ABSTRACT
Resumen Con el advenimiento de tratamientos multidisciplinarios y de alta calidad, la supervivencia global a cinco años por cáncer en la población pediátrica ha mejorado considerablemente, llegando a ser hasta de 80% en países de altos ingresos. En Colombia también ha habido un aumento progresivo de la supervivencia global a 5 años, particularmente para las neoplasias hematológicas. En consecuencia, el número de supervivientes de cáncer infantil ha aumentado de forma importante en los últimos años y junto con ellos la aparición de eventos adversos tardíos relacionados con mayor morbilidad y riesgo de muerte prematura en la edad adulta. Aunque se han venido implementando estrategias de seguimiento a supervivientes de cáncer infantil en países de altos ingresos, en Colombia se han realizado pocos esfuerzos para la implementación de estas estrategias. De hecho, la práctica común en la mayoría de los centros de tratamiento consiste en dar de alta al niño que cumple 5 años de seguimiento oncológico, sin instrucciones precisas para dicho seguimiento. El objetivo del presente trabajo es argumentar sobre la necesidad de diseñar e implementar estrategias de seguimiento para supervivientes de cáncer infantil en el contexto colombiano.
Abstract With the advent of high-quality multidisciplinary treatments, the overall 5-year cancer survival in the pediatric population has improved considerably, reaching up to 80% in high-income countries. In Colombia, there has also been a progressive increase in overall 5-year survival, particularly for hematologic malignancies. Consequently, the number of childhood cancer survivors has increased significantly in recent years and, together with them, the occurrence of late adverse events related to increased morbidity and risk of premature death in adulthood. Although follow-up strategies have been implemented for childhood cancer survivors in high-income countries, few efforts have been made in Colombia to implement these strategies. In fact, the common practice in most treatment centers is to discharge children who have had 5 years of cancer follow-up, without precise instructions for long-term follow-up. This paper aims to argue about the need to design and implement follow-up strategies for survivors of childhood cancer in the Colombian context.
Subject(s)
Child , Total Quality Management , Mortality, Premature , Cancer Survivors , Neoplasms , Health Strategies , Aftercare , SurvivorshipABSTRACT
ABSTRACT BACKGROUND: Postpoliomyelitis syndrome is a clinical condition that can affect poliomyelitis survivors. OBJECTIVE: Our aim was to evaluate knowledge of poliomyelitis and postpoliomyelitis syndrome among Brazilian healthcare professionals. DESIGN AND SETTING: Cross-sectional study conducted at a Brazilian public higher education institution located in the state of Goiás. METHODS: The participants (n = 578) were Brazilian physicians, physical therapists, nurses, nutritionists and psychologists. A self-administered questionnaire (30 questions) was designed to probe knowledge about poliomyelitis and postpoliomyelitis syndrome. From the questionnaire, we created a structured test to objectively evaluate the knowledge of these professionals. The test was composed of 20 questions and was scored over a range from 0 (totally ill-informed) to 20 (totally well-informed). RESULTS: In general, the physicians, physical therapists and nurses demonstrated better understanding of poliomyelitis and postpoliomyelitis syndrome. The healthcare professionals who had received previous information about poliomyelitis and postpoliomyelitis syndrome had significantly higher scores than those who had never received information (P < 0.001). On average, this difference was approximately 28.6%. CONCLUSIONS: The findings from the present study indicate that there is a critical need for improvement of knowledge about postpoliomyelitis syndrome among Brazilian healthcare professionals. The services provided by these professionals may therefore become compromised. Furthermore, public healthcare initiatives should be implemented to improve knowledge among healthcare professionals.
Subject(s)
Humans , Poliomyelitis , Health Personnel , Brazil , Health Knowledge, Attitudes, Practice , Cross-Sectional StudiesABSTRACT
Primary hypothyroidism commonly occurs after radiotherapy (RT), and coincides with increased circulating thyroid-stimulating hormone (TSH) levels.We tested therefore the protective effect of suppressing TSH with L-thyroxine during RT for medulloblastoma/PNET and Hodgkin lymphoma (HL) in a prospective cohort study. From1998 to 2001, a total of 37 euthyroid children with medulloblastoma/PNET plus 14 with HL, scheduled for craniospinal irradiation and mediastinum/neck radiotherapy, respectively, underwent thyroid ultrasound and free triiodothyronine (FT3), free thyroxine (FT4), and TSH evaluation at the beginning and end of craniospinal iiradiation. From 14 days before and up to the end of radiotherapy, patients were administered L-thyroxine checking every 3 days TSH to ensure a value < 0.3 μIU/mL. During follow-up, blood tests and ultrasound were repeated; primary hypothyroidism was considered an increased TSH level greater than normal range. Twenty-two/37 patients with medulloblastoma/PNET and all the 14 patients with HL were alive after a median 231 months from radiotherapy with 7/22 and 8/14 having correctly reached TSH levels < 0.3 μIU/mL and well matched for other variables. Twenty years on, hypothyroidism-free survival rates differed significantly, being 60% ± 15% and 15.6% ± 8.2% in TSH-suppressed vs. not-TSH suppressed patients, respectively (P = 0.001). These findings suggest that hypothyroidism could be durably prevented in two populations at risk of late RT sequelae, but it should be confirmed in a larger cohort.
Subject(s)
Child , Humans , Cerebellar Neoplasms , Hodgkin Disease/radiotherapy , Hypothyroidism/prevention & control , Medulloblastoma/radiotherapy , Prospective Studies , ThyrotropinABSTRACT
O transplante de medula óssea (TMO) é um procedimento indicado para o tratamento de doenças hematológicas, que afetam muitas mulheres jovens. O aperfeiçoamento dos cuidados durante o TMO proporciona altos índices de cura e de sobrevida. No entanto, pode deixar sequelas em vários órgãos e sistemas, entre eles o sistema reprodutor e os órgãos genitais, impactando negativamente a qualidade de vida das receptoras do TMO. O objetivo desta publicação foi realizar uma revisão narrativa sobre o tema e propor um protocolo assistencial que torne acessível os cuidados relacionados à saúde sexual e reprodutiva a esse grupo especial de mulheres, baseado em dados clínicos de um ambulatório de assistência ginecológica às mulheres transplantadas no Hospital Amaral Carvalho, em Jaú, no interior de São Paulo.(AU)
Bone marrow transplantation (BMT) is indicated for the treatment of hematological diseases which affect many young women. The improvement of care during BMT procedures provides higher cure and survival rates. however, it can cause sequelae in various organs and systems, including the reproductive system and genitals, negatively impacting quality of life. The purpose of this publication is to present a narrative review related to this theme and to propose a healthcare protocol that allows sexual and reproductive care in this special group of patients, based on the clinical experience of a gynecological outpatient clinic at the Amaral Carvalho Hospital, in Jaú (SP) which specifically care for these women.(AU)
Subject(s)
Humans , Female , Postoperative Complications , Bone Marrow Transplantation/adverse effects , Clinical Protocols , Risk Factors , Immunosuppression Therapy/adverse effects , Primary Ovarian Insufficiency/physiopathology , Female Urogenital Diseases/physiopathology , Graft vs Host Disease/physiopathologyABSTRACT
El consumo de cocaína y/o cannabis durante el embarazo constituye un problema en ascenso, de importancia para la salud pública mundial. Los niños expuestos pueden presentar un amplio rango de complicaciones en el período perinatal, pero los conocimientos sobre la evolución posterior son escasos.Objetivo: Describir y comparar las trayectorias sanitarias de niños expuestos y no expuestos prenatalmente a cocaína y/o cannabis durante 4 años. Métodos: Estudio de cohorte retrospectivo con grupo de comparación doble. Los niños expuestos fueron detectados en el Servicio de Neonatología de un hospital público mediante una prueba de orina, entre 2009 y 2013. Resultados: Se evaluaron 29 niños expuestos y 58 no expuestos. Las principales drogas detectadas en el grupo expuesto fueron cocaína y cannabis. La mayoría de las madres fueron policonsumidoras. En los niños del grupo expuesto, se encontraron diferencias significativas en menor frecuencia de controles de salud (p < 0,0001) y mayor frecuencia de consultas en Emergencias (p = 0,0295) e Internaciones (p = 0,007), principalmente, por cuadros respiratorios. Presentaron, además, mayor frecuencia de enfermedad pulmonar obstructiva crónica, cambios de hogar y judicialización. En ese grupo, hubo 1 niño y 2 progenitores muertos por causa violenta. No hubo ninguna muerte en el grupo no expuesto.Conclusiones: Los niños expuestos a cocaína y/o cannabis prenatalmente tuvieron menor número de controles de salud y mayor frecuencia de consultas en Emergencias e Internaciones. Presentaron, además, mayor frecuencia de enfermedad pulmonar obstructiva crónica, cambios de hogar, judicialización y muertes violentas en el grupo familiar directo.
Cocaine and/or cannabis use during pregnancy is a growing problem of relevance for global public health. Exposed children may have a wide range of perinatal complications, but there is little knowledge on their course.Objective: To describe and compare the health trajectories of children prenatally exposed and unexposed to cocaine and/or cannabis over 4 years.Methods: Retrospective, cohort study with a double control group. Exposed children were detected through a urine test by the Department of Neonatology of a public hospital between 2009 and 2013. Results: A total of 29 exposed children and 58 unexposed children were assessed. The most common drugs detected in the exposed group were cocaine and cannabis. Most mothers were poly-drug users. The exposed group showed significant differences in relation to a lower frequency of health checkups (p < 0.0001) and a higher number of visits to the emergency department (p = 0.0295) and hospitalizations (p = 0.007), mainly due to respiratory conditions. In addition, they had a greater rate of chronic obstructive pulmonary disease, changes of home, and legal interventions. In this group, 1 child and 2 parents had a violent death. No deaths were reported in the unexposed group. Conclusions: Children prenatally exposed to cocaine and/or cannabis had a lower number of health checkups and a higher number of visits to the emergency department and hospitalizations. Besides, they showed a greater rate of chronic obstructive pulmonary disease, changes of home, legal interventions, and violent deaths in the direct family group.
Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Infant , Child, Preschool , Prenatal Exposure Delayed Effects , Cannabis/adverse effects , Indicators of Morbidity and Mortality , Follow-Up Studies , Cocaine/adverse effects , Retrospective Studies , MothersABSTRACT
Objective To investigate the late effects induced by ionizing radiation and the rehabilitation treatment of local radiation injury by medical follow-up of the patient exposed to192 Ir at 5.7 accident in Nanjing,and to provide more experience for the treatments in the medical emergency of nuclear or radiological accident.Methods According to the history inquiry and physical examination of the patient in detail and the record of clinical symptoms and signs,the changes of the blood system,immune system,reproductive system,eyes,nervous system were systematically evaluated.The effects of rehabilitation treatment for the patient with lower limb dysfunction were also assessed.Results After the medical treatments of the patient,the hematopoietic immune system was restored,but the bone marrow aspiration still showed low bone marrow hyperplasia in right ilium.Meanwhile,the level of sex hormones was within the normal range,but semen examination showed sperm motility was 0.The radiation damage also occurred in the eye lens,retina and fundus.Howevcr,the psychological evaluation showed that the patient was stable and the right lower limb skin wound healing was well except for dysfunction and pain in some extent,which was relieved after the rehabilitation treatment.Conclusions The physiological function of the exposed victim with mild bone marrow type acute radiation sickness could be completely or partially restored after the clinical treatment in the early stage.
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El propósito de esta revisión, es determinar el impacto del tratamiento de quimioterapia sobre el sistema musculoesquelético de los niños y adolescentes con Leucemia Linfoblástica Aguda (LLA). Los estudios pertinentes fueron identificados en las bases de datos Pubmed, LILACS y ScieLO, combinando los siguientes términos de búsqueda: leucemia linfoblástica, niños, osteonecrosis y efectos tardíos. Se tuvieron en cuenta 33 artículos, publicados entre 2002 y 2012, encontrándose mayor número de literatura disponible sobre las complicaciones en la administración de corticoides, constituyéndose la osteonecrosis como la principal consecuencia de la quimioterapia sobre el sistema musculoesquelético.
The purpose of this review is to determine the impact of chemotherapy on the musculoskeletal system in children and adolescents with Acute Lymphoblastic Leukemia (ALL). Relevant studies were identified in the databases PubMed, LILACS, Elsevier and ScieLO, combining the following search terms: lymphoblastic leukemia, children, osteonecrosis and late effects. Thirty- three articles published between 2002 and 2012 were considered. More available literature was found on complications in the administration of corticosteroids, being osteonecrosis the main consequence of chemotherapy on the musculoskeletal system.
Subject(s)
Child, Preschool , Child , Adolescent , Child , Precursor Cell Lymphoblastic Leukemia-Lymphoma , OsteonecrosisABSTRACT
OBJECTIVE: To obtain information on the socioeconomic, medical, and functional status of polio survivors, and to use these results as the preliminary data for establishing the middle-aged cohort of polio survivors. METHODS: The subjects were recruited based on the medical records of multiple hospitals and centers. They were assessed through a structured questionnaire over the phone. Post-poliomyelitis syndrome (PPS) was identified according to the specified diagnostic criteria. Differences between polio survivors with or without PPS were evaluated, and the risk factors for PPS were analyzed by the odds ratio (OR). RESULTS: Majority of polio survivors were middle-aged and mean age was 51.2+/-8.3 years. A total of 188 out of 313 polio survivors met the adopted criteria for PPS based on the symptoms, yielding a prevalence of 61.6%. Mean interval between acute poliomyelitis and the development of PPS was 38.5+/-11.6 years. Female gender (OR 1.82; confidence interval [CI] 1.09-3.06), the age at onset of poliomyelitis (OR 1.75; CI 1.05-2.94), the use of orthoses or walking aids (OR 2.46; CI 1.44-4.20), and the history of medical treatment for paralysis, pain or gait disturbance (OR 2.62; CI 1.52-4.51) represented independent risk factors for PPS. CONCLUSION: We found that the majority of Korean polio survivors entered middle age with many medical, functional, and social problems. Female gender, early age of onset of poliomyelitis, the use of orthoses or walking aids, and the history of medical treatment for paralysis, pain or gait disturbance were identified as the significant risk factors for PPS. A comprehensive and multidisciplinary plan should be prepared to manage polio survivors considering their need for health care services and the risk factors for late effects, such as PPS.
Subject(s)
Female , Humans , Middle Aged , Age of Onset , Cohort Studies , Surveys and Questionnaires , Delivery of Health Care , Gait , Interviews as Topic , Medical Records , Odds Ratio , Orthotic Devices , Paralysis , Poliomyelitis , Postpoliomyelitis Syndrome , Prevalence , Risk Factors , Social Problems , Survivors , Walking , Surveys and QuestionnairesABSTRACT
Recent advances in childhood cancer treatment have increased survival rates to 80%. Two out of three survivors experience late effects (LEs). From a group of 241 survivors previously described, 193 were followed at the long-term follow-up clinic (LTFC) of Severance Hospital in Korea; the presence of LEs was confirmed by oncologists. We reported the change in LEs during 3 yr of follow-up. The median follow-up from diagnosis was 10.4 yr (5.1-26.2 yr). Among 193 survivors, the percentage of patients with at least one LE increased from 63.2% at the initial visit to 75.1% at the most recent visit (P = 0.011). The proportion of patients having multiple LEs and grade 2 or higher LEs increased from the initial visit (P = 0.001 respectively). Forty-eight non-responders to the LTFC were older and had less frequent and severe LEs than responders at initial visit (all P < 0.05). In multivariate analysis, younger age at diagnosis, older age at initial visit, a diagnosis of a brain tumor or lymphoma, and use of radiotherapy were significant risk factors for LEs (all P < 0.05). Adverse changes in LEs were seen among the survivors, regardless of most clinical risk factors. They need to receive comprehensive, long-term follow up.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Age Factors , Brain Neoplasms/mortality , Disease Progression , Follow-Up Studies , Hematopoietic Stem Cell Transplantation , Hematopoietic Stem Cells/cytology , Lymphoma/mortality , Multivariate Analysis , Neoplasms/mortality , Risk Factors , Severity of Illness Index , Survival RateABSTRACT
Extended-field and subtotal nodal radiation therapy (RT),developed in the 1960 s,was first reliably curative treatment for early-stage Hodgkin lymphoma (HL). However, the large volume of normal tissue irradiated resulted in significant delayed toxicity, including cardiac disease and second cancers (SC).The 30-year cumulative incidence of heart disease among adult survivors receiving 40-45 Gy of extended-field or mantle RT is approximately 30 ％; the incidence of SC is similar. How to improve disease control while reducing the toxicity of treatment has been a major objective of HL trials. Contemporary involved-field RT (IFRT) and involved-node RT (INRT) reduces irradiated volumes and produces significant reductions in normal tissue dose, and response-adapted therapy may be a means of identifying those patients most likely to benefit from treatment reduction or intensification, and enhanced screening will facilitate early intervention to reduce the clinical burden of late effects. There is a increasing interest in elucidating the genetic correlation of treatment toxicity.
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BACKGROUND: We prospectively investigated the incidence and features of late organ complications in long-term childhood cancer survivors (LTCCS) who took part in a specially designed health promotion program (HPP).METHODS: We developed our own HPP for LTCCS based on the Children's Oncology Group (COG) program, by modifying the adult HPP in Hanyang University Medical Center. The study included survivors who had received chemotherapy and/or radiotherapy for childhood cancer and had survived for at least 4 years after the end of treatment without evidence of recurrence.RESULTS: A total of 38 survivors were enrolled in the study. One or more abnormal findings were identified in 33 (87%) of the survivors, and two or more abnormal findings were present in 16 (42%) of the survivors. The most frequent type of abnormality was identified by thyroid ultrasonography, which detected benign nodules or cysts in 17 (45%) of the survivors. High-risk posttraumatic stress disorder needing medical treatment was detected in 1 of 17 survivors who were examined by psychological questionnaire.CONCLUSION: Most (87%) of childhood cancer survivors have at least 1 major or minor late effect. They must be continuously monitored after completion of treatment for early detection of late effects as well as cancer recurrence. Nationally integrated research is needed to provide standardized and comprehensive HPP for LTCCS considering domestic circumstances in Korea.
Subject(s)
Adult , Humans , Academic Medical Centers , Health Promotion , Incidence , Korea , Prevalence , Prospective Studies , Recurrence , Stress Disorders, Post-Traumatic , Survivors , Thyroid GlandABSTRACT
BACKGROUND: We prospectively investigated the incidence and features of late organ complications in long-term childhood cancer survivors (LTCCS) who took part in a specially designed health promotion program (HPP). METHODS: We developed our own HPP for LTCCS based on the Children's Oncology Group (COG) program, by modifying the adult HPP in Hanyang University Medical Center. The study included survivors who had received chemotherapy and/or radiotherapy for childhood cancer and had survived for at least 4 years after the end of treatment without evidence of recurrence. RESULTS: A total of 38 survivors were enrolled in the study. One or more abnormal findings were identified in 33 (87%) of the survivors, and two or more abnormal findings were present in 16 (42%) of the survivors. The most frequent type of abnormality was identified by thyroid ultrasonography, which detected benign nodules or cysts in 17 (45%) of the survivors. High-risk posttraumatic stress disorder needing medical treatment was detected in 1 of 17 survivors who were examined by psychological questionnaire. CONCLUSION: Most (87%) of childhood cancer survivors have at least 1 major or minor late effect. They must be continuously monitored after completion of treatment for early detection of late effects as well as cancer recurrence. Nationally integrated research is needed to provide standardized and comprehensive HPP for LTCCS considering domestic circumstances in Korea.
Subject(s)
Adult , Humans , Academic Medical Centers , Health Promotion , Incidence , Korea , Prevalence , Prospective Studies , Recurrence , Stress Disorders, Post-Traumatic , Survivors , Thyroid GlandABSTRACT
A radioterapia em região de cabeça e pescoço provoca inúmeras sequelas ao paciente irradiado, afetando o sistema estomatognático e com repercussões sistêmicas importantes. As sequelas da radiação ionizante podem ser extensas e, algumas vezes, permanentes, em especial nas glândulas salivares e no tecido ósseo. É relevante que o cirurgião dentista tenha conhecimento das reações adversas e das formas adequadas de prevenção e tratamento para amenizar o desconforto e melhorar a condição de vida do paciente irradiado. Portanto, a conscientização e motivação deste paciente, com a promoção de saúde oral através da adequação do meio bucal e orientações sobre ações preventivas, são essenciais para se obter o melhor prognóstico.
Head and neck radiotherapy causes countless sequelae in irradiated patients, affecting the stomatognathic system, with significant systemic implications. Sequelae of exposure to ionizing radiation may be extensive and sometimes permanent, particularly in the salivary glands and bone tissue. It is of utmost importance that the surgeon dentist be aware of adverse reactions and appropriate forms of treatment to alleviate discomfort and improve the quality of life of the irradiated patient. Therefore, awareness and motivation of the patient, with promotion of oral health through the adaptation of the oral environment and guidance on preventive measures are essential to get a better prognosis.
Subject(s)
Humans , Head and Neck Neoplasms , Radiobiology , Radiotherapy , Radiotherapy/adverse effects , Ageusia , Dysgeusia , Opportunistic Infections , Osteoradionecrosis , Periodontal Diseases , Stomatitis , Trismus , XerostomiaABSTRACT
Advances in research and medical and supportive care have contributed to a growing population of adults formerly treated for childhood cancer. History of cancer and its therapy can have significant life-long health implications. Late effects of cancer therapy can be insidious on onset, occur outside the pediatric age, and contribute to premature morbidity and mortality. In this review, I have focused on the key long-term effects of pediatric cancer therapy, particularly on the metabolic syndrome, including cardiopulmonary complications, infertility, and secondary neoplasm.
Subject(s)
Adult , Humans , Infertility , SurvivorsABSTRACT
OBJETIVO: Determinar se o número de áreas anatômicas envolvidas pode modificar os grupos de risco padrão no linfoma de Hodgkin pediátrico, identificando as crianças que poderiam se beneficiar de uma redução da intensidade do tratamento. MÉTODOS: Estudo retrospectivo com avaliação de idade, sexo, histologia, classificação de Ann-Arbor, presença de sintomas B, número de áreas anatômicas envolvidas, grupos de risco (favorável versus desfavorável) e exames laboratoriais. Todos os pacientes receberam quimioterapia com doxorrubicina. Os pacientes em remissão completa por 5 anos ou mais foram avaliados para a detecção de efeitos tardios. RESULTADOS: Sessenta e nove pacientes (2-18 anos) foram incluídos, sendo que 68 por cento pertenciam ao grupo de risco desfavorável. A sobrevida global e a sobrevida livre de eventos foram de 94 e 87 por cento, respectivamente. Os efeitos tardios foram detectados em 46 casos. Estágio avançado e > quatro áreas anatômicas envolvidas tiveram impacto negativo sobre a sobrevida livre de eventos, enquanto que o número de áreas anatômicas envolvidas apresentou significância estatística de acordo com a análise de Cox (razão de risco = 6,4; IC95 por cento = 1,08-38,33; p = 0,04). Os grupos de risco foram ajustados por número de áreas anatômicas envolvidas (< quatro/> quatro áreas anatômicas envolvidas), com uma significativa realocação de pacientes (p = 0,008). Dos 30 pacientes com efeitos tardios, 21 estavam no grupo de risco desfavorável original, e 14 poderiam ter sido realocados para o grupo de risco favorável com base no número de áreas anatômicas envolvidas. CONCLUSÃO: Se uma reestratificação tivesse sido aplicada, um número considerável de crianças teria recebido tratamento de menor intensidade e, consequentemente, poderia ter tido menores chances de apresentar efeitos tardios. Um estudo prospectivo poderia definir se o ajuste de grupos de risco pelo número de áreas anatômicas envolvidas teria algum impacto sobre ...
OBJECTIVE: To determine if the number of involved anatomic areas can modify the standard risk groups in pediatric Hodgkin's lymphoma, identifying children who would benefit from a reduction in treatment intensity. METHODS: Retrospective study evaluating age, sex, histology, Ann-Arbor stage, presence of B symptoms, number of involved anatomic areas, risk grouping (favorable vs. unfavorable), and laboratory exams. All patients received doxorubicin-containing chemotherapy. Patients in complete remission for 5 years or longer were evaluated as for late effects. RESULTS: Sixty-nine patients (2-18 years) were included, 68 percent belonged to the unfavorable risk group. Overall survival and event-free survival were 94 and 87 percent, respectively. Late effects were screened in 46 cases. Advanced stage and > four involved anatomic areas had negative impact on event-free survival, while only the number of involved anatomic areas retained statistical significance when using Cox analysis (hazard ratio = 6.4, 95 percentCI = 1.08-38.33; p = 0.04). Risk groups were adjusted by number of involved anatomic areas (< four/> four involved anatomic areas), with a significant reallocation of patients (p = 0.008). Of the 30 patients with late effects, 21 were in the original unfavorable risk group and 14 (66.6 percent) could have been reallocated to the favorable risk group based on the number of involved anatomic areas. CONCLUSION: If re-stratification had been applied, a considerable number of children would have received less intensive treatment and, consequently, could have had lower chances of late effects. A prospective study could define if adjustment of risk group by number of involved anatomic areas would have any impact on survival rates.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , Antibiotics, Antineoplastic/adverse effects , Endocrine System Diseases/prevention & control , Heart Diseases/prevention & control , Hodgkin Disease/drug therapy , Hodgkin Disease/pathology , Age Factors , Antibiotics, Antineoplastic/therapeutic use , Doxorubicin/adverse effects , Doxorubicin/therapeutic use , Epidemiologic Methods , Endocrine System Diseases/chemically induced , Heart Diseases/chemically induced , Prognosis , Risk Factors , Sex Factors , Treatment OutcomeABSTRACT
Los niños y adolescentes sobrevivientes de cáncer pueden presentar a largo plazo alteraciones endocrinas como consecuencia del tratamiento antineoplásico recibido. Con el objeto de identificar en forma temprana estos efectos tardíos, se presenta una guía práctica que permite realizar un seguimiento desde el punto de visto endocrino, evaluando los factores de riesgo y las complicaciones tardías potenciales que puedan desarrollarse de acuerdo al agente terapéutico utilizado y su dosis. Las alteraciones en el crecimiento, especialmente las causadas por la radioterapia y/ o cirugía craneal, los desórdenes de la pubertad e infertilidad como consecuencia de la quimioterapia, y la osteopenia, son algunas de las endocrinopatías más relevantes. La implementación de un tratamiento hormonal temprano ofrece la oportunidad de optimizar el crecimiento, brindar bienestar y mejorar la calidad de vida al paciente con cáncer en remisión.
Childhood cancer survivors can manifest late endocrine effects after completion of cancer therapy. In order to make an early identification of long-term endocrine sequelae, we present a practical guideline for the follow-up and assessment of the risk factors and potential late complications that will develop in relation to the therapeutic agent used and its dose. Growth impairment due to brain irradiation and/or surgery, pubertal disorders and infertility caused by chemotherapy, and osteopenia, are some of the most prevalent endocrinopathies. Early hormonal treatment can lead to enhance growth rate, available stamina and improve quality of life of the patient with cancer in remission.
ABSTRACT
BACKGROUND: Wilms tumor, the most common primary malignant renal tumor of childhood, has relatively good prognosis among solid tumors occurring in childhood because of the improved operation skill, proper selection of chemotherapeutic agents, and combined radiotherapy on the primary and distant metastatic sites after nephrectomy. However, successful therapy has been associated with long-term toxicity occurring years or decades later. So it is important to identify and understand the possible late effects of treatment for Wilms tumor. METHODS: We reviewed 73 cases of Wilms tumor who were diagnosed and treated from Mar., 1983 to Nov., 1996 and calculated the survival rate. In addition, 42 cases were investigated to see the late effects of treatment for Wilms tumor since Feb., 1993, especially with predesigned indices such as blood pressure, blood urea nitrogen(BUN), serum creatinine(S-Cr), 24 hour urine protein/creatinine(24 HU Pr/Cr), 24 hour urine microalbumin(24 HU MA), 24 hour urine beta2-microglobulin/creatinine(24 HU beta2-MG/Cr). RESULTS: Overall survival rate of Wilms tumor was 86% in 5 years. There was significant difference in survival between stage I, II, III group and stage IV, V group(90% vs 72%, P=0.032), and survival rate of favorable histology group was higher than that of unfavorable histology group(92% vs 73%, P=0.043). Of the 42 cases in our study of late effects, no patient has presented significant late sequelae causing morbidity, and there were one case of transient hypertension, three cases of microalbuminuria, three cases of proteinuria, one case of asymptomatic microscopic hematuria, one case of radiation hepatitis and two cases of nut-cracker syndrome. No abnormality was noted in BUN, S-Cr, or 24 HU beta2-MG/Cr. CONCLUSION: Wilms tumor in our center have an excellent prognosis and no significant late sequelae that might affect long-term morbidity were found. But thorough and further longer follow-up is mandatory to understand the possible late effects fully, so that cope with properly and improve the quality of life.