Childhood Cancer Treatments and Associated Endocrine Late Effects: A Concise Guide for the Pediatric Endocrinologist

2018 ◽  
Vol 91 (2) ◽  
pp. 74-82 ◽  
Author(s):  
Wassim Chemaitilly ◽  
Charles A. Sklar
Keyword(s):  
Childhood Cancer ◽  
Late Effects ◽  
Alkylating Agents ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Pediatric Endocrinologist ◽  
Number Of Patients ◽  
Endocrine Organs ◽  
Concise Guide ◽  
The Impact

Endocrine complications are frequently observed in childhood cancer survivors (CCS); in many instances, these complications develop months to years after the completion of cancer therapy. The estimated prevalence of endocrine late effects is 50% among CCS; the main risk factors are external beam radiation that includes key endocrine organs (the hypothalamus/pituitary, thyroid and gonads) and/or alkylating agents. Novel agents targeting tumor growth have increased the options available to a small number of patients albeit with the need for treatment over long periods of time. Some of these agents, such as certain tyrosine kinase inhibitors and immune system modulators have been shown to cause permanent endocrine deficits. This chapter offers a brief summary of the conventional treatment strategies for the most common cancers of childhood and a brief overview of the endocrine late effects most commonly associated with these exposures. The impact of targeted therapies on the endocrine system will also be discussed. The aim of this chapter is to provide basic guidance to the consulting pediatric endocrinologist in preparation for the clinical encounter with a CCS. A more detailed discussion of the management of specific endocrine late effects can be found in the other chapters in this series.

scholarly journals Emerging Use of Public-Private Partnerships in Public Radiotherapy Facilities in Nigeria

2021 ◽  
pp. 1260-1269
Author(s):  
Chidinma P. Anakwenze Akinfenwa ◽  
Abiola Ibraheem ◽  
Kenneth Nwankwo ◽  
Nwamaka Lasebikan ◽  
Musa Ali-Gombe ◽  
...  
Keyword(s):  
Public Hospitals ◽  
Public Private Partnerships ◽  
External Beam Radiation ◽  
Linear Accelerators ◽  
Beam Radiation ◽  
Maintenance And Repair ◽  
The Public ◽  
Number Of Patients ◽  
The Impact ◽  
Maintenance Plan

PURPOSE Radiotherapy (RT) treatment at public hospitals in Nigeria is often interrupted by prolonged periods of machine breakdown because of insufficient funds for maintenance and repair. These delays have prompted the uptake of public-private partnerships (PPPs) to acquire and maintain RT equipment. This study aimed to understand Nigeria's current RT capacity and the impact of PPPs on RT availability and cost. METHODS Eleven radiation oncologists, each representing one of the 11 RT centers in Nigeria (eight public and three private), were invited to complete a survey on the type, status, acquisition, and maintenance plan of existing RT equipment, cost incurred by patients for external-beam radiation (EBRT) and brachytherapy treatment, and number of patients treated per year on each machine. Type and status of equipment at nonresponding facilities were obtained through literature review and confirmed with the facility. RESULTS A total of eight (81%) respondents completed the survey, all representing public centers, three of which reported PPP use. They reported 11 megavoltage units in total (seven linear accelerators [LINACs] and four Cobalt-60s) and 10 brachytherapy afterloaders. Of those, 57% (4/7) of the LINACs, 100% (4/4) of the Cobalt-60s, and 63% (7/11) of the afterloaders were in clinical use. All commissioned equipment supported by PPPs (three LINACs and one afterloader) were in operation. The public EBRT equipment were nonfunctional 35% of the year (resulting in 60% fewer patients treated per year). The PPP EBRT and afterloaders did not experience any periods of breakdown, but PPP costs were 338% higher than public equipment. CONCLUSION This study characterizes the use of PPP as a more reliable method of RT delivery in Nigeria, albeit at higher costs.

Calculated prostate cancer volume greater than 4.0 cm3 identifies patients with localized prostate cancer who have a poor prognosis following radical prostatectomy or external-beam radiation therapy.

1998 ◽  
Vol 16 (9) ◽  
pp. 3094-3100 ◽  
Author(s):  
A V D'Amico ◽  
R Whittington ◽  
S B Malkowicz ◽  
D Schultz ◽  
I Kaplan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
Clinical Staging ◽  
External Beam ◽  
Beam Radiation ◽  
Psa Failure ◽  
The Impact

PURPOSE Patients with palpable extraprostatic disease (T3) have a poor prostate-specific antigen (PSA) failure-free (bNED) survival rate after radical prostatectomy (RP) or external-beam radiation therapy (RT). This study was performed to validate or refute the prognostic value of the previously defined calculated prostate cancer volume (cV(Ca)). PATIENTS AND METHODS For patients with clinically localized disease (T1c,2), a Cox regression multivariable analysis was used to assess the ability of the cV(Ca) value to predict time to posttherapy PSA failure following RP or RT. RESULTS The cV(Ca) value was a significant predictor (P < or = .0005) of time to posttherapy PSA failure in both an RP and RT data set independent of the one used to derive the cV(Ca)-based clinical staging system. In both RP- and RT-managed patients, estimates of 3-year bNED survival were not statistically different for patients with either T1c,2 disease and a cV(Ca) greater than 4.0 cm3 (RP, 27%; RT, 18%) or T3 disease (RP, 37%; RT, 34%). Despite pathologic T2 disease, the 3-year estimate of bNED survival was at most 51% in RP-managed patients with T1c,2 disease and cV(Ca) greater than 4.0 cm3. CONCLUSION A cV(Ca) greater than 4.0 cm3 identified patients with T1c.2 disease whose bNED survival was poor after RT or RP despite pathologic T2 disease that suggests the presence of occult micrometastatic disease in many of these patients. Prospective randomized trials to evaluate the impact on survival of adjuvant systemic therapy in these high-risk patients are justified.

The impact of clinical trial evidence and sociodemographic factors on institutional practice patterns for stage I testicular cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 372-372
Author(s):  
Gautum Agarwal ◽  
Oscar Valderamma ◽  
Sabine Nguyen ◽  
Adam Luchey ◽  
Julio Pow-Sang ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Sociodemographic Factors ◽  
Education Level ◽  
Stage I ◽  
External Beam Radiation ◽  
Retroperitoneal Lymph Node Dissection ◽  
Beam Radiation ◽  
Therapeutic Decisions ◽  
Multiple Variables ◽  
The Impact

372 Background: Contemporary management for patients with stage I testicular cancer (TC) continues to evolve. Survival is dependent upon staging, surveillance, and the treatment(s) rendered. We sought to determine whether treatment recommendations have been impacted by evidence gained from recent clinical trials and how sociodemographic factors might affect therapeutic decisions for patients with stage I pure seminoma (PS) and nonseminoma (NSGCT). Methods: We performed a single institution, institutional review board approved, retrospective review of patients evaluated for TC from 1999 to 2013. Chi-square and logistic regression analyses were performed between multiple variables including: type of treatment, specialty of the provider, year of treatment, insurance status, distance traveled to our hospital, and education level. Results: Four hundred forty patients were evaluated; of this group 121 patients had stage I TC. For NSGCT patients, living further than 50 miles from our center was associated with treatment (p=0.013). NSGCT patients who had completed an undergraduate education were more likely to undergo surveillance compared to those with a high school education (p<0.01). If intervention was recommended, NSGCT patients evaluated prior to 2010 were more likely to undergo primary retroperitoneal lymph node dissection (RPLND) (p<0.01). After 2010 these patients were more likely to have primary chemotherapy (PC) (p<0.01). NSGCT patients evaluated by urologic oncologists had higher RPLND rates while patients evaluated by medical oncologists more often received PC (p<0.01). The percentage of PS patients receiving external beam radiation decreased from 40% to 5% after 2010, while the rate of surveillance increased from 47% to 79% (p=0.016). For all stage I patients the presence of lymphovascular invasion was associated with treatment compared to surveillance (p<0.001). Conclusions: The management of patients with stage I TC has changed significantly over the past decade. In our study, management recommendations have been shown to be dependent upon the specialty of the provider and other social factors such as distance from the hospital as well as education level, which suggests the possibility of bias during patient counseling.

Testosterone recovery as biomarker for overall and cause-specific survival in combined treated patients with high-risk and locally advanced prostate cancer.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 188-188
Author(s):  
Mathew Deek ◽  
Victoria Vaage ◽  
Knut H. Hole ◽  
Theodore L. DeWeese ◽  
Andreas Stensvold ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Median Time ◽  
Locally Advanced ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Group A ◽  
Group B ◽  
The Impact ◽  
Cause Specific Survival

188 Background: Androgen deprivation therapy (ADT) can cause considerable toxicity and may influence outcome. The study assessed the impact of testosterone recovery (TR) on survival after ADT and definitive radiotherapy in two independent cohorts. Methods: Two hundred and forty-four patients (high risk JHH cohort N=106, T1c-T3N0M0 [A], locally advanced OUH cohort N=138, T1c-T4N0-1M0 [B]) with adenocarcinoma of the prostate were included in this retrospective analysis. Short and long-term ADT was given (median 12 months A, 24 months B, respectively,) and along with conformal external beam radiation 76-80 Gy given to the prostate in cohort A, 74 Gy prescribed in cohort B and 46-50 Gy to the whole pelvis. Testosterone levels were measured at the end of ADT and at biochemical relapse. TR was defined as ≥ 9 nmol/L. Kaplan Meier plots were generated for overall survival (OS) and cause-specific survival (CSS) stratified by TR, in addition to patient characteristics median time to TR and FU were calculated. Results: The median age in the A cohort was 66.7 years and 64.7 years in the B group. FU was 6 years for A and 8 years in B. Patients in group A received median ADT of 12 months and 24 months in group B. The median time to TR was 1.6 yr in A and 2.5 yrs in B, respectively. Patients in group A stratified to TR showed no difference in overall survival (p=0.92)), on contrary, patients in group B showed improved overall survival depending on TR (Fig. 1, KM plot, 10 year OS 75.3% vs 59.9% p=0.034). CSS was seemed to trend towards improvement with TR for cohort A (p=0.19) and was improved in cohort B (p=0.022). The Univariate ADT length, age, and RT dose was associated with time to TR, but on multivariate analysis only longer ADT time (p = 0.03) was significantly associated with time to TR. Conclusions: TR was associated with improved OS in patients with unfavorable locally advanced disease a finding not seen in patients with high-risk disease.

American Society of Clinical Oncology Clinical Evidence Review on the Ongoing Care of Adult Cancer Survivors: Cardiac and Pulmonary Late Effects

2007 ◽  
Vol 25 (25) ◽  
pp. 3991-4008 ◽  
Author(s):  
Joseph R. Carver ◽  
Charles L. Shapiro ◽  
Andrea Ng ◽  
Linda Jacobs ◽  
Cindy Schwartz ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Clinical Oncology ◽  
Late Effects ◽  
Pulmonary Toxicity ◽  
External Beam Radiation ◽  
Drug Discontinuation ◽  
Beam Radiation ◽  
Adult Cancer Survivors ◽  
American Society

Purpose To review the evidence on the incidence of long-term cardiac or pulmonary toxicity secondary to chemotherapy, radiotherapy, or trastuzumab in symptomatic and asymptomatic cancer survivors. Methods An American Society of Clinical Oncology Panel reviewed pertinent information from the literature through February 2006. Results Few studies directly addressing the benefits of screening for long-term cardiac or pulmonary toxicity in asymptomatic cancer survivors who received chemotherapy, radiotherapy, or trastuzumab were identified. The reviewed literature included primarily retrospective and cross-sectional studies describing the incidence of cardiac and pulmonary late effects. Anatomic and/or functional abnormalities have been associated with use of all currently available anthracyclines and their derivatives. Trastuzumab-related cardiac dysfunction rarely causes death, and in most cases is reversible with improvement in cardiac function on drug discontinuation and/or treatment with cardiac medications. The estimated aggregate incidence of radiation-induced cardiac disease is 10% to 30% by 5 to 10 years post-treatment, although the incidence may be lower with modern techniques. Radiation pneumonitis is reported in 5% to 15% of lung cancer patients receiving definitive external-beam radiation therapy. A minority of patients may develop progressive pulmonary fibrosis; late complications include cor pulmonale and respiratory failure. Bleomycin-induced pneumonitis is an acute rather than late effect of treatment. Late pulmonary complications in bone marrow or stem cell transplantation patients who develop interstitial pneumonitis include idiopathic pneumonia syndrome and bronchiolitis obliterans. Conclusion An increased incidence of cardiac and/or pulmonary dysfunction is observed in cancer survivors. Research is needed to identify high-risk patients, and to determine the optimal screening strategies and subsequent treatment.

Knowledge of diagnosis, treatment history, and risk of late effects among childhood cancer survivors and parents: The impact of a survivorship clinic

2015 ◽  
Vol 62 (8) ◽  
pp. 1444-1451 ◽  
Author(s):  
Robert B. Lindell ◽  
Shannon J. Koh ◽  
JoAnn M. Alvarez ◽  
Tatsuki Koyama ◽  
Adam J. Esbenshade ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Childhood Cancer ◽  
Late Effects ◽  
Childhood Cancer Survivors ◽  
Treatment History ◽  
The Impact
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