RESUMO
UNLABELLED: The increasing number of childhood cancer survivors has resulted in growing interest in the late effects of chemo- and radiotherapy including growth also. THE AIM OF STUDY: The aim of study was to evaluate growth in children treated for acute lymphoblastic leukaemia (ALL) and Wilms' tumour who achieved complete continuous first remission following treatment. PATIENTS AND METHODS: 52 children included in this study: 30 treated for ALL - group I and 22 with Wilms' tumour - group II since 1986 to 1996. Group I- all children received prophylactic cranial irradiation at the total dose 12 and 18 Gy and chemotherapy according to therapeutic course BFM 83 and BFM 90. Group II - all children received abdomen irradiation with total dose 15-35 Gy, chemotherapy according to therapeutic course SIOP 9 and SIOP 92. We analysed growth velocity from the time of diagnosis to the time of examination. Results were reported as standard deviation score (SDS) to allow for comparison of patients of different age and sex. RESULTS: We observed significant growth deceleration in the first year of treatment and catch-up after 12 months from completion of therapy in both groups. The greatest reduction in yearly decrements in height SDS occurred in the first year after diagnosis. Patients of group I treated with prophylactic cranial irradiation with total dose 12 Gy presented significantly higher catch-up growth than treated with dose 18 Gy one year from completion of cancer therapy (p=0.001). Growth hormone deficiency in children of both groups was not observed. Bone age deceleration was retarded one year or more in both groups (group I p=0.025, group II p=0.001). CONCLUSIONS: 1) The chemotherapy and radiotherapy contribute to growth retardation in the first year of treatment in both groups 2) It seems that prophylactic cranial irradiation in children with ALL with total doses 12 and 18 Gy does not contribute to retardation of growth velocity after cancer treatment 3) Endocrine follow-up should be introduced in order to detect and treat complications as early as possible.
