Management of Acute and Late Endocrine Effects Following Childhood Cancer Treatment
Recent advances in the treatment of pediatric cancers have resulted in increasing numbers of children surviving their malignancy. Current survival rates are approaching 75%, and it had been estimated that by 2010, 1 in 715 young adults would be a long-ter
- PDF / 302,702 Bytes
- 18 Pages / 504.57 x 720 pts Page_size
- 35 Downloads / 178 Views
10
Jill L. Brodsky and Adda Grimberg
Abstract
Recent advances in the treatment of pediatric cancers have resulted in increasing numbers of children surviving their malignancy. Current survival rates are approaching 75%, and it had been estimated that by 2010, 1 in 715 young adults would be a long-term survivor of childhood cancer. Therapeutic options consist of a combination of multi-agent chemotherapy, surgery, radiotherapy, and bone marrow or stem cell transplantation. Unfortunately, decreasing mortality from malignancy comes at the cost of increased morbidity resulting in acute and late effects of treatment. Endocrine disorders affect up to 50% of childhood cancer survivors following chemotherapy and radiotherapy. This chapter describes the acute and late endocrine effects of treatment for childhood cancer by endocrine system and chronology of onset, with a discussion of the pathophysiology, diagnosis, and treatment for each system involved. Keywords
Cancer • Craniospinal irradiation • Chemotherapy • Growth hormone deficiency • Hypogonadism • Precocious puberty • Hypothyroidism • Adrenal insufficiency • Diabetes insipidus • SIADH • Cerebral salt wasting • Bone • Obesity • Metabolic syndrome • Diabetes mellitus
Introduction J.L. Brodsky, M.D. (*) Pediatrics, The Mid-Hudson Medical Group, 30 Columbia Street, Poughkeepsie, NY 12601, USA e-mail: [email protected] A. Grimberg, M.D. Pediatric Endocrinology, Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia, PA, USA e-mail: [email protected]
Recent advances in the treatment of pediatric cancers have resulted in increasing numbers of children surviving their malignancy. Current survival rates are approaching 75%, and it had been estimated that by 2010, 1 in 715 young adults would be a long-term survivor of childhood cancer [1]. Therapeutic options consist of a combination of multi-agent chemotherapy,
S. Radovick and M.H. MacGillivray (eds.), Pediatric Endocrinology: A Practical Clinical Guide, Second Edition, Contemporary Endocrinology, DOI 10.1007/978-1-60761-395-4_10, © Springer Science+Business Media New York 2013
167
168
surgery, radiotherapy, and bone marrow or stem cell transplantation. Unfortunately, decreasing mortality from malignancy comes at the cost of increased morbidity resulting in acute and late effects of treatment. Among 10,397 survivors in the Childhood Cancer Survivor Study, the cumulative incidence of a chronic health condition reached 73.4% 30 years after the cancer diagnosis, with a cumulative incidence of 42.4% for severe, disabling, or life-threatening conditions or death due to a chronic condition [2]. Endocrine disorders affect up to 50% of childhood cancer survivors following chemotherapy and radiotherapy [3, 4]. Late effects may occur soon after treatment; however, they may not develop for many years after cure. Therefore, lifelong follow-up of survivors in a multidisciplinary setting is recommended to ensure early diagnosis, timely institution of appropriate treatment, and counseling wh
Data Loading...
