 0.90; 95% CI, 0.83 to 0.97), osteoporosis (RR, 0.87; 95% CI, 0.76 to 0.99), and overweight/obesity (RR, 0.92; 95% CI, 0.88 to 0.96). CONCLUSION Endocrine and metabolic disorders are independently associated with poor HRQOL and suboptimal physical activity among childhood cancer survivors.
Collapse
Affiliation(s)
- Kamnesh R Pradhan
- Division of Pediatric Hematology–Oncology, Indiana University School of Medicine, Indianapolis, Indiana
- Correspondence and Reprint Requests: Kamnesh R. Pradhan, MD, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, Indiana 46202. E-mail Address:
| | - Yan Chen
- University of Alberta School of Public Health, Edmonton, Alberta, Canada
| | - Sogol Moustoufi-Moab
- Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kevin Krull
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Charles Sklar
- Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Leslie Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Yutaka Yasui
- University of Alberta School of Public Health, Edmonton, Alberta, Canada
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Paul C Nathan
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Chemaitilly W, Liu Q, Iersel L, Ness K, Li Z, Wilson C, Brinkman T, Klosky J, Barnes N, Clark K, Howell R, Smith S, Krasin M, Metzger M, Armstrong G, Bishop M, van Santen H, Pui CH, Srivastava DK, Yasui Y, Hudson M, Robison L, Green D, Sklar C. OR18-1 Leydig Cell Function in Adult Survivors of Childhood Cancer. J Endocr Soc 2019. [PMCID: PMC6554829 DOI: 10.1210/js.2019-or18-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Context: Direct assessment of Leydig cell function in adult survivors of childhood cancer has been limited. Objectives: To describe the prevalence of, and risk factors for, Leydig cell failure (LCF) and associated adverse health outcomes. Design: Retrospective cohort with cross-sectional health outcomes analysis. Patients: 1534 participants (median age 30.8 years; range 18.1-63.8) evaluated at a median of 22.0 years (range 7.5-49.8) after cancer diagnosis. Survivors with LH/FSH deficiency were excluded. Main Outcome Measure: LCF was defined as serum total testosterone < 250 ng/dL (8.67 nmol/L) combined with LH >8.6 IU/L; compensated LCF by testosterone ≥ 250 ng/dL and LH >8.6 IU/L. Polytomous logistic regression evaluated associations between demographic and treatment-related risk factors and LCF or compensated LCF. Log-binomial regression examined associations between these diagnoses and risk of diabetes mellitus, dyslipidemia, abdominal obesity, frailty, erectile dysfunction, and psychological distress. Piecewise exponential models analyzed the association between mortality and LCF/compensated LCF. Results: The prevalence of LCF and compensated LCF was 8.0% (95% confidence interval (CI) 6.7%-9.4%) and 22.8% (95% CI 20.7%-25.0%), respectively. Individuals aged 36-45.9 years (odds ratio (OR) 3.8, 95% CI 1.9-7.9) or ≥46 years (OR 4.9, 95% CI 2.2-11.1) at the time of study had a significantly higher risk of LCF than those 18-25 years old. Participants treated with direct testicular radiotherapy at doses >0-19.9 (OR 81.6, 95% CI 24.9-266.7) or ≥ 20 Gy (OR >999, 95% CI 109.9->999) had a higher risk of LCF than those not exposed to this treatment. Individuals treated with alkylating agents at cyclophosphamide equivalent doses 4000-7999 mg/m2 (OR 3.6, 95% CI 1.9-6.9) or 8000-11999 mg/m2 (OR 3.7, 95% CI 1.9-7.3) or ≥ 12000 mg/m2 (OR 8.7, 95% CI 4.7-16.4) had a higher risk of LCF than those not exposed to these agents. LCF was independently associated with abdominal obesity (prevalence ratio (PR) 1.6, 95% CI 1.2-2.1), diabetes mellitus (PR 2.9, 95% CI 1.8-4.6), erectile dysfunction (PR 1.8, 95% CI 1.4-2.5), frailty (PR 2.5, 95% CI 1.2-5.3) and mortality (PR 4.8, 95% CI 2.3-10.1). For compensated LCF, the risk factor associations were similar to those found for LCF; however, no significant associations were found with adverse physical or psychosocial outcomes. Conclusion: In adult survivors of childhood cancer, older age, direct testicular radiotherapy and high dose alkylating agents were associated with LCF, which was associated with poor general health outcomes. Further studies are needed to investigate the role of sex hormone replacement in mitigating such outcomes.
Collapse
Affiliation(s)
| | - Qi Liu
- School of Public Health, Edmonton, AB, Canada
| | - Laura Iersel
- Pediatric Endocrinology, Wilhelmina Children's Hospital, Utrecht, , Netherlands
| | - Kirsten Ness
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Zhenghong Li
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Carmen Wilson
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Tara Brinkman
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | - James Klosky
- Emory University School of Medicine, Atlanta, GA, United States
| | - Nicole Barnes
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Karen Clark
- Pediatric Endocrinology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Rebecca Howell
- University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Susan Smith
- University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Matthew Krasin
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Monika Metzger
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | | | - Michael Bishop
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | | | - Ching-Hon Pui
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | | | - Yutaka Yasui
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Melissa Hudson
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Leslie Robison
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Daniel Green
- St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Charles Sklar
- Dept of Ped, Memorial Sloan-Kettering Cancer Center, New York, NY, United States
| |
Collapse
|
3
|
de Blank P, Li N, Ullrich N, Fisher MJ, Bhatia S, Yasui Y, Sklar C, Leisenring W, Howell R, Oeffinger K, Hardy K, Fatih Okcu M, Gibson T, Robison L, Armstrong GT, Krull K. NFM-03. EFFECT OF NEUROFIBROMATOSIS TYPE 1 ON LONG-TERM HEALTH OUTCOMES IN ADULT SURVIVORS OF CHILDHOOD ASTROCYTOMA: A REPORT FROM THE CHILDHOOD CANCER SURVIVOR STUDY. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peter de Blank
- University of Cincinnati, Cincinnati, OH, USA
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Nan Li
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | | | | | - Smita Bhatia
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yutaka Yasui
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Charles Sklar
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | | | - Todd Gibson
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Les Robison
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| | | | - Kevin Krull
- St. Jude Children’s Research Hospital, Memphis, TN, USA
| |
Collapse
|
4
|
Lockney NA, Friedman DN, Wexler L, Sklar C, Casey D, Wolden S. Late Toxicities of Intensity-Modulated Radiation Therapy for Head and Neck Rhabdomyosarcoma. Pediatr Blood Cancer 2016; 63:1608-14. [PMID: 27195454 PMCID: PMC4955714 DOI: 10.1002/pbc.26061] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 04/22/2016] [Indexed: 11/07/2022]
Abstract
PURPOSE/OBJECTIVES To examine the late effects of intensity-modulated radiation therapy (IMRT) in pediatric patients with rhabdomyosarcoma of the head and neck. MATERIALS/METHODS All 1-year survivors of pediatric head and neck rhabdomyosarcoma treated with IMRT at a single institution from 1999 to 2014 were assessed for long-term complications. Late toxicities were graded according to CTCAE version 4.03. RESULTS Among 30 patients, median age at IMRT was 7.4 (1.5-20.8) years, median follow-up was 7.7 (1.2-14.4) years, and median IMRT dose was 50.4 (36-50.4) Gy. Tumor subsites included parameningeal (80%), orbit (13%), and other (7%). Common late toxicities were facial disfigurement (n = 23, 77%), growth hormone deficiency (n = 11, 37%), cataract (n = 10, 34%), and dental problems (n = 10, 33%). Twenty-two patients (73%) had ≥2 late toxicities and 14 patients (47%) had ≥3 late toxicities. Seventeen patients (57%) experienced grade 2 toxicity and 10 patients (33%) had grade 3 toxicity. Grade 3 toxicities included visual disturbance, cataract, facial disfigurement, chronic sinusitis/otitis, and hearing loss. Severe facial deformity was noted in nine patients (30%), and three patients underwent cosmetic surgery. Patients with severe facial deformity were treated at younger ages (median 6.0 years vs. 8.1 years for patients with no/nonsevere facial deformity) and more likely to have infratemporal fossa tumors. There were no secondary solid malignancies. CONCLUSIONS Late radiation toxicities are common in survivors of pediatric head and neck rhabdomyosarcoma treated with IMRT. While the majority of late effects are mild-moderate, they can significantly impact quality of life, particularly facial disfigurement.
Collapse
Affiliation(s)
- Natalie A. Lockney
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Leonard Wexler
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Charles Sklar
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Dana Casey
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Suzanne Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
5
|
Anur P, Friedman DN, Sklar C, Oeffinger K, Castiel M, Kearney J, Singh B, Prockop SE, Kernan NA, Scaradavou A, Kobos R, Curran K, Ruggiero J, Zakak N, O'Reilly RJ, Boulad F. Late effects in patients with Fanconi anemia following allogeneic hematopoietic stem cell transplantation from alternative donors. Bone Marrow Transplant 2016; 51:938-44. [PMID: 26999465 PMCID: PMC4968886 DOI: 10.1038/bmt.2016.32] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 01/29/2016] [Accepted: 02/01/2016] [Indexed: 12/17/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) is curative for hematological manifestations of Fanconi anemia (FA). We performed a retrospective analysis of 22 patients with FA and aplastic anemia, myelodysplastic syndrome or acute myelogenous leukemia who underwent a HSCT at Memorial Sloan Kettering Cancer Center and survived at least 1 year post HSCT. Patients underwent either a TBI- (N=18) or busulfan- (N=4) based cytoreduction followed by T-cell-depleted transplants from alternative donors. Twenty patients were alive at time of the study with a 5- and 10-year overall survival of 100 and 84% and no evidence of chronic GvHD. Among the 18 patients receiving a TBI-based regimen, 11 (61%) had persistent hemochromatosis, 4 (22%) developed hypothyroidism, 7 (39%) had insulin resistance and 5 (27%) developed hypertriglyceridemia after transplant. Eleven of 16 evaluable patients (68%), receiving TBI, developed gonadal dysfunction. Two patients who received a TBI-based regimen died of squamous cell carcinoma. One patient developed hemochromatosis, hypothyroidism and gonadal dysfunction after busulfan-based cytoreduction. TBI appears to be a risk factor for malignant and endocrine late effects in the FA host. Multidisciplinary follow-up of patients with FA (including cancer screening) is essential for early detection and management of late complications, and improving long-term outcomes.
Collapse
Affiliation(s)
- P Anur
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - D N Friedman
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - C Sklar
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K Oeffinger
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Castiel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Kearney
- Department of Psychiatry, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - B Singh
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S E Prockop
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - N A Kernan
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A Scaradavou
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R Kobos
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K Curran
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Ruggiero
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - N Zakak
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R J O'Reilly
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - F Boulad
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Pediatrics, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
| |
Collapse
|
6
|
Lockney N, Friedman D, Wexler L, Sklar C, Casey D, Wolden S. Late Toxicities of Intensity Modulated Radiation Therapy for Head and Neck Rhabdomyosarcoma. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
7
|
Armenian SH, Kremer LC, Sklar C. Approaches to reduce the long-term burden of treatment-related complications in survivors of childhood cancer. Am Soc Clin Oncol Educ Book 2015:196-204. [PMID: 25993157 DOI: 10.14694/edbook_am.2015.35.196] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Advances in diagnostics, treatment strategies, and supportive care have contributed to a marked improvement in outcomes for children with cancer. This has resulted in a growing number of long-term childhood cancer survivors. Currently there are over 360,000 individuals who are survivors of childhood cancer in the United States. However, treatment for patients with childhood cancer with chemotherapy, radiation, and/or hematopoietic stem cell transplantation can result in health-related complications that may not become evident until years after completion of treatment. As a result, several initiatives have been established to help standardize the surveillance for treatment-related late effects in childhood cancer survivors. This review highlights emerging concepts related to commonly reported late effects, such as subsequent malignant neoplasms, cardiovascular disease, and endocrinopathies. It also discusses relevant population-based screening strategies to mitigate the long-term health-related burden in vulnerable populations of survivors.
Collapse
Affiliation(s)
- Saro H Armenian
- From the Department of Population Sciences, City of Hope, Duarte, CA; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leontien C Kremer
- From the Department of Population Sciences, City of Hope, Duarte, CA; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Charles Sklar
- From the Department of Population Sciences, City of Hope, Duarte, CA; Department of Pediatric Oncology, Emma Children's Hospital/Academic Medical Center, Amsterdam, Netherlands; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
8
|
Kamran S, Chen Y, Wolden S, Feldman D, Sklar C, Yasui Y, Robison L, Stovall M, Neglia J, Oeffinger K. Risk of Testicular Cancer Following Childhood Cancer Testicular Radiation. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
9
|
Essig S, Li Q, Chen Y, Hitzler J, Leisenring W, Greenberg M, Sklar C, Hudson MM, Armstrong GT, Krull KR, Neglia JP, Oeffinger KC, Robison LL, Kuehni CE, Yasui Y, Nathan PC. Risk of late effects of treatment in children newly diagnosed with standard-risk acute lymphoblastic leukaemia: a report from the Childhood Cancer Survivor Study cohort. Lancet Oncol 2014; 15:841-51. [PMID: 24954778 DOI: 10.1016/s1470-2045(14)70265-7] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Treatment of patients with paediatric acute lymphoblastic leukaemia has evolved such that the risk of late effects in survivors treated in accordance with contemporary protocols could be different from that noted in those treated decades ago. We aimed to estimate the risk of late effects in children with standard-risk acute lymphoblastic leukaemia treated with contemporary protocols. METHODS We used data from similarly treated members of the Childhood Cancer Survivor Study cohort. The Childhood Cancer Survivor Study is a multicentre, North American study of 5-year survivors of childhood cancer diagnosed between 1970 and 1986. We included cohort members if they were aged 1·0-9·9 years at the time of diagnosis of acute lymphoblastic leukaemia and had received treatment consistent with contemporary standard-risk protocols for acute lymphoblastic leukaemia. We calculated mortality rates and standardised mortality ratios, stratified by sex and survival time, after diagnosis of acute lymphoblastic leukaemia. We calculated standardised incidence ratios and absolute excess risk for subsequent neoplasms with age-specific, sex-specific, and calendar-year-specific rates from the Surveillance, Epidemiology and End Results Program. Outcomes were compared with a sibling cohort and the general US population. FINDINGS We included 556 (13%) of 4329 cohort members treated for acute lymphoblastic leukaemia. Median follow-up of the survivors from 5 years after diagnosis was 18·4 years (range 0·0-33·0). 28 (5%) of 556 participants had died (standardised mortality ratio 3·5, 95% CI 2·3-5·0). 16 (57%) deaths were due to causes other than recurrence of acute lymphoblastic leukaemia. Six (1%) survivors developed a subsequent malignant neoplasm (standardised incidence ratio 2·6, 95% CI 1·0-5·7). 107 participants (95% CI 81-193) in each group would need to be followed-up for 1 year to observe one extra chronic health disorder in the survivor group compared with the sibling group. 415 participants (376-939) in each group would need to be followed-up for 1 year to observe one extra severe, life-threatening, or fatal disorder in the group of survivors. Survivors did not differ from siblings in their educational attainment, rate of marriage, or independent living. INTERPRETATION The prevalence of adverse long-term outcomes in children treated for standard risk acute lymphoblastic leukaemia according to contemporary protocols is low, but regular care from a knowledgeable primary-care practitioner is warranted. FUNDING National Cancer Institute, American Lebanese-Syrian Associated Charities, Swiss Cancer Research.
Collapse
Affiliation(s)
- Stefan Essig
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Qiaozhi Li
- School of Public Health, University of Alberta, Edmonton, Alberta, AB, Canada
| | - Yan Chen
- School of Public Health, University of Alberta, Edmonton, Alberta, AB, Canada
| | - Johann Hitzler
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Wendy Leisenring
- Programs in Clinical Statistics and Cancer Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mark Greenberg
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Charles Sklar
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Melissa M Hudson
- Departments of Oncology and Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Gregory T Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Kevin R Krull
- Departments of Epidemiology and Cancer Control and Psychology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Joseph P Neglia
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Yutaka Yasui
- School of Public Health, University of Alberta, Edmonton, Alberta, AB, Canada
| | - Paul C Nathan
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
10
|
Strobel K, Simpson P, Donohoue P, Firat S, Jogal S, Lai JS, Beaumont J, Goldman S, Huang C, Barrera M, Rokeach A, Hancock K, Cataudella D, Schulte F, Chung J, Bartels U, Janzen L, Sung L, Strother D, Hukin J, Downie A, Zelcer S, Atenafu E, Schiavello E, Biassoni V, Meazza C, Podda M, Massimino M, Wells EM, Ullrich NJ, Seidel K, Leisenring W, Sklar C, Armstrong GT, Diller L, King A, krull K, Neglia JP, Stovall M, Whelan K, Robison LL, Packer RJ, Remes T, Harila-Saari A, Suo-Palosaari M, Lahteenmaki P, Arikoski P, Riikonen P, Rantala H, Ojaniemi M, Bull K, Kennedy C, Bailey S, Ellison D, Clifford S, Dembowska-Baginska B, Brozyna A, Drogosiewicz M, Perek-Polnik M, Swieszkowska E, Filipek I, Tarasinska M, Korzeniewska J, Perek D, Salgado D, Nunes S, Pereira P, Vinhais S, Salih S, Elsarrag S, Prange E, Contreas K, Possin P, Frierdich S, Eickhoff J, Puccetti D, Huang C, Ladas E, Buck C, Arbit N, Gudrunardottir T, Lannering B, Remke M, Taylor MD, Wells EM, Keating RF, Packer RJ, Stapleton S, Flanary J, Hamblin F, Amankwah E, Ghazarian S, Jagt CT, van de Wetering M, Schouten-van Meeteren AYN, Lai JS, Nowinski C, Hartsell W, Chang JHC, Cella D, Goldman S, Krishna U, Nagrulkar A, Takle M, Kannan S, Gupta T, Jalali R, Northman L, Morris M, Ross S, Guo D, Chordas C, Liptak C, Delaney B, Ullrich N, Manley P, Avula S, Pizer B, Ong CC, Harave S, Mallucci C, Kumar R, Margol A, Finlay J, Dhall G, Robison N, Krieger M, Kiehna E, Coates T, Nelson M, Grimm J, Evans A, Nelson MB, Britt B, Margol A, Robison N, Dhall G, Finlay J, Cooksey R, Wu S, Gode A, Klesse L, Oden J, Vega G, Gargan L, Bowers D, Madden JR, Prince E, Zeitler P, Foreman NK, Liu AK. QUALITY OF LIFE/AFTERCARE. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
11
|
Acquaye AA, Vera-Bolanos E, Gilbert MR, Armstrong TS, Lin L, Amidei C, Lovely M, Arzbaecher J, Page M, Mogensen K, Lupica K, Maher ME, Armstrong TS, Won M, Wefel JS, Gilbert MR, Pugh S, Wendland MM, Brachman DG, Brown PD, Crocker IR, Robins HI, Lee RJ, Mehta M, Arvold N, Wang Y, Zigler C, Schrag D, Dominici F, Boele F, Douw L, de Groot M, van Thuijl H, Cleijne W, Heimans J, Taphoorn M, Reijneveld J, Klein M, Bunevicius A, Tamasauskas S, Tamasauskas A, Deltuva V, Bunevicius R, Cahill J, Lin L, Armstrong T, Acquaye A, Vera-Bolanos E, Gilbert M, Padhye N, Chan J, Clarke J, Lawton K, Rabbitt J, DeSilva A, Prados M, Rosen M, Cher L, Diamond E, Applebaum A, Corner G, DeRosa A, Breitbart W, DeAngelis L, Hoogendoorn P, Ikuta S, Muragaki Y, Maruyama T, Nitta M, Tamura M, Okamoto S, Iseki H, Okada Y, Lacouture M, Davis ME, Elzinga G, Butowski N, Tran D, Villano J, Wong E, Legge D, Cher L, Legge D, Cher L, Mills K, Lin L, Acquaye A, Vera-Bolanos E, Gilbert M, Armstrong T, Lovely M, Sullivan D, Mueller S, Fullerton H, Stratton K, Leisenring W, Armstrong G, Weathers R, Stovall M, Goldsby R, Sklar C, Robison L, Krull K, Pace A, Villani V, Focarelli S, Benincasa D, Benincasa A, Carapella CM, Pompili A, Peiffer AM, Burke A, Leyer CM, Shing E, Kearns WT, Hinson WH, Case D, Rapp SR, Shaw EG, Chan MD, Porensky E, Cavaliere R, Newton H, Shilds A, Burgess S, Ravelo A, Taylor F, Mazar I, Abrey L, Rooney A, Graham C, McKenzie H, Fraser M, MacKinnon M, McNamara S, Rampling R, Carson A, Grant R, Rooney A, Heimans L, Woltz S, Kerrigan S, McNamara S, Grant R, Seibl-Leven M, Wittenstein K, Rohn G, Goldbrunner R, Timmer M, Kennedy J, Sherman W, Sen-Gupta I, Garic I, Macken M, Gerard E, Raizer J, Schuele S, Grontoft M, Stragliotto G, Taphoorn MJ, Henriksson R, Bottomley A, Cloughesy T, Wick W, Mason W, Saran F, Nishikawa R, Ravelo A, Hilton M, Chinot OL, Trad W, Simpson T, Wright K, Tran T, Choong C, Barton M, Hovey E, Robinson K, Koh ES, Vera-Bolanos E, Acquaye AA, Brown PD, Chung C, Gilbert MR, Vardy J, Armstrong TS, Walbert T, Mendoza T, Vera-Bolanos E, Gilbert M, Acquaye A, Armstrong T, Walbert T, Glantz M, Schultz L, Puduvalli VK, Oudenhoven M, Farin C, Hoffman R, Armstrong T, Ewend M, Wu J. SYMPTOM MANAGEMENT/QUALITY OF LIFE. Neuro Oncol 2013; 15:iii226-iii234. [PMCID: PMC3823907 DOI: 10.1093/neuonc/not192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
|
12
|
Abstract
BACKGROUND Data on 25-hydroxyvitamin D (25-OH D) status among survivors of childhood cancer are limited. Our aim was to determine the prevalence of and risk factors for 25-OH D insufficiency in a large, diverse population of cancer survivors being followed in a childhood cancer survivor clinic. PROCEDURE Retrospective chart review in survivors seen for routine long-term follow-up, who underwent routine screening blood studies including 25-OH D levels. Vitamin D insufficiency was defined as 25-OH D <20 ng/ml. RESULTS Four hundred eighty-four subjects (234 males) were evaluable for this analysis. Median age at 25-OH D testing was 12.3 years (2.05-36.4) and median age at cancer diagnosis was 3.9 years (0-18). Diagnoses included brain tumors (23.6%), neuroblastoma (21%), and leukemia (17.6%). Mean 25-OH D level was 25.2 ng/ml (SD = 10.37); 29% of subjects were 25-OH D insufficient. In univariate analysis, race, pubertal status, and age at cancer diagnosis were associated with 25-OH D insufficiency (P < 0.05). In multivariate analysis, a model including race and pubertal status provided a good fit for the data. CONCLUSIONS The prevalence of 25-OH D insufficiency in these cancer survivors was high but similar to what has been described in the general population. No cancer specific variables were associated with 25-OH D insufficiency. Since cancer survivors are at a higher risk for subsequent malignancies, cardiovascular disease, and low bone mineral density, all of which may be affected by 25-OH D levels, interventions to improve 25-OH D status in this vulnerable population are needed.
Collapse
Affiliation(s)
- Abha Choudhary
- Department of Pediatrics, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
| | - Joanne Chou
- Department of Epidemiology, Biostatistics, Memorial Sloan- Kettering Cancer Center, New York, New York
| | - Glenn Heller
- Department of Epidemiology, Biostatistics, Memorial Sloan- Kettering Cancer Center, New York, New York
| | - Charles Sklar
- Department of Pediatrics, Memorial Sloan – Kettering Cancer Center, New York, New York
,Correspondence to: Department of Pediatrics, Memorial Sloan – Kettering Cancer Center, 1275 York Avenue, New York, NY 10065.
| |
Collapse
|
13
|
Spector LG, Ritter K, Demerath EW, Sklar C, Ross JA, Krailo M, Nagarajan R, Malkin D, Bergemann TL, Savage SA, Johnson W. Abstract 2532: Pediatric osteosarcoma patients are taller than average from birth to age twelve: a report from the Children's Oncology Group. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-2532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Osteosarcoma (OS) is the most common form of bone cancer in children and displays a peak incidence that coincides with the pubertal growth spurt. Consequently a number of studies have investigated whether cases are taller at diagnosis than the general pediatric population; a recent analysis which pooled seven such studies found that cases were disproportionately in the 51st-89th and especially the >90th percentiles of height-for-age (HFA). However, no study to our knowledge has examined whether OS patients exhibit greater HFA at earlier ages. During 2008-2010 we enrolled 290 OS cases <20 years of age diagnosed at Children's Oncology Group institutions in the United States and Canada in a genetic epidemiologic study. In addition to collecting buccal cell samples for genetic analysis we requested permission to obtain length/height data from medical records from birth to diagnosis. Records were obtained for 153 male and 111 female participants. Anthropometrics and date of measurement were doubly entered into a custom database, and inconsistencies were resolved by a third abstraction. Between 1 and 46 measurements (median = 11) were recorded up to the earlier of diagnosis or 12 years of age. Mixed effects cubic spline models were applied to length/height to produce individual growth curves using Stata. Sex was included as a main effect and as interactions with the model slope terms to account for gender differences in growth. Individual estimates of length/height at every three months of age between birth and age two years, and at each year of age thereafter, were computed and transformed to Z-scores according to the CDC 2000 reference. OS cases of both sexes were consistently longer or taller than reference data at all ages, as at no age did the 95% confidence interval around mean Z-score include 0 (i.e. the population mean and median). Under 2 years of age length was examined; mean Z-score at birth was 0.56 (71st %ile), rose to 0.72 (76th %ile) at 0.5 years, and fell to 0.31 (62nd %ile) at 2 years. Over 2 years of age height was examined; mean Z-score was 0.48 (68th %ile) at 4 years, dipped to 0.33 (63rd %ile) at 8-9 years, and rose to 0.49 (69th %ile) at 12 years. No differences in mean Z-score at each age were observed by age at diagnosis (sex specific inter-quartile range of age at diagnosis vs. other), location of tumor (long bone of the lower limb vs. other), or race (White non-Hispanic vs. other). Our data clearly indicate that pediatric OS patients are substantially longer/taller than the United States national norm at all ages before puberty.
Citation Format: Logan G. Spector, Kathryn Ritter, Ellen W. Demerath, Charles Sklar, Julie A. Ross, Mark Krailo, Rajaram Nagarajan, David Malkin, Tracy L. Bergemann, Sharon A. Savage, William Johnson. Pediatric osteosarcoma patients are taller than average from birth to age twelve: a report from the Children's Oncology Group. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2532. doi:10.1158/1538-7445.AM2013-2532
Collapse
Affiliation(s)
| | | | | | - Charles Sklar
- 2Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Mark Krailo
- 3University of Southern California, Los Angeles, CA
| | | | - David Malkin
- 5Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | |
Collapse
|
14
|
Rednam S, Scheurer M, Adesina A, Lau C, Okcu M, Deatrick J, Ogle S, Fisher M, Barakat L, Hardie T, Li Y, Ginsberg J, Ben-Arush M, Krivoy E, Rosenkranz R, Peretz-Nahum M, Brown RJ, Love J, Warburton D, McBride WH, Bluml S, Mueller S, Sear K, Hills N, Chettout N, Afghani S, Lew L, Tolentino E, Haas-Kogan D, Fullerton H, Reddick W, Palmer S, Glass J, Li Y, Ogg R, Gajjar A, Omar A, Perkins S, Shinohara E, Spoljaric D, Isenberg J, Whittington M, Hauff M, King A, Litzelman K, Barker E, Catrine K, Puccetti D, Possin P, Witt W, Mallucci C, Kumar R, Pizer B, Williams D, Pettorini B, Piscione J, Bouffet E, Shams I, Kulkarni A, Remes T, Harila-Saari A, Suo-Palosaari M, Arikoski P, Riikonen P, Sutela A, Koskenkorva P, Ojaniemi M, Rantala H, Campen CJ, Ashby D, Fisher PG, Monje M, Kulkarni AV, Piscione J, Shams I, Bouffet E, Nakamura H, Makino K, Yano S, Kuratsu JI, Jadrijevic-Cvrlje F, Batinica M, Toledano H, Hoffman T, Ezer-Cohen Y, Michowiz S, Yaniv I, Cohen IJ, Adler I, Mindel S, Gopalakrishnamoorthy M, Saunders D, Gaze M, Spoudeas H, Kieffer V, Dellatolas G, Chevignard M, Puget S, Dhermain F, Grill J, Dufour C, Muir R, Hunter A, Latchman A, de Camargo O, Scheinemann K, Dhir N, Zaky W, Zomorodian T, Wong K, Dhall G, Macy M, Lauro C, Zeitler P, Foreman N, Liu A, Chocholous M, Dodier P, Peyrl A, Dieckmann K, Hausler G, Slavc I, Avula S, Kumar R, Mallucci C, Pettorini B, Garlick D, Pizer B, Armstrong G, Kawashima T, Leisenring W, Stovall M, Sklar C, Robison L, Samaan C, Duckworth J, Scheinemann K, Greenberg-Kushnir N, Freedman S, Eshel R, Zverling N, Elhasid R, Dvir R, Yalon M, Kulkarni AV, Constantini S, Wilne S, Liu JF, Trusler J, Lundsell S, Kennedy C, Clough L, Dickson N, Lakhanpaul M, Baker M, Dudley J, Grundy R, Walker D, von Hoff K, Herzog N, Ottensmeier H, Grabow D, Gerber NU, Friedrich C, von Bueren AO, Resch A, Kortmann RD, Kaatsch P, Doerr HG, Rutkowski S, del Bufalo F, Mastronuzzi A, Serra A, de Sio L, Locatelli F, Biassoni V, Leonardi M, Ajovalasit D, Riva D, Vago C, Usilla A, Fidani P, Serra A, Schiavello E, Gariboldi F, Massimino M, Lober R, Perrault S, Partap S, Edwards M, Fisher P, Yeom K, Salgado D, Nunes S, Vinhais S, Salgado D, Nunes S, Vinhais S, Wells EM, Seidel K, Ullrich NJ, Leisenring W, Armstrong G, Diller L, King A, Krull KR, Neglia J, Robison LL, Stovall M, Whelan K, Sklar C, Russell CE, Bouffet E, Brownstone D, Kaise C, Kennedy C, Bull K, Culliford D, Chevignard M, Spoudeas H, Calaminus G, Bertin D, Vallero S, Romano E, Basso ME, Biasin E, Fagioli F, Ziara K, L'Hotta A, Williams A, Thede R, Moore K, James A, King A, Bjorn E, Franzen P, Haag A, Lax AK, Moreno I, Scheinemann K, Obeid J, Timmons BW, Iwata W, Wagner S, Lai JS, Waddell K, VanLeeuwen S, Newmark M, Noonan J, O'Connell K, Urban M, Yount S, Goldman S, Piscione J, Igoe D, Cunningham T, Orfus M, Bouffet E, Mabbott D, Liptak C, Manley P, Recklitis C, Zhang P, Shaikh F, Narang I, Bouffet E, Matsumoto K, Yamasaki K, Okada K, Fujisaki H, Osugi Y, Hara J, Phipps K, Gumley D, Jacques T, Hargrave D, Saunders D, Michalski A, Manley P, Chordas C, Chi S, Robison N, Bandopadhayay P, Marcus K, Zimmerman MA, Goumnerova L, Kieran M, Brand S, Brinkman T, Chordas C, Delaney B, Diver T, Rey C, Manley P, Liptak C, Madden JR, Hemenway MS, Dorneman L, Stiller D, Liu AK, Foreman NK, Vibhakar R, Mitchell M, Hemenway M, Foreman N, Madden J, Reddick W, Glass J, Li Y, Ogg R, Gajjar A, Ryan M, O'Kane R, Picton S, Kenny T, Stiller C, Chumas P, Bendel A, Patterson R, Barrera M, Schulte F, Bartels U, Janzen L, Johnston D, Cataudella D, Chung J, Sung L, Hancock K, Hukin J, Zelcer S, Brandon S, Montour-Proulx I, Strother D, Cooksey R, Bowers D, Gargan L, Gode A, Klesse L, Oden J, Vega G, Sala F, Nuzzi D, Mulino M, Masotto B, Mazza C, Bricolo A, Gerosa M, Tong M, Bouffet E, Laughlin S, Mackie S, Taylor L, Sharpe G, Al-Salihi O, Nicolin G. QUALITY OF LIFE/AFTERCARE. Neuro Oncol 2012; 14:i125-i139. [PMCID: PMC3483352 DOI: 10.1093/neuonc/nos106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
|
15
|
Musselman J, Bergemann T, Krailo M, Malkin D, Ross J, Savage S, Nagarajan R, Sklar C, Spector L. Abstract LB-333: A case-parent-triad approach in assessing risk of osteosarcoma associated with genetic variation in insulin-like growth factor 1/growth hormone axis genes: a Children's Oncology Group (COG) study. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-lb-333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Osteosarcoma (OS) is a rare malignant bone tumor with an overall incidence rate of 4.6 cases per million children aged 0-19 years in the United States. OS incidence peaks sharply in adolescence coinciding with the pubertal growth spurt. While the etiology of OS is largely unknown, its distinctive age-incidence pattern suggests that growth and development is crucial in the genesis of OS. Prior studies have suggested that variants in genes in the insulin-like growth factor 1 (IGF1)/growth hormone (GH) axis pathway are associated with OS. We assessed this hypothesis by examining 307 single nucleotide polymorphisms (SNPs) in 12 genes from this pathway (GHRH, GH1, GHR, GHRHR, IGF1, IGF1R, IGF2, IGF2R, IGFBP1, IGFBP3, IGFBP6, AND IGFALS) in a case-parent-triad study of cases and their biological parents. The sample included 229 complete triads and 56 dyads diagnosed during 2008-2011 at Children's Oncology Group institutions. Buccal cell samples were collected via the Oragene kit (DNA Genotek, Ottawa, Ontario) and returned by mail; genotyping was conducted by Sequenom iPLEX Gold method. We used log-linear models to estimate relative risks (RR) and 95% confidence intervals (CI) associated with transmitting one or two copies of the variant compared to no copies. After Bonferroni correction, 2 SNPs in IGFBP1 (rs10231774: RR = 1.44 and 0.07 for 1 and 2 vs. 0 copies, respectively; p < 0.001) and IGFALS (rs2575352: RR = 2.82 and 0.22 for 1 and 2 vs. 0 copies, respectively; p < 0.001), both in the upstream coding regions of IGF pathway genes, were significantly associated with OS incidence. These results confirm previous findings that variation in the IGF1/GH axis influence OS risk and further support the axis’ biologically and epidemiologically plausible role in OS development.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-333. doi:1538-7445.AM2012-LB-333
Collapse
Affiliation(s)
| | | | - Mark Krailo
- 3University of Southern California, LosAngeles, CA
| | - David Malkin
- 4University of Toronto, Toronto, Ontario, Canada
| | - Julie Ross
- 1University of Minnesota, Minneapolis, MN
| | | | | | - Charles Sklar
- 7Memorial Sloan-Kettering Cancer Center, New York, NY
| | | |
Collapse
|
16
|
Sands SA, Zhou T, O'Neil SH, Patel SK, Allen J, McGuire Cullen P, Kaleita TA, Noll R, Sklar C, Finlay JL. Long-term follow-up of children treated for high-grade gliomas: children's oncology group L991 final study report. J Clin Oncol 2012; 30:943-9. [PMID: 22355055 PMCID: PMC3341107 DOI: 10.1200/jco.2011.35.7533] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE High-grade gliomas of the CNS are characterized by poor treatment response and prognosis for long-term survival. The Children's Oncology Group (COG) L991 study investigated the neuropsychological, behavioral, and quality of life (QoL) outcomes after treatment on the Children's Cancer Group (CCG) trial for high-grade gliomas (CCG-945). PATIENTS AND METHODS Fifty-four patients (29 males, 25 females) with a median age of 8.8 years at diagnosis (range, 0.2 to 19.5 years) were enrolled at 25 institutions in North America, representing 81% of available survivors; median length of follow-up was 15.1 years (range, 9.5 to 19.2 years), and median age at study evaluation was 23.6 years (range, 11.3 to 36 years). Standardized tests of neuropsychological functioning and QoL were performed. Descriptive statistics summarized principal findings, and one-way analysis of variance identified potential predictors of outcomes. RESULTS With an average follow-up time of 15 years, survivors demonstrated intellectual functioning within the low-average range. Executive functioning and verbal memory were between the low-average and borderline ranges. In contrast, visual memory and psychomotor processing speed were between the borderline and impaired ranges, respectively. Approximately 75% of patient reported overall QoL within or above normal limits for both physical and psychosocial domains. Nonhemispheric tumor location (midline or cerebellum), female sex, and younger age at treatment emerged as independent risk factors. CONCLUSION These results serve as a benchmark for comparison with future pediatric high-grade glioma studies, in addition to identifying at-risk cohorts that warrant further research and proactive interventions to minimize late effects while striving to ensure survival.
Collapse
Affiliation(s)
- Stephen Alan Sands
- Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Anur P, Sklar C, Kernan N, Prockop S, Scaradavou A, Small T, O'Reilly R, Boulad F. Allogeneic Stem Cell Transplantation for Sickle Cell Anemia (SCA) at MSKCC: A Single Institution Series. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
18
|
Affiliation(s)
- Charles Sklar
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | |
Collapse
|
19
|
Goldsby R, Chen Y, Raber S, Li L, Diefenbach K, Shnorhavorian M, Kadan-Lottick N, Kastrinos F, Yasui Y, Stovall M, Oeffinger K, Sklar C, Armstrong GT, Robison LL, Diller L. Survivors of childhood cancer have increased risk of gastrointestinal complications later in life. Gastroenterology 2011; 140:1464-71.e1. [PMID: 21315721 PMCID: PMC3081911 DOI: 10.1053/j.gastro.2011.01.049] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 01/07/2011] [Accepted: 01/20/2011] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS Children who receive cancer therapy experience numerous acute gastrointestinal (GI) toxicities. However, the long-term GI consequences have not been extensively studied. We evaluated the incidence of long-term GI outcomes and identified treatment-related risk factors. METHODS Upper GI, hepatic, and lower GI adverse outcomes were assessed in cases from participants in the Childhood Cancer Survivor Study, a study of 14,358 survivors of childhood cancer who were diagnosed between 1970 and 1986; data were compared with those from randomly selected siblings. The median age at cancer diagnosis was 6.8 years (range, 0-21.0 years), and the median age at outcome assessment was 23.2 years (5.6-48.9 years) for survivors and 26.6 years (1.8-56.2 years) for siblings. Rates of self-reported late GI complications (occurred 5 or more years after cancer diagnosis) were determined and associated with patient characteristics and cancer treatments, adjusting for age, sex, and race. RESULTS Compared with siblings, survivors had increased risk of late-onset complications of the upper GI tract (rate ratio [RR], 1.8; 95% confidence interval [CI], 1.6-2.0), liver (RR, 2.1; 95% CI, 1.8-2.5), and lower GI tract (RR, 1.9; 95% CI, 1.7-2.2). The RRs for requiring colostomy/ileostomy, liver biopsy, or developing cirrhosis were 5.6 (95% CI, 2.4-13.1), 24.1 (95% CI, 7.5-77.8), and 8.9 (95% CI, 2.0-40.0), respectively. Older age at diagnosis, intensified therapy, abdominal radiation, and abdominal surgery increased the risk of certain GI complications. CONCLUSIONS Individuals who received therapy for cancer during childhood have an increased risk of developing GI complications later in life.
Collapse
Affiliation(s)
- Robert Goldsby
- Pediatric Hematology/Oncology, UCSF Benioff Children's Hospital, San Francisco, California, USA.
| | - Yan Chen
- Public Health Sciences, University of Alberta, Edmonton, AB
| | - Shannon Raber
- Pediatric Hematology/Oncology, UCSF Children’s Hospital, San Francisco, CA
| | - Linda Li
- Pediatric Hematology/Oncology, UCSF Children’s Hospital, San Francisco, CA
| | - Karen Diefenbach
- Pediatric Surgery, Yale University School of Medicine, New Haven, CT
| | | | | | - Fay Kastrinos
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York , NY
| | - Yutaka Yasui
- Public Health Sciences, University of Alberta, Edmonton, AB
| | | | - Kevin Oeffinger
- Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Charles Sklar
- Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Gregory T. Armstrong
- Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, TN
| | - Leslie L. Robison
- Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, TN
| | - Lisa Diller
- Pediatric Oncology, Dana-Farber Cancer Institute/Children’s Hospital, Boston, MA
| |
Collapse
|
20
|
Nagarajan R, Kamruzzaman A, Ness KK, Marchese VG, Sklar C, Mertens A, Yasui Y, Robison LL, Marina N. Twenty years of follow-up of survivors of childhood osteosarcoma: a report from the Childhood Cancer Survivor Study. Cancer 2011; 117:625-34. [PMID: 20922787 PMCID: PMC3025070 DOI: 10.1002/cncr.25446] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 04/13/2010] [Accepted: 04/14/2010] [Indexed: 11/11/2022]
Abstract
BACKGROUND Osteosarcoma survivors have received significant chemotherapy and have undergone substantial surgeries. Their very long-term outcomes (20 year) are reported here. METHODS The authors assessed the long-term outcomes of 733 5-year survivors of childhood osteosarcoma diagnosed from 1970 to 1986 to provide a comprehensive evaluation of medical and psychosocial outcomes for survivors enrolled in the Childhood Cancer Survivor Study (CCSS). Outcomes evaluated included overall survival, second malignant neoplasms (SMNs), recurrent osteosarcoma, chronic health conditions, health status (general and mental health and functional limitations), and psychosocial factors. Outcomes of osteosarcoma survivors were compared with general-population statistics, other CCSS survivors, and CCSS siblings. RESULTS Survivors had a mean follow-up of 21.6 years. The overall survival of children diagnosed with osteosarcoma who survived 5 years at 20 years from original diagnosis was 88.6% (95% confidence interval [CI], 86.6%-90.5%). The cumulative incidence of SMNs at 25 years was 5.4%, with a standardized incidence ratio of 4.79 (95% CI, 3.54-6.33; P<.01). Overall, 86.9% of osteosarcoma survivors experienced at least 1 chronic medical condition, and >50% experienced ≥2 conditions. Compared with survivors of other cancers, osteosarcoma survivors did not differ in their reported general health status (odds ratio [OR], 0.9; 95% CI, 0.7-1.2), but were more likely to report an adverse health status in at least 1 domain (OR, 1.9; 95% CI, 1.6-2.2), with activity limitations (29.1%) being the most common. CONCLUSIONS Childhood osteosarcoma survivors in this cohort did relatively well, considering their extensive treatment, but are at risk of experiencing chronic medical conditions and adverse health status. Survivors warrant life-long follow-up.
Collapse
Affiliation(s)
- Rajaram Nagarajan
- Division of Hematology/Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Carter J, Raviv L, Applegarth L, Ford JS, Josephs L, Grill E, Sklar C, Sonoda Y, Baser RE, Barakat RR. A cross-sectional study of the psychosexual impact of cancer-related infertility in women: third-party reproductive assistance. J Cancer Surviv 2010; 4:236-46. [PMID: 20373042 DOI: 10.1007/s11764-010-0121-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 03/01/2010] [Indexed: 01/10/2023]
Abstract
INTRODUCTION This study empirically assessed emotional and sexual functioning, reproductive concerns, and quality of life (QOL) of cancer-related infertile women in comparison to those without a cancer history and explored awareness of third-party reproduction options in cancer survivors. METHODS One hundred twenty-two cancer survivors (Gynecologic and Bone Marrow/Stem Cell Transplant) with cancer-related infertility and 50 non-cancer infertile women completed a self-report survey assessing: reproductive concerns (RCS), mood (CES D), distress (IES), sexual function (FSFI), menopause (SCL), QOL (SF 12), relationships (ADAS), and exploratory (reproductive options) items. RESULTS Cancer survivors exhibited greater sexual dysfunction and lower physical QOL than non-cancer infertile women (P < 0.001). No significant group differences were identified for mood (CES-D), mental health QOL (SF-12), reproductive concerns (RCS), and relationship satisfaction (ADAS). All groups scored in the FSFI range of sexual dysfunction, and with RCS scores above published means. Multivariate comparisons showed comparable depression and distress levels for all groups, but cancer survivors had poorer physical QOL [F(5,146)=4.22, P < 0.01]. A significant effect was also found for knowledge of third-party reproductive options on depression and distress levels [F(3,97)=4.62,P < 0.01]. Adjusted means demonstrated higher depression and distress scores for women with perceived unmet informational needs. CONCLUSIONS Overall, loss of fertility was an emotionally challenging experience for women regardless of its cause. Cancer survivors were found to have lower scores of physical QOL and sexual function than non-cancer infertile women. Unmet informational needs about reproductive options appeared to be associated with negative mood and increased distress in cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Targeted interventions to increase knowledge about reproductive options could be of great assistance to women pursuing parenthood in cancer survivorship. Additionally, intervention studies to improve sexual functioning and QOL in women with cancer-related infertility should be a priority of future research.
Collapse
Affiliation(s)
- Jeanne Carter
- Department of Psychiatry, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Yoffe R, Khakoo Y, Dunkel IJ, Souweidane M, Lis E, Sklar C. Recurrent ependymoma treated with high-dose tamoxifen in a peripubertal female: Impact on tumor and the pituitary-ovarian axis. Pediatr Blood Cancer 2007; 49:758-60. [PMID: 16261561 DOI: 10.1002/pbc.20647] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Due to high rates of recurrence, the prognosis of childhood ependymoma remains guarded. Anecdotal evidence suggests that tamoxifen may have a role in the treatment of these tumors. We present a case of a child with recurrent ependymoma treated with tamoxifen who showed tumor regression on two separate occasions. However, treatment with tamoxifen resulted in the development of large ovarian cysts associated with supraphysiological plasma concentrations of estradiol.
Collapse
Affiliation(s)
- Rona Yoffe
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | | | | | | | | |
Collapse
|
23
|
Kaste SC, Baker S, Goodman P, Leisenring W, Stovall M, Hayashi R, Yeazel M, Hudson MM, Sklar C, Robison LL. Dental health of long-term survivors of childhood cancer: The childhood cancer survivor study (CCSS). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.9017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9017 Background: This study describes the frequencies of and risk factors for altered oral health and dental development in pediatric patients who have survived childhood cancer. Methods: We identified 8,522 participants and 2,831 siblings in the CCSS with information on dental health. Dental outcomes of treatment and socioeconomic-demographic (SED) data, were analyzed using univariate and multivariate logistic regression models to estimate odds ratios (OR). Results: Survivors included 4,249 females (49.9%), 7,367 white non-Hispanic (86.5%). Median age at cancer diagnosis, 6.8y (range, 0–20 y); time from diagnosis to interview, 31.4 y (range, 17–54 y). Overall, 30% of survivors self-reported ≥ 1 oral-dental abnormality: microdontia (10%), hypodontia (8%), > 5 caries (55%), root stunting (6%), enamel hypoplasia (13%), gingivitis (7%). Compared to siblings, survivors were at increased risk of ≥ 1 oral-dental abnormalities when adjusted for SED (OR = 2.0, p<0.001). Increased risk of abnormalities was associated with being female (p<0.001) or white non-Hispanic (p=0.001), having an income < $20K (p=0.001) or lower education (p=0.004), and lack of health insurance (p=0.02). Patients with central nervous system tumors, neuroblastoma and soft tissue sarcoma had highest risk of abnormality (all P-values < 0.001). In multivariate models adjusted for SED, radiation dose to jaw, and exposure to increasing doses of alkylating agents increased risk of oral-dental abnormalities (radiation dose = 20 Gy OR = 5.6, p < 0.001; alkylating agent score OR=1.6, p<0.0001). Conclusions: Childhood cancer therapy results in adverse long- term oral-dental sequelae and is associated with specific treatment factors. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- S. C. Kaste
- St Jude Children's Research Hosp, Memphis, TN; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; M D Anderson Cancer Center, Houston, TX; St Louis Children's Hospital, St Louis, MO; St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan Kettering, New York, NY
| | - S. Baker
- St Jude Children's Research Hosp, Memphis, TN; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; M D Anderson Cancer Center, Houston, TX; St Louis Children's Hospital, St Louis, MO; St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan Kettering, New York, NY
| | - P. Goodman
- St Jude Children's Research Hosp, Memphis, TN; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; M D Anderson Cancer Center, Houston, TX; St Louis Children's Hospital, St Louis, MO; St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan Kettering, New York, NY
| | - W. Leisenring
- St Jude Children's Research Hosp, Memphis, TN; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; M D Anderson Cancer Center, Houston, TX; St Louis Children's Hospital, St Louis, MO; St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan Kettering, New York, NY
| | - M. Stovall
- St Jude Children's Research Hosp, Memphis, TN; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; M D Anderson Cancer Center, Houston, TX; St Louis Children's Hospital, St Louis, MO; St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan Kettering, New York, NY
| | - R. Hayashi
- St Jude Children's Research Hosp, Memphis, TN; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; M D Anderson Cancer Center, Houston, TX; St Louis Children's Hospital, St Louis, MO; St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan Kettering, New York, NY
| | - M. Yeazel
- St Jude Children's Research Hosp, Memphis, TN; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; M D Anderson Cancer Center, Houston, TX; St Louis Children's Hospital, St Louis, MO; St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan Kettering, New York, NY
| | - M. M. Hudson
- St Jude Children's Research Hosp, Memphis, TN; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; M D Anderson Cancer Center, Houston, TX; St Louis Children's Hospital, St Louis, MO; St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan Kettering, New York, NY
| | - C. Sklar
- St Jude Children's Research Hosp, Memphis, TN; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; M D Anderson Cancer Center, Houston, TX; St Louis Children's Hospital, St Louis, MO; St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan Kettering, New York, NY
| | - L. L. Robison
- St Jude Children's Research Hosp, Memphis, TN; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; M D Anderson Cancer Center, Houston, TX; St Louis Children's Hospital, St Louis, MO; St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan Kettering, New York, NY
| |
Collapse
|
24
|
Mason GE, Aung L, Gall S, Meyers PA, Sklar C, Butler R, Healey JH, Gorlick RG. Quality of life following amputation or limb salvage in patients with lower extremity sarcoma. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
19530 Background: Currently between 80–90% of patients with lower extremity sarcoma undergo limb salvage procedures. A few trials show that the functional quality of life is significantly higher for limb salvage surgery compared to patients with amputation. While taking quality of life and psychological consequences into account it would seem that limb salvage would be the procedure of preference; however, this difference has yet to be demonstrated in previous studies. Methods: Eighty-two long-term survivors of lower extremity sarcoma were studied to make a comparison of the overall quality of life in limb salvage and amputation patients. Forty-eight patients with limb salvage (age 14–49 years) and thirty-four patients with amputations (age 15–49 years) were studied who were at least one-year post- surgical procedure. Sensitive psychometric measures such as self-report questionnaires and visual analog scales were used to assess psychological consequences and quality of life. Results: The overall quality of life of patients with the limb salvage was significantly higher than patients with amputation (p-value < 0.01). For the quality of life questionnaire, the limb salvage patients had a higher mean value in every domain except parent-child relations. The domains that showed a significant difference between patients with limb salvage and patients with amputations are material well being, occupational relations, creative-aesthetic behavior, and sports activity. Conclusions: For patients with lower extremity sarcoma, the psychological quality of life is better for those who received the limb salvage procedure. The significance of this study is that it one of the first to show that there is a direct benefit to limb salvage surgery as compared to amputation in regards to several psychological factors and total quality of life. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- G. E. Mason
- Albert Einstein College of Medicine, Bronx, NY; University of South Florida All Children’s Hospital, St. Petersburg, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Oregon Health & Science University, Portland, OR
| | - L. Aung
- Albert Einstein College of Medicine, Bronx, NY; University of South Florida All Children’s Hospital, St. Petersburg, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Oregon Health & Science University, Portland, OR
| | - S. Gall
- Albert Einstein College of Medicine, Bronx, NY; University of South Florida All Children’s Hospital, St. Petersburg, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Oregon Health & Science University, Portland, OR
| | - P. A. Meyers
- Albert Einstein College of Medicine, Bronx, NY; University of South Florida All Children’s Hospital, St. Petersburg, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Oregon Health & Science University, Portland, OR
| | - C. Sklar
- Albert Einstein College of Medicine, Bronx, NY; University of South Florida All Children’s Hospital, St. Petersburg, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Oregon Health & Science University, Portland, OR
| | - R. Butler
- Albert Einstein College of Medicine, Bronx, NY; University of South Florida All Children’s Hospital, St. Petersburg, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Oregon Health & Science University, Portland, OR
| | - J. H. Healey
- Albert Einstein College of Medicine, Bronx, NY; University of South Florida All Children’s Hospital, St. Petersburg, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Oregon Health & Science University, Portland, OR
| | - R. G. Gorlick
- Albert Einstein College of Medicine, Bronx, NY; University of South Florida All Children’s Hospital, St. Petersburg, FL; Memorial Sloan Kettering Cancer Center, New York, NY; Oregon Health & Science University, Portland, OR
| |
Collapse
|
25
|
Gajjar A, Merchant T, Sklar C, Wallace D, Xiong Z, Shelso J, Broniscer A, Fouladi M, Kun L, Laughton S. Endocrine outcome for children with embryonal brain tumors treated with craniospinal irradiation on the SJMB96 trial. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.9571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9571 Background: To investigate the relationship between endocrine deficits with the radiation (RT) dose to the hypothalamic- pituitary axis (HPA) in medulloblastoma/PNET patients treated with risk-adapted craniospinal irradiation (CSI) followed by chemotherapy. Methods: 88 patients who survived at least 2 years from diagnosis were included in this analysis. CSI doses were 23.4 Gy or 36–39.6 Gy depending on clinical risk; the primary tumor site received 55.8 Gy. All pts had regular endocrine follow-up and screening to test for growth hormone (GH), thyroid hormone (TH) and adrenocorticotrophin hormone (ACTH) deficiency. Patients that had abnormal results on the screening tests underwent further evaluation by stimulation testing of the HPA. Only patients diagnosed with central hypothyroidism were included in the analysis for TH deficiency. Results: Of the 88 pts included in the study cohort, 77 pts had abnormal screening tests and underwent provocative testing. The median radiation dose to the hypothalamus was 42 Gy (26–57 Gy) and pituitary was 44 Gy (26–58 Gy). Patients receiving higher RT doses to the pituitary had a significantly higher incidence of growth hormone deficiency with 4-year estimates of 100 ±3% for those receiving = 44Gy and 82±7% for those receiving < 44 Gy (p=0.024). Four-year estimates of thyroid hormone deficiency for patients receiving = 44 Gy to the pituitary were 67±21% and 18±14% for those receiving < 44 Gy (p<0.010). There was no correlation between the dose to the pituitary with the incidence of ACTH deficiency. The estimated change in height z-score for patients receiving < 44 Gy to the pituitary was - 0.53 units per year (-0.44 to -0.63) compared with -0.70 units per year (-0.62 to -0.78) for those receiving = 44 Gy. Conclusions: Data from this prospective study demonstrate that RT to the HPA is the key determinant for developing endocrinopathies in patients with medulloblastoma/PNET. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- A. Gajjar
- St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - T. Merchant
- St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - C. Sklar
- St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - D. Wallace
- St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Z. Xiong
- St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J. Shelso
- St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - A. Broniscer
- St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - M. Fouladi
- St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - L. Kun
- St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY
| | - S. Laughton
- St Jude Children's Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY
| |
Collapse
|
26
|
Baker KS, Ness KK, Steinberger J, Carter A, Francisco L, Burns LJ, Sklar C, Forman S, Weisdorf D, Gurney JG, Bhatia S. Diabetes, hypertension, and cardiovascular events in survivors of hematopoietic cell transplantation: a report from the bone marrow transplantation survivor study. Blood 2006; 109:1765-72. [PMID: 17047152 PMCID: PMC1794046 DOI: 10.1182/blood-2006-05-022335] [Citation(s) in RCA: 242] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We ascertained the prevalence of self-reported late occurrence of diabetes, hypertension, and cardiovascular (CV) disease in 1089 hematopoietic cell transplantation (HCT) survivors who underwent HCT between 1974 and 1998, survived at least 2 years, and were not currently taking immunosuppressant agents and compared them with 383 sibling controls. All subjects completed a 255-item health questionnaire. The mean age at survey completion was 39.3 years for survivors and 38.6 years for siblings; mean follow-up was 8.6 years. Adjusting for age, sex, race, and body mass index (BMI), survivors of allogeneic HCT were 3.65 times (95% confidence interval [CI], 1.82-7.32) more likely to report diabetes than siblings and 2.06 times (95% CI, 1.39-3.04) more likely to report hypertension compared with siblings but did not report other CV outcomes with any greater frequency. Recipients of autologous HCTs were no more likely than siblings to report any of the outcomes studied. Allogeneic HCT survivors were also more likely to develop hypertension (odds ratio [OR]=2.31; 95% CI, 1.45-3.67) than autologous recipients. Total body irradiation (TBI) exposure was associated with an increased risk of diabetes (OR=3.42; 95% CI, 1.55-7.52). Thus, HCT survivors have a higher age- and BMI-adjusted risk of diabetes and hypertension, potentially leading to a higher than expected risk of CV events with age.
Collapse
Affiliation(s)
- K Scott Baker
- Department of Pediatrics, University of Minnesota, Minneapolis 55455, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Aplenc R, Blanco J, Leisenring W, Davies S, Relling M, Robison L, Sklar C, Stovall M, Bhatia S. Polymorphisms in candidate genes in patients with congestive heart failure (CHF) after childhood cancer: A Report from the Childhood Cancer Survivor Study (CCSS). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.9004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9004 Background: In cancer survivors, CHF associated with the use of anthracyclines is an important clinical complication. Risk factors for anthracycline associated cardiac toxicity, including cumulative dose, gender, and age, have been described. However, these risk factors do not fully explain the observed clinical variability. Notably, the potential role of genetic risk factors has not been studied. A recent “unifying hypothesis” postulates that the early cardiac damage is mediated mostly by oxidative stress while the more chronic type of toxicity is induced by anthracycline alcohol metabolites synthesized by carbonyl reductases (CBRs). Therefore we hypothesized that genetic polymorphisms in genes encoding for enzymes involved in oxidative stress pathways, and the metabolism of anthracyclines may impact on the risk of anthracycline-related cardiotoxicity. Methods: We conducted a nested case-control study within a cohort of 5,739 patients enrolled in the CCSS. Forty-seven cases with CHF and 195 matched controls (matched for demographics, follow-up and treatment) were genotyped for 10 genetic polymorphisms in 7 genes: catalase (CAT), GSTP, GSTT, GSTM, superoxide dismutase (SOD 1), NQO1, and CBR3. Results: In the subjects who received anthracyclines, multivariable analyses of CHF risk, adjusted for gender, smoking history, recurrence, and family history of heart disease, showed the GSTP +313A>G polymorphism was a significant risk factor, HR = 5.0, p = 0.01 for the A/G genotype vs. A/A; HR = 3.3, p = 0.19 for the G/G genotype vs. A/A. In addition, a suggested association between CBR3 V244M polymorphism and the risk of CHF after treatment with anthracyclines, HR=10.2, p=0.06 for G/G vs. A/A; HR = 4.0, p=0.18 for G/A vs. A/A was seen in an identical multivariable analysis. Conclusions: These data suggest that specific polymorphic genetic variants on a panel of candidate genes relevant to the anthracycline pharmacodynamics may modify the risk of CHF in childhood cancer survivors. Future studies to further refine the role of these novel genetic risk factors affecting a large population are warranted. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- R. Aplenc
- Children’s Hospital of Philadelphia, Philadelphia, PA; State University of New York, Buffalo, NY; University of Washington, Seattle, WA; University of Cincinnati, Cincinnati, OH; St. Jude’s Childrens Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; City of Hope, Duarte, CA
| | - J. Blanco
- Children’s Hospital of Philadelphia, Philadelphia, PA; State University of New York, Buffalo, NY; University of Washington, Seattle, WA; University of Cincinnati, Cincinnati, OH; St. Jude’s Childrens Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; City of Hope, Duarte, CA
| | - W. Leisenring
- Children’s Hospital of Philadelphia, Philadelphia, PA; State University of New York, Buffalo, NY; University of Washington, Seattle, WA; University of Cincinnati, Cincinnati, OH; St. Jude’s Childrens Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; City of Hope, Duarte, CA
| | - S. Davies
- Children’s Hospital of Philadelphia, Philadelphia, PA; State University of New York, Buffalo, NY; University of Washington, Seattle, WA; University of Cincinnati, Cincinnati, OH; St. Jude’s Childrens Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; City of Hope, Duarte, CA
| | - M. Relling
- Children’s Hospital of Philadelphia, Philadelphia, PA; State University of New York, Buffalo, NY; University of Washington, Seattle, WA; University of Cincinnati, Cincinnati, OH; St. Jude’s Childrens Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; City of Hope, Duarte, CA
| | - L. Robison
- Children’s Hospital of Philadelphia, Philadelphia, PA; State University of New York, Buffalo, NY; University of Washington, Seattle, WA; University of Cincinnati, Cincinnati, OH; St. Jude’s Childrens Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; City of Hope, Duarte, CA
| | - C. Sklar
- Children’s Hospital of Philadelphia, Philadelphia, PA; State University of New York, Buffalo, NY; University of Washington, Seattle, WA; University of Cincinnati, Cincinnati, OH; St. Jude’s Childrens Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; City of Hope, Duarte, CA
| | - M. Stovall
- Children’s Hospital of Philadelphia, Philadelphia, PA; State University of New York, Buffalo, NY; University of Washington, Seattle, WA; University of Cincinnati, Cincinnati, OH; St. Jude’s Childrens Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; City of Hope, Duarte, CA
| | - S. Bhatia
- Children’s Hospital of Philadelphia, Philadelphia, PA; State University of New York, Buffalo, NY; University of Washington, Seattle, WA; University of Cincinnati, Cincinnati, OH; St. Jude’s Childrens Research Hospital, Memphis, TN; Memorial Sloan-Kettering Cancer Center, New York, NY; M. D. Anderson Cancer Center, Houston, TX; City of Hope, Duarte, CA
| |
Collapse
|
28
|
Whelan K, Mertens A, Castleberry R, Mitby P, Kawashima T, Sklar C, Packer R, Waterbor J, Blatt J, Robison L. Visual complications in childhood cancer survivors: A Childhood Cancer Survivor Study report. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.9006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9006 Background: The Childhood Cancer Survivor Study (CCSS) is an NIH funded project (U01-CA 55727) designed to study the effects of childhood cancer treatment on long- term survivors. Previous studies have found associations between certain cancer therapies and visual complications. Methods: The CCSS is a retrospective cohort study investigating health outcomes of long-term survivors (> 5 years) diagnosed and treated between 1970 and 1986 compared to a randomly selected sibling cohort. Questionnaires were completed by 14,362 survivors of childhood cancer and 3,901 sibling controls. Analysis determined the first occurrence of 8 visual conditions in 3 time periods: during therapy, end of therapy to 5 years post diagnosis, and greater than or equal to 5 years post diagnosis. Multivariate analyses, adjusting for current age and gender, determined the relative risks (RR) and 95% confidence interval (CI) of visual conditions by treatment exposure. Results: Survivors had statistically significant increases in the RR of cataracts, glaucoma, legal blindness, double vision, retinal condition, and dry eyes, across all time periods, when compared to siblings. During the time period of 5 or more years post-diagnosis, statistically significant positive associations were present for cataracts and other head radiation, craniospinal radiation, total body radiation, and prednisone; glaucoma and craniospinal radiation; double vision and craniospinal radiation; legally blind and other head radiation and craniospinal radiation; and dry eyes and other head radiation, total body radiation, and dexamethasone. There were no statistically significant associations between treatment factors and retinal conditions. Conclusions: Childhood cancer survivors are at risk of developing visual complications and treatment related factors are important determinants of this risk. Follow-up is needed to evaluate the impact of visual conditions on quality of life. [Table: see text] No significant financial relationships to disclose.
Collapse
Affiliation(s)
- K. Whelan
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| | - A. Mertens
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| | - R. Castleberry
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| | - P. Mitby
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| | - T. Kawashima
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| | - C. Sklar
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| | - R. Packer
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| | - J. Waterbor
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| | - J. Blatt
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| | - L. Robison
- University of Alabama at Birmingham, Birmingham, AL; University of Minnesota, Minneapolis, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; Memorial Sloan-Kettering Cancer Center, New York, NY; Children’s National Medical Center, Washington D.C., DC; University of North Carolina, Chapel Hill, NC; St. Jude’s Children’s Reseach Hospital, Memphis, TN
| |
Collapse
|
29
|
Ronckers C, Sigurdson A, Stovall M, Smith S, Sklar C, Land C, Neglia J, Mertens A, Hammond S, Meadows A, Robison L, Inskip P. 042: Radiation and Thyroid Cancer in the Childhood Cancer Survivor Study: A Detailed Evaluation of Dose-Response and its Modifiers. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s11a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Ronckers
- National Cancer Institute, Bethesda, MD 20892
| | - A Sigurdson
- National Cancer Institute, Bethesda, MD 20892
| | - M Stovall
- National Cancer Institute, Bethesda, MD 20892
| | - S Smith
- National Cancer Institute, Bethesda, MD 20892
| | - C Sklar
- National Cancer Institute, Bethesda, MD 20892
| | - C Land
- National Cancer Institute, Bethesda, MD 20892
| | - J Neglia
- National Cancer Institute, Bethesda, MD 20892
| | - A Mertens
- National Cancer Institute, Bethesda, MD 20892
| | - S Hammond
- National Cancer Institute, Bethesda, MD 20892
| | - A Meadows
- National Cancer Institute, Bethesda, MD 20892
| | - L Robison
- National Cancer Institute, Bethesda, MD 20892
| | - P Inskip
- National Cancer Institute, Bethesda, MD 20892
| |
Collapse
|
30
|
Abstract
Ovarian damage following cancer therapy is dependent on age at treatment as well as the type of therapeutic exposures. Older age and exposure to higher doses of alkylating agents and higher doses of radiation to the ovary are associated with a greater likelihood of ovarian failure. Acute loss of ovarian function during or shortly following treatment is relatively uncommon in females treated during childhood and adolescence but can be seen following myeloablative, alkylator-based cytoreduction (e.g., busulfan and cyclophosphamide) for stem cell transplant and following direct ovarian radiation with doses >10 Gy. For survivors who retain normal ovarian function after cancer therapy, there is an increased risk of premature menopause later in life. The risk factors associated with an early menopause include exposure to high doses of alkylating agents and abdomino-pelvic radiation.
Collapse
Affiliation(s)
- Charles Sklar
- Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA.
| |
Collapse
|
31
|
Nagarajan R, Clohisy DR, Neglia JP, Yasui Y, Mitby PA, Sklar C, Finklestein JZ, Greenberg M, Reaman GH, Zeltzer L, Robison LL. Function and quality-of-life of survivors of pelvic and lower extremity osteosarcoma and Ewing's sarcoma: the Childhood Cancer Survivor Study. Br J Cancer 2005; 91:1858-65. [PMID: 15534610 PMCID: PMC2410143 DOI: 10.1038/sj.bjc.6602220] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Limb-sparing surgeries have been performed more frequently than amputation based on the belief that limb-sparing surgeries provide improved function and quality-of-life (QOL). However, this has not been extensively studied in the paediatric population, which has unique characteristics that have implications for function and QOL. Using the Childhood Cancer Survivor Study, 528 adult long-term survivors of pediatric lower extremity bone tumours, diagnosed between 1970 and 1986, were contacted and completed questionnaries assessing function and QOL. Survivors were an average of 21 years from diagnosis with an average age of 35 years. Overall they reported excellent function and QOL. Compared to those who had a limb-sparing procedure, amputees were not more likely to have lower function and QOL scores and self-perception of disability included general health status, lower educational attainment, older age and female gender. Findings from this study suggest that, over time, amputees do as well as those who underwent limb-sparing surgeries between 1970 and 1986. However, female gender, lower educational attainment and older current age appear to influence function, QOL and disability.
Collapse
Affiliation(s)
- R Nagarajan
- Division of Pediatrics, Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Mayo Mail Code 484, 420 Delaware St., SE Minneapolis, MN 55455, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Byrne J, Fears TR, Mills JL, Zeltzer LK, Sklar C, Nicholson HS, Haupt R, Reaman GH, Meadows AT, Robison LL. Fertility in women treated with cranial radiotherapy for childhood acute lymphoblastic leukemia. Pediatr Blood Cancer 2004; 42:589-97. [PMID: 15127413 DOI: 10.1002/pbc.20033] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Fertility impairments among women treated during childhood for cancer are known to occur after some, but not all, types of anticancer therapy. Although leukemia is the most common cancer of childhood, until now fertility in survivors has not been comprehensively assessed. PROCEDURE We investigated functional impairment of fertility in women who were long-term survivors of acute lymphoblastic leukemia (ALL) with a retrospective cohort study. Proven fertility (defined as ever pregnant) was evaluated by self-report among 182 females treated on protocols of the Children's Cancer Group (age at interview, 22.6 years on average) and 170 controls drawn from among the survivors' female siblings (23.4 years). The interview included psychosocial inventories designed to detect mood problems. RESULTS Significant fertility deficits were noted in female survivors treated with cranial radiotherapy (CRT) at any dose around the time of menarche (relative fertility (RF)) = 0.27, 95% CI = 0.09, 0.82, P = 0.03). Controlling for marital status, mood at interview, and many fertility-related situations did not change the association. CONCLUSION This study provides evidence for fertility deficits after treatment for ALL with CRT, and, in addition, for the first time, suggests that girls treated around the time of menarche are especially at risk. Clinical confirmation of these results is needed. If gonadal damage occurs in women receiving these treatments, their risk for further sequelae, such as osteoporosis and heart disease, may be significantly raised, requiring active management and intervention.
Collapse
Affiliation(s)
- Julianne Byrne
- Department of Hematology/Oncology, Children's National Medical Center, Washington, DC 20010, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Byrne J, Fears TR, Mills JL, Zeltzer LK, Sklar C, Meadows AT, Reaman GH, Robison LL. Fertility of long-term male survivors of acute lymphoblastic leukemia diagnosed during childhood. Pediatr Blood Cancer 2004; 42:364-72. [PMID: 14966835 DOI: 10.1002/pbc.10449] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Fertility impairments among men treated during childhood for cancer are known to occur after some, but not all, types of anti-cancer therapy. This is the first study to evaluate proven fertility among adult male survivors of childhood acute lymphoblastic leukemia (ALL). In a retrospective cohort study, proven fertility (ever fathered a pregnancy) was evaluated by self-report among 213 men treated for ALL before age 18 on protocols of the Children's Cancer Group (CCG). Controls (N = 145) were drawn from among male siblings. Overall, with a proportional hazards analysis, proven fertility of male survivors was not different from that of controls (relative fertility (RF) = 0.95, 95% CI 0.63-1.43). However, married men treated before age 10 with high dose (24 cGy) cranial radiotherapy (RT), without spinal RT, had only 9% of the fertility of controls (Relative risk, RR = 0.09, 95% CI 0.01-0.82). High dose cranial RT at older ages was not associated with a statistically significant fertility deficit (RR = 0.56, 95% CI 0.25-1.28). In this first study of proven fertility among men treated for childhood leukemia, the majority of survivors showed no evidence of fertility impairment compared to controls. However, men treated at a young age with high dose cranial RT may have impaired fertility. These results suggest that further investigation of men with these treatments is needed to confirm and extend these findings.
Collapse
Affiliation(s)
- Julianne Byrne
- The Children's National Medical Center, Washington, DC 20010, USA.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Acharya S, Sarafoglou K, LaQuaglia M, Lindsley S, Gerald W, Wollner N, Tan C, Sklar C. Thyroid neoplasms after therapeutic radiation for malignancies during childhood or adolescence. Cancer 2003; 97:2397-403. [PMID: 12733137 DOI: 10.1002/cncr.11362] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Recent data indicate that the risk of developing a thyroid neoplasm clearly is increased after high-dose, therapeutic radiation therapy during childhood. To better understand the time course, natural history, and histopathology of thyroid lesions that develop after high-dose irradiation, the authors undertook a retrospective study of all survivors of childhood and adolescent malignancies who were treated at Memorial Sloan-Kettering Cancer Center and who developed a clinically apparent thyroid neoplasm. METHODS The authors searched the data base of the Department of Pediatrics, the hospital-based tumor registry, and the hospital medical records database for patients with thyroid neoplasms. RESULTS Thirty-three patients were identified who developed a thyroid neoplasm after therapeutic radiation. Primary diagnoses were Hodgkin disease (n = 18 patients), non-Hodgkin lymphoma (n = 10 patients), acute lymphoblastic leukemia (n = 2 patients), acute myeloid leukemia (n = 1 patient), Wilms tumor (n = 1 patient), and neuroblastoma (n = 1 patient). The median age at the time of diagnosis of the primary malignancy was 12.0 years (range, 3.7-18.3 years), the median radiation dose to the thyroid gland was 2400 centigrays (cGy; range, 1000-4200 cGy), and the median interval from the time of radiation therapy until the recognition of thyroid disease was 13.0 years (range, 6.2-30.1 years). Thirteen of 33 thyroid lesions (39%) were malignant (11 papillary carcinomas and 2 follicular carcinomas). Age at diagnosis, gender ratio, and time elapsed since initial treatment did not differ between patients with malignant and benign lesions, but the median radiation dose to the thyroid was lower in patients who had malignant disease compared with patients who had benign disease (2000 cGy vs. 2950 cGy; P = 0.03). Disease was confined to the neck in all patients who had malignant thyroid lesions; after a median follow-up of 6.5 years (range, 0.9-12 years), none of the patients developed progressive or recurrent disease. CONCLUSIONS Data from this study suggest that a high proportion of clinically apparent thyroid neoplasms that develop after therapeutic radiation for a childhood malignancy are malignant. However, most of these thyroid malignancies do not appear to behave in an aggressive fashion. Because thyroid neoplasms may not become evident for decades after radiation therapy, all individuals who are at risk require life-long follow-up.
Collapse
Affiliation(s)
- Suchitra Acharya
- Department of Pediatrics, New York Presbyterian Hospital and Cornell-Weil Medical School, New York, New York, USA
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Mertens AC, Yasui Y, Liu Y, Stovall M, Hutchinson R, Ginsberg J, Sklar C, Robison LL. Pulmonary complications in survivors of childhood and adolescent cancer. A report from the Childhood Cancer Survivor Study. Cancer 2002; 95:2431-41. [PMID: 12436452 DOI: 10.1002/cncr.10978] [Citation(s) in RCA: 191] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The Childhood Cancer Survivor Study is a resource that was designed to investigate long-term effects among 5-year survivors of childhood and adolescent malignancies. Previous studies have shown that exposure to chemotherapy and/or radiation can compromise pulmonary function in these survivors of childhood cancer. METHODS Using information obtained from questionnaires from 12,390 childhood cancer survivors and 3546 randomly selected siblings, the authors evaluated the rate of first occurrence of 15 selected pulmonary conditions in three periods: during therapy, from the end of therapy to 5 years postdiagnosis, and >/= 5 years postdiagnosis. Multivariate analyses were used to determine the relative risks with 95% confidence intervals of reported pulmonary conditions by exposure to the following treatment variables: radiation therapy to the chest, bleomycin, cyclophosphamide, busulfan, lomustine (CCNU), and/or carmustine (BCNU). RESULTS Compared with siblings, survivors had a statistically significant increased relative risk (RR) of lung fibrosis, recurrent pneumonia, chronic cough, pleurisy, use of supplemental oxygen, abnormal chest wall, exercise-induced shortness of breath, bronchitis, recurrent sinus infection, and tonsillitis for all three periods. During the period of >or= 5 years postdiagnosis, statistically significant associations were present for lung fibrosis and chest radiation (RR, 4.3; P = 0 001); for supplemental oxygen use and chest radiation (RR, 1.8; P < 0.001), BCNU (RR, 1.4; P = 0.05), bleomycin (RR, 1.7; P = 0.001), busulfan (RR, 3.2; P = 0.002), CCNU (RR, 2.1; P < 0.001), and cyclophosphamide (RR, 1.5; P = 0.01); for recurrent pneumonia and chest radiation (RR, 2.2; P = 0.001) and cyclophosphamide (RR, 1.6; P = 0.04); for chronic cough and chest radiation (RR, 2.0; P < 0.001), bleomycin (RR, 1.9; P < 0.001), and cyclophosphamide (RR, 1.3; P = 0.004); and for pleurisy and chest radiation (RR, 1.4; P = 0.02) and busulfan (RR, 5.1; P = 0.02). Chest radiation was associated with a 3.5% cumulative incidence of lung fibrosis at 20 years after diagnosis. CONCLUSIONS For self-report of pulmonary conditions, treatment-related factors that continue to manifest > 5 years after diagnosis and treatment are important determinants of risk. Continued follow-up of childhood cancer survivors is needed to evaluate the impact of pulmonary conditions on quality of life.
Collapse
Affiliation(s)
- Ann C Mertens
- Department of Pediatrics, University of Minnesota Medical School and Cancer Center, Minneapolis, Minnesota, USA
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
More than 70% of children diagnosed with cancer can now be expected to be long-term survivors. However, the consequences of 'cure' might be considerable for the survivors of cancer: 60-70% of young adults who have survived childhood cancer will develop at least one medical disability as a result of their cancer or, more commonly, as a result of their therapy. Of these, the most devastating is a second cancer.
Collapse
Affiliation(s)
- Smita Bhatia
- City of Hope National Medical Center, Duarte, California 91010, USA
| | | |
Collapse
|
37
|
Abstract
Abnormalities of endocrine function and growth are common following stem cell transplantation in the pediatric/adolescent population. Impaired linear growth and adult short stature are associated with younger age at transplant, use of TBI and prior cranial irradiation, and development of chronic GvHD. Primary hypothyroidism is the most common abnormality of the thyroid and is observed in 10-28% of cases following fractionated TBI. Autoimmune hyperthyroidism has also been described post-stem cell transplant and most often results from adoptive transfer of abnormal clones of T or B cells from donor to recipient. Gonadal dysfunction is extremely prevalent and includes oligo-azoospermia in the majority of males treated with TBI, and primary ovarian failure in most women treated with TBI or Busulfan/Cyclophosphamide. Leydig cell function, however, is retained in most males treated with standard forms of cytoreduction. Many patients demonstrate reduced bone mineral density and are at risk of developing osteoporosis in the future.
Collapse
Affiliation(s)
- C Sklar
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, NY, NY 10021, USA.
| | | | | | | |
Collapse
|
38
|
Abstract
BACKGROUND Turner's syndrome is a genetic disorder of females with well-described karyotypic abnormalities and phenotypic features. Recombinant human growth hormone (HGH) therapy is one component of a hormonal treatment strategy for these patients and is used to promote sexual maturity and to increase height. METHODS Literature review of hepatic complications following the initiation of growth hormone therapy for patients with Turner's syndrome, and case report presentation of a 13-year-old female with Turner's syndrome developing a hepatic adenoma following 3 years of HGH treatment. RESULTS The association between Turner's syndrome and HGH treatment-associated hepatic adenoma has not been described previous to this report. In this patient, surgical resection was contraindicated and the patient was successfully treated by hepatic artery embolization. The unique management issues relating to this case, and a possible association between HGH therapy and the development of hepatic adenoma are discussed. CONCLUSION This work represents the first documentation of a hepatic adenoma developing in a patient with Turner's syndrome following HGH treatment, and suggests a novel and causal association between HGH treatment and the development of hepatic adenoma in patients with Turner's syndrome.
Collapse
Affiliation(s)
- J Espat
- Hepatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, N.Y., USA
| | | | | | | |
Collapse
|
39
|
Sklar C. Paying the price for cure-treating cancer survivors with growth hormone. J Clin Endocrinol Metab 2000; 85:4441-3. [PMID: 11134090 DOI: 10.1210/jcem.85.12.7152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- C Sklar
- Long-Term Follow-Up Program, Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
| |
Collapse
|
40
|
Sklar C, Whitton J, Mertens A, Stovall M, Green D, Marina N, Greffe B, Wolden S, Robison L. Abnormalities of the thyroid in survivors of Hodgkin's disease: data from the Childhood Cancer Survivor Study. J Clin Endocrinol Metab 2000; 85:3227-32. [PMID: 10999813 DOI: 10.1210/jcem.85.9.6808] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Treatment for Hodgkin's disease (HD) is associated with a variety of thyroid abnormalities, including hypothyroidism, hyperthyroidism, and thyroid neoplasms. Due to the small sample size and short follow-up time of most published studies, it has been difficult to appreciate the full extent of the problem and to characterize the interaction between various patient and treatment variables. To overcome these limitations we have assessed thyroid status in 1,791 (959 males) HD survivors from among 13,674 participants in the Childhood Cancer Survivor Study, a cohort of 5-yr survivors of childhood and adolescent cancer diagnosed between 1970 and 1986. Thyroid abnormalities were ascertained as part of a 22-page questionnaire sent to participants. Survivors were a median of 14 yr (range, 2-20 yr) at diagnosis of HD and a median of 30 yr (range, 12-47 yr) at follow-up. Seventy-nine percent of subjects were treated with radiation (median dose of radiation to the thyroid, 3,500 cGy; range, 0.37-5,500 cGy). Control data were available from 2,808 (1,346 males) sibling controls. Thirty-four percent of the entire cohort has been diagnosed with at least one thyroid abnormality. Hypothyroidism was the most common disturbance, with a relative risk of 17.1 (P < 0.0001) compared to sibling controls. Increasing dose of radiation, older age at diagnosis of HD, and female sex were all independently associated with an increased risk of hypothyroidism. Actuarial risk of hypothyroidism for subjects treated with 4,500 cGy or more is 50% at 20 yr from diagnosis. Hyperthyroidism was reported by 5% of survivors, which was 8-fold greater (P < 0.0001) than the incidence reported by the controls. Thyroid dose of 3,500 cGy or more was the only risk factor identified for hyperthyroidism. The risk of thyroid nodules was 27 times (P < 0.0001) that in sibling controls. Female sex and radiation dose to the thyroid of 2,500 cGy or more were independent risk factors for thyroid nodules. The actuarial risk of a female survivor developing a thyroid nodule is 20% at 20 yr from diagnosis. Thyroid cancer was diagnosed in 20 survivors, which is 18 times the expected rate for the general population. After taking into account the possibility that some of the relative risk estimates may be exaggerated due to ascertainment bias, abnormalities of the thyroid are still extremely common in young adult survivors of childhood HD, particularly among females treated with high doses of radiation to the neck.
Collapse
Affiliation(s)
- C Sklar
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
La Quaglia MP, Black T, Holcomb GW, Sklar C, Azizkhan RG, Haase GM, Newman KD. Differentiated thyroid cancer: clinical characteristics, treatment, and outcome in patients under 21 years of age who present with distant metastases. A report from the Surgical Discipline Committee of the Children's Cancer Group. J Pediatr Surg 2000; 35:955-9; discussion 960. [PMID: 10873043 DOI: 10.1053/jpsu.2000.6935] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE Young patients with differentiated thyroid cancer typically present with regional lymph node involvement (60% to 80%), and 10% to 20% have distant metastases. This study characterizes the clinical presentation, treatment, and outcome in patients with differentiated thyroid cancer who were less than 21 years of age at diagnosis and who presented with distant parenchymal metastases. METHODS A retrospective, multi-institutional data base that included 327 patients in this age group with differentiated thyroid carcinoma was searched for patients who presented with distant metastases, and 83 cases (25%) were found. The median time to first disease progression was 2.4 years (range, 0.1 to 12.4 years) and the overall median follow-up was 10.9 years (range, 1.0 to 42.1 years). RESULTS The median age at diagnosis was 14.6 years (range, 6.6 to 20.8 years); 69% were girls and 92% were white. In 12%, there was a history of prior head and neck irradiation, and 10% of these patients had a family history of carcinoma. Preoperative needle biopsies were performed in 25%. Regional lymph nodes were positive in 90%, and extrathyroidal extension occurred in 48%. The site of distant metastases included the lungs in all patients. Total thyroidectomy, subtotal thyroidectomy, lobectomy, and nodule excision was done in 66%, 24%, 3%, and 8% of patients, respectively. There was no residual cervical disease after surgery in 75%, whereas 14% had microscopic and 11% had gross residual. Histopathologic subtypes included papillary-follicular (48%), papillary (42%), and follicular (10%). The median tumor size was 3.0 cm (range, 0.4 to 11.0 cm). In this group, 100% of patients received adjuvant iodine 131I therapy, and the overall survival rate at 10 years was 100%. The progression-free survival rate was 76% at 5 years and 66% at 10 years from diagnosis. CONCLUSIONS A significant number of young patients with thyroid cancer present with distant metastases and will require radioiodine therapy. This should be considered when planning the surgical approach because total or subtotal thyroidectomy facilitates 131I imaging and treatment. Although about one third of these patients will experience relapse or disease progression, the overall mortality rate is low.
Collapse
Affiliation(s)
- M P La Quaglia
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | | | | | | | | | | | |
Collapse
|
42
|
Affiliation(s)
- C Sklar
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
| |
Collapse
|
43
|
Papadakis V, Vlachopapadopoulou E, Van Syckle K, Ganshaw L, Kalmanti M, Tan C, Sklar C. Gonadal function in young patients successfully treated for Hodgkin disease. Med Pediatr Oncol 1999; 32:366-72. [PMID: 10219339 DOI: 10.1002/(sici)1096-911x(199905)32:5<366::aid-mpo10>3.0.co;2-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Gonadal function in pediatric and young adult survivors of Hodgkin disease is not very well defined. This study evaluates the outcome following the Multiple Drug Protocol (MDP) and the results are compared to the published experience. PROCEDURE Ovarian and testicular function was assessed in 65 patients (36 males) with Hodgkin disease in first or second complete remission after treatment with either radiation (RT, n = 13), chemotherapy (CT, n = 9), or both (n = 43). Chemotherapy consisted of six cycles of the MDP (doxorubicin, procarbazine, prednisone, vincristine, and cyclophosphamide). Median age at diagnosis was 13.1 years (range, 2.4-22.6) and median age at evaluation was 22.6 years (range, 15.1-33.7), which was 6.7 years (range, 2.0-19.8) after the completion of all treatments. For the purpose of analysis, patients were divided into three groups: group A, patients who received only RT that did not include the pelvis (8 females, 5 males); group B, patients who received CT but no pelvic RT (15 females, 25 males); and group C, patients who received CT plus pelvic RT (6 females, 6 males). RESULTS All patients progressed spontaneously through puberty and evaluable patients were found to be sexually mature (Tanner stage IV and V). Serum follicle stimulating hormone (FSH) was increased in 0/5, 13/25, and 5/6 and testicular volume was decreased in 1/3, 4/11, and 2/3 group A, B, and C male patients, respectively. Leydig cell dysfunction was uncommon; 91% and 88% of males had normal serum concentrations of luteinizing hormone (LH) and testosterone, respectively. FSH and LH were increased in 0/8, 3/15, and 2/6 group A, B, and C female patients, respectively, at last follow-up, indicating a 17% prevalence of ovarian dysfunction. Serial data in seven females whose initial levels of FSH/LH were elevated revealed normalization in four. Six females delivered eight normal children. CONCLUSIONS The majority of males who received CT +/- RT have evidence of germ cell dysfunction, while Leydig cell function is unaffected in most. In females, although abnormal function early after the end of treatment was observed, ovarian function remained or returned to normal in most young women. Thus, in females the results of hormone testing performed early after treatment may not be predictive of their eventual reproductive potential.
Collapse
Affiliation(s)
- V Papadakis
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
| | | | | | | | | | | | | |
Collapse
|
44
|
Rivkees SA, Sklar C, Freemark M. Clinical review 99: The management of Graves' disease in children, with special emphasis on radioiodine treatment. J Clin Endocrinol Metab 1998; 83:3767-76. [PMID: 9814445 DOI: 10.1210/jcem.83.11.5239] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- S A Rivkees
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
| | | | | |
Collapse
|
45
|
Affiliation(s)
- F Boulad
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | | | |
Collapse
|
46
|
Abstract
When the hypothalamic-pituitary axis (HPA) is included in the treatment field in children and adults, a variety of neuroendocrine disturbances are more common than has been appreciated in the past. Clinical damage to the pituitary and thyroid glands usually occurs months to years after treatment, and is preceded by a long subclinical phase. Primary brain tumors represent the largest group of malignant solid tumors in children. The survival rates of 50% reported in the literature are achieved at the expense of late occurring effects. Radiation-induced abnormalities are generally dose-dependent. Growth hormone deficiency and premature sexual development can occur at doses as low as 18 Gy in conventional fractionation, and is the most common neuroendocrine problem in children. In patients treated with > 40 Gy on the HPA, deficiency of gonadotropins, thyroid stimulating hormone, and adrenocorticotropin can be found. Following high-dose radiotherapy (> 50 Gy), hyperprolactinemia can be seen, especially among young women. Most neuroendocrine disturbances that develop as a result of HPA can be treated efficiently, provided that an early detection of these endocrine dysfunctions abnormalities is done.
Collapse
Affiliation(s)
- S Bieri
- Département cantonal de radio-oncologie, Ospedale San Giovanni, Bellinzona, Suisse
| | | | | | | |
Collapse
|
47
|
Abstract
PURPOSE Childhood cancer and its treatment can affect normal bone accretion. In this study, bone mineral density (BMD) in young adult survivors of childhood cancer is assessed to determine what cancer-related factors, patient characteristics, or treatment-related complications correlate with reductions in BMD. PATIENTS AND METHODS The study population consisted of 40 (24 women) long-term survivors of childhood cancer treated at the Memorial Sloan-Kettering Cancer Center for a solid tumor (n = 16), lymphoma (n = 14), or acute leukemia (n = 10) at a mean age of 12.7 +/- 0.96 years and evaluated at a mean age of 25.8 +/- 0.7 years. Dual energy X-ray absorptiometry was used to determine BMD of the lumbar spine, femoral neck, and total body and single photon absorptiometry was used to determine BMD of the distal radius. RESULTS The mean BMD standard deviation score (SDS) for the patients was significantly reduced compared to controls at the distal radius (-1.57 +/- 0.18, p = 0.0001), femoral neck (-0.68 +/- 0.20, p = 0.00014), and total body (-0.33 +/- 0.15, p = 0.03) but not at the lumbar spine (-0.22 +/- 0.22, p = 0.33). Univariate analysis revealed that gonadal dysfunction (i.e., estrogen or testosterone insufficiency) (p = 0.018) was the only variable that correlated with a reduced BMD. CONCLUSION Young adult survivors of childhood cancer have reduced BMD. Because age at study coincides with the normal age of attainment of peak bone mass and peak bone mass is a major determinant of BMD later in life, many of these patients are at increased risk for osteoporosis and fractures.
Collapse
Affiliation(s)
- J Aisenberg
- Department of Pediatrics, New York Hospital-Cornell University Medical College, New York, USA
| | | | | | | | | | | | | |
Collapse
|
48
|
Newman KD, Black T, Heller G, Azizkhan RG, Holcomb GW, Sklar C, Vlamis V, Haase GM, La Quaglia MP. Differentiated thyroid cancer: determinants of disease progression in patients <21 years of age at diagnosis: a report from the Surgical Discipline Committee of the Children's Cancer Group. Ann Surg 1998; 227:533-41. [PMID: 9563542 PMCID: PMC1191309 DOI: 10.1097/00000658-199804000-00014] [Citation(s) in RCA: 169] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study was done to define the extent of disease and evaluate the effect of staging and treatment variables on progression-free survival in patients with differentiated thyroid carcinoma who were less than 21 years of age at diagnosis. SUMMARY BACKGROUND DATA Differentiated thyroid cancer in young patients is associated with early regional lymph node involvement and distant parenchymal metastases. Despite this, the overall long-term survival rate is greater than 90%, which suggests that biologic rather than treatment factors have a greater effect on outcome. METHODS Variables analyzed for their impact on progression-free survival in a multi-institutional cohort of 329 patients included age, antecedent thyroid irradiation, extrathyroidal tumor extension, size, nodal involvement, distant metastases, technique of thyroid surgery and lymphatic dissection, initial treatment with 131Iodine, residual cervical disease, and histopathologic subtype. Surgical complications were correlated with the specific procedures completed on the thyroid gland or cervical lymphatics. RESULTS The overall progression-free survival rate was 67% (95%, CI: 61%-73%) at 10 years with 2 disease-related deaths. Regional lymph node and distant metastases were present in 74% and 25% of patients, respectively. Progression-free survival was less in younger patients (p = 0.009) and those with residual cervical disease after thyroid surgery (p = 0.001). Permanent hypocalcemia was more frequent after total or subtotal thyroidectomy (p = 0.001) while wound complications increased after radical neck dissections (p < 0.00001). CONCLUSIONS The progression-free survival rate was better after a complete resection and in older patients. Progression-free survival rate was the same after lobectomy or more extensive thyroid procedures, but comparison was confounded by the increased use of total or subtotal thyroidectomy in patients with advanced disease. The risk of permanent hypocalcemia increased when total or subtotal thyroidectomy was done. Thyroid lobectomy alone may be appropriate for patients with small localized lesions while total or subtotal thyroidectomy should be considered for more extensive tumors.
Collapse
Affiliation(s)
- K D Newman
- Department of Pediatric Surgery, Children's National Medical Center, Washington, DC, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Chin D, Sklar C, Donahue B, Uli N, Geneiser N, Allen J, Nirenberg A, David R, Kohn B, Oberfield SE. Thyroid dysfunction as a late effect in survivors of pediatric medulloblastoma/primitive neuroectodermal tumors: a comparison of hyperfractionated versus conventional radiotherapy. Cancer 1997; 80:798-804. [PMID: 9264364 DOI: 10.1002/(sici)1097-0142(19970815)80:4<798::aid-cncr19>3.0.co;2-o] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Primary hypothyroidism is a common sequela of craniospinal radiotherapy in the treatment of pediatric brain tumors. METHODS The authors compared the incidence of primary hypothyroidism after hyperfractionated radiotherapy (HFRT) (n = 14 patients) versus conventionally fractionated radiotherapy (CRT) (n = 34 patients) in a group of pediatric patients with medulloblastoma/primitive neuroectodermal tumors (MB/PNET). RESULTS The mean age at the time of tumor diagnosis was 7.9 years in the HFRT group and 8.4 years in the CRT group. The patients were followed for a mean of 4.6 years (HFRT) and 8.3 years (CRT) after diagnosis. Mean radiation doses to the thyroid were similar in both radiotherapy groups (29 gray [Gy] [HFRT] vs. 24 Gy [CRT]). Approximately 14% of the HFRT and 62% of the CRT patients developed primary hypothyroidism within a similar period after irradiation (3.2 years [HFRT] vs. 3.0 years [CRT]). Analysis by cumulative incidence function demonstrated a significant difference in the risk of developing thyroid dysfunction between these two groups of patients (P = 0.02). CONCLUSIONS The current study findings suggest that the use of HFRT in the treatment of pediatric patients with MB/PNET is associated with a lower risk of these patients developing primary hypothyroidism.
Collapse
Affiliation(s)
- D Chin
- Division of Pediatric Endocrinology, New York University Medical Center, New York 10016, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
Long-term survival in children with cancer has increased markedly in the past 15 years. However, impaired linear growth and thyroid dysfunction that vary according to the age at diagnosis and treatment and to the dose and duration of radiation and chemotherapy have been described in these patients. The impact of cranial irradiation on the hypothalamic-pituitary-adrenal axis and on pubertal maturation has been less well studied. A positive correlation between the age at diagnosis and the age at onset of puberty in children who have been treated with high-dose cranial radiation therapy for central nervous system (CNS) tumors has been found recently. Frank adrenal insufficiency is uncommon after high-dose CNS irradiation, but alterations in the hypothalamic-pituitary-adrenal axis do occur. Assessments of the effects of newer modes of radiation therapy such as hyperfractionated craniospinal radiation suggest a lower incidence of primary hypothyroidism in the long term.
Collapse
Affiliation(s)
- S E Oberfield
- Department of Pediatrics, New York University Medical Center, NY 10016, USA
| | | | | | | | | |
Collapse
|