Late Effects of Cancer Treatment

You are looking at 1 - 6 of 6 items

Kevin C J Yuen Departments of Neuroendocrinology and Neurosurgery, Barrow Neurological Institute, University of Arizona College of Medicine and Creighton School of Medicine, Phoenix, Arizona, United States

Search for other papers by Kevin C J Yuen in
Google Scholar
PubMed
Close
,
Gudmundur Johannsson Department of Endocrinology, Sahlgrenska University Hospital and Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

Search for other papers by Gudmundur Johannsson in
Google Scholar
PubMed
Close
,
Ken K Y Ho The Garvan Institute of Medical Research and the Faculty of Medicine, University of New South Wales, Sydney, Australia

Search for other papers by Ken K Y Ho in
Google Scholar
PubMed
Close
,
Bradley S Miller Pediatric Endocrinology, University of Minnesota Medical School, M Health Fairview Masonic Children’s Hospital, Minneapolis, Minnesota, United States

Search for other papers by Bradley S Miller in
Google Scholar
PubMed
Close
,
Ignacio Bergada Centro de Investigaciones Endocrinológicas "Dr César Bergadá" (CEDIE), CONICET-FEI-División de Endocrinología, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina

Search for other papers by Ignacio Bergada in
Google Scholar
PubMed
Close
, and
Alan D Rogol Pediatric Diabetes and Endocrinology, University of Virginia, Charlottesville, Virginia, United States

Search for other papers by Alan D Rogol in
Google Scholar
PubMed
Close

Growth hormone deficiency (GHD) is a clinical syndrome that can manifest either as isolated or associated with additional pituitary hormone deficiencies. Although diminished height velocity and short stature are useful and important clinical markers to consider testing for GHD in children, the signs and symptoms of GHD are not always so apparent in adults. Quality of life and metabolic health are often impacted in patients with GHD; thus, making an accurate diagnosis is important so that appropriate growth hormone (GH) replacement therapy can be offered to these patients. Screening and testing for GHD require sound clinical judgment that follows after obtaining a complete medical history of patients with a hypothalamic–pituitary disorder and a thorough physical examination with specific features for each period of life, while targeted biochemical testing and imaging are required to confirm the diagnosis. Random measurements of serum GH levels are not recommended to screen for GHD (except in neonates) as endogenous GH secretion is episodic and pulsatile throughout the lifespan. One or more GH stimulation tests may be required, but existing methods of testing might be inaccurate, difficult to perform, and can be imprecise. Furthermore, there are multiple caveats when interpreting test results including individual patient factors, differences in peak GH cut-offs (by age and test), testing time points, and heterogeneity of GH and insulin-like growth factor 1 assays. In this article, we provide a global overview of the accuracy and cut-offs for diagnosis of GHD in children and adults and discuss the caveats in conducting and interpreting these tests.

Open access
Victoria Chatzimavridou-Grigoriadou Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, UK
Department of Endocrinology, University of Manchester, School of Medical Sciences, Manchester, UK

Search for other papers by Victoria Chatzimavridou-Grigoriadou in
Google Scholar
PubMed
Close
,
Lisa H Barraclough Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, UK
Department of Endocrinology, University of Manchester, School of Medical Sciences, Manchester, UK

Search for other papers by Lisa H Barraclough in
Google Scholar
PubMed
Close
,
Rohit Kochhar Department of Clinical Oncology, Christie Hospital NHS Foundation Trust, Manchester, UK

Search for other papers by Rohit Kochhar in
Google Scholar
PubMed
Close
,
Lucy Buckley Department of Radiology, Christie Hospital NHS Foundation Trust, Manchester, UK

Search for other papers by Lucy Buckley in
Google Scholar
PubMed
Close
,
Nooreen Alam Department of Radiotherapy, Christie Hospital NHS Foundation Trust, Manchester, UK

Search for other papers by Nooreen Alam in
Google Scholar
PubMed
Close
, and
Claire E Higham Department of Endocrinology, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK

Search for other papers by Claire E Higham in
Google Scholar
PubMed
Close

Background

Radiotherapy-related insufficiency fractures (RRIFs) represent a common, burdensome consequence of pelvic radiotherapy. Their underlying mechanisms remain unclear, and data on the effect of osteoporosis are contradictory, with limited studies assessing bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA).

Methods

BMD by DXA (Hologic) scan and fracture risk following pelvic RRIF were retrospectively assessed in 39 patients (median age 68 years) at a tertiary cancer centre. Patient characteristics and treatment history are presented narratively; correlations were explored using univariate regression analyses.

Results

Additional cancer treatments included chemotherapy (n = 31), surgery (n = 20) and brachytherapy (n = 19). Median interval between initiation of radiotherapy and RRIF was 11 (7.5–20.8) and that between RRIF and DXA 3 was (1–6) months. Three patients had normal BMD, 16 had osteopenia and 16 osteoporosis, following World Health Organization classification. Four patients were <40 years at the time of DXA (all Z-scores > –2). Median 10-year risk for hip and major osteoporotic fracture was 3.1% (1.5–5.7) and 11.5% (7.1–13.8), respectively. Only 33.3% of patients had high fracture risk (hip fracture >4% and/or major osteoporotic >20%), and 31% fell above the intervention threshold per National Osteoporosis Guidelines Group (NOGG) guidance (2017). Higher BMD was predicted by lower pelvic radiotherapy dose (only in L3 and L4), concomitant chemotherapy and higher body mass index.

Conclusion

At the time of RRIF, most patients did not have osteoporosis, some had normal BMD and overall had low fracture risk. Whilst low BMD is a probable risk factor, it is unlikely to be the main mechanism underlying RRIFs, and further studies are required to understand the predictive value of BMD.

Open access
Ichelle Maa van Roessel Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, AB Utrecht, The Netherlands
Princess Máxima Center for Pediatric Oncology, AB Utrecht, The Netherlands

Search for other papers by Ichelle Maa van Roessel in
Google Scholar
PubMed
Close
,
Boudewijn Bakker Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, AB Utrecht, The Netherlands
Princess Máxima Center for Pediatric Oncology, AB Utrecht, The Netherlands

Search for other papers by Boudewijn Bakker in
Google Scholar
PubMed
Close
,
Hanneke M van Santen Department of Pediatric Endocrinology, Wilhelmina Children's Hospital, University Medical Center Utrecht, AB Utrecht, The Netherlands
Princess Máxima Center for Pediatric Oncology, AB Utrecht, The Netherlands

Search for other papers by Hanneke M van Santen in
Google Scholar
PubMed
Close
, and
Wassim Chemaitilly Division of Pediatric Endocrinology, UPMC Children’s Hospitalof Pittsburgh, Pittsburgh, Pennsylvania, USA

Search for other papers by Wassim Chemaitilly in
Google Scholar
PubMed
Close

Childhood cancer survivors are at risk for developing endocrine disorders, including deficits in growth hormone, thyroid hormone and sex hormones. The influence these hormones have on cell growth and metabolism has raised concerns regarding the safety of their use as treatments in survivors of childhood cancer and brain tumors. This article offers a summary of current knowledge, controversies and areas for future research pertaining to this area.

Open access
Alexander Heinzel RWTH University Hospital Aachen, Department of Nuclear Medicine, Aachen, Germany

Search for other papers by Alexander Heinzel in
Google Scholar
PubMed
Close
,
Dirk Müller Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany

Search for other papers by Dirk Müller in
Google Scholar
PubMed
Close
,
Hanneke M van Santen Wilhelmina Children’s Hospital, University Medical Center Utrecht, Department of Pediatric Endocrinology, Utrecht, The Netherlands
Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands

Search for other papers by Hanneke M van Santen in
Google Scholar
PubMed
Close
,
Sarah C Clement Wilhelmina Children’s Hospital, University Medical Center Utrecht, Department of Pediatric Endocrinology, Utrecht, The Netherlands
Emma Children’s Hospital, Amsterdam UMC, Department of Pediatrics, Amsterdam, The Netherlands

Search for other papers by Sarah C Clement in
Google Scholar
PubMed
Close
,
Arthur B Schneider University of Illinois at Chicago, Department of Medicine, Chicago, IL, USA

Search for other papers by Arthur B Schneider in
Google Scholar
PubMed
Close
, and
Frederik A Verburg Erasmus MC Rotterdam, Department of Radiology & Nuclear Medicine, Rotterdam, The Netherlands
University Hospital Würzburg, Department of Nuclear Medicine, Würzburg, Germany

Search for other papers by Frederik A Verburg in
Google Scholar
PubMed
Close

Background

Childhood cancer survivors (CCS) who received radiation therapy exposing the thyroid gland are at increased risk of developing differentiated thyroid cancer (DTC). Therefore, the International Guideline Harmonization Group (IGHG) on late effects of childhood cancer therefore recommends surveillance. It is unclear whether surveillance reduces mortality.

Aim

The aim of this study was to compare four strategies for DTC surveillance in CCS with the aim of reducing mortality: Strategy-1, no surveillance; Strategy-2, ultrasound alone; Strategy-3, ultrasound followed by fine-needle biopsy (FNB); Strategy-4, palpation followed by ultrasound and FNB.

Materials and methods

A decision tree was formulated with 10-year thyroid cancer-specific survival as the endpoint, based on data extracted from literature.

Results

It was calculated that 12.6% of CCS will develop DTC. Using Strategy-1, all CCS with DTC would erroneously not be operated upon, but no CCS would have unnecessary surgery. With Strategy-2, all CCS with and 55.6% of CCS without DTC would be operated. Using Strategy-3, 11.1% of CCS with DTC would be correctly operated upon, 11.2% without DTC would be operated upon and 1.5% with DTC would not be operated upon. With Strategy-4, these percentages would be 6.8, 3.9 and 5.8%, respectively. Median 10-year survival rates would be equal across strategies (0.997).

Conclusion

Different surveillance strategies for DTC in CCS all result in the same high DTC survival. Therefore, the indication for surveillance may lie in a reduction of surgery-related morbidity rather than DTC-related mortality. In accordance with the IGHG guidelines, the precise strategy should be decided upon in a process of shared decision-making.

Open access
J Gebauer Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Campus Luebeck and Institute for Endocrinology and Diabetes, University of Luebeck, Luebeck, Germany

Search for other papers by J Gebauer in
Google Scholar
PubMed
Close
,
R Skinner Department of Paediatric and Adolescent Haematology and Oncology and Children’s BMT Unit, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, and Translational and Clinical Research Institute, Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK

Search for other papers by R Skinner in
Google Scholar
PubMed
Close
,
R Haupt DOPO Clinic, Department of Hematology/Oncolgy, IRCCS Istituto Giannina Gaslini, Genova, Italy

Search for other papers by R Haupt in
Google Scholar
PubMed
Close
,
L Kremer Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
Amsterdam UMC, Emma’s Children’s Hospital, Amsterdam, The Netherlands

Search for other papers by L Kremer in
Google Scholar
PubMed
Close
,
H van der Pal Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands

Search for other papers by H van der Pal in
Google Scholar
PubMed
Close
,
G Michel Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland

Search for other papers by G Michel in
Google Scholar
PubMed
Close
,
G T Armstrong Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA

Search for other papers by G T Armstrong in
Google Scholar
PubMed
Close
,
M M Hudson Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA

Search for other papers by M M Hudson in
Google Scholar
PubMed
Close
,
L Hjorth Department of Clinical Sciences Lund, Paediatrics, Lund University, Skane University Hospital, Lund, Sweden

Search for other papers by L Hjorth in
Google Scholar
PubMed
Close
,
H Lehnert Paris Lodron University of Salzburg, Salzburg, Austria

Search for other papers by H Lehnert in
Google Scholar
PubMed
Close
, and
T Langer Pediatric Hematology and Oncology, University Hospital of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany

Search for other papers by T Langer in
Google Scholar
PubMed
Close

Many long-term childhood cancer survivors suffer from treatment-related late effects, which may occur in any organ and include a wide spectrum of conditions. Long-term follow-up (LTFU) is recommended to facilitate early diagnosis and to ensure better health outcomes. Due to the heterogeneity of these sequelae, different specialists work together in the diagnosis and treatment of these conditions. Experts from both pediatric and internal medicine are involved in age-appropriate care by providing a transition process. Hence, LTFU of childhood cancer survivors is a prototypic example of multidisciplinary care for patients with complex needs treated in a specialized setting. International collaborations of healthcare professionals and scientists involved in LTFU of childhood cancer survivors, such as the International Guideline Harmonization Group, compile surveillance recommendations that can be clinically adopted all over the world. These global networks of clinicians and researchers make a joint effort to address gaps in knowledge, increase visibility and awareness of cancer survivorship and provide an excellent example of how progress in clinical care and scientific research may be achieved by international and multidisciplinary collaboration.

Open access
Judith Gebauer Department of Internal Medicine I, University Hospital Schleswig-Holstein, Luebeck, Germany

Search for other papers by Judith Gebauer in
Google Scholar
PubMed
Close
and
Claire E Higham Department of Endocrinology, Christie Hospital NHS Foundation Trust, University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK

Search for other papers by Claire E Higham in
Google Scholar
PubMed
Close
Open access