Late Effect of Treatment of Nephroblastoma in Patients Treated in 1980– 2001 in a Single Centre
Authors:
J. Radvanský 1; K. Slabý 1; J. Radvanská 2; J. Mališ 2; T. Eckschalger 2; J. Šulc 1; M. Šafářová 1; A. Kolský 3; M. Procházka 1; J. Gilík 4
Authors place of work:
Klinika rehabilitace a tělovýchovného lékařství 2. LF UK a FN Motol, Praha
1; Klinika dětské hematologie a onkologie 2. LF UK a FN Motol, Praha
2; Klinika dětí a dorostu 3. LF UK, Praha
3; Dětské kardiocentrum FN Motol, Praha
4
Published in the journal:
Klin Onkol 2010; 23(4): 245-255
Category:
Original Articles
Summary
Backgrounds:
The aim of the study was to describe the late effects in a cohort of patients in long-term remission (> 5 years from end of treatment) diagnosed and treated for nephroblastoma at the single paediatric centre during 1980– 2001.
Patients and Methods:
151 patients were examined for renal function, lipid profile, sonography, echocardiography, exercise capacity and postural status. Age at diagnosis was 3.7 ± 2.7 years, median 3.1, range 0.01– 17.2 years. The cohort included 55% of women. Age in the study 19.4 ± 5.8, median 19.6 years, range 7.8– 36 years. Anthracyclines (ATC) were administered to 25.9% of the cohort. Abdominal radiotherapy (RTA) was required in 34.2%.
Results:
Creatinine clearance was on average 1.56 ± 0.56 ml/ s/ 1.73m2, (median 1.49 ml/ s/ 1.73m2). Proteinuria was 0.18 ± 0.30 g/ 24 h/ m2, median 0.13 mg/ 24 h/ m2. Three patients had proteinuria above 1g/ 24 h with a normal glomerular filtration rate and s‑ albumin. Hypertension was treated in 8.6% of patients (6% by pharmacotherapy). Increased diastolic blood pressure (DBP) and systolic blood pressure (SBP) was found in adolescents: DBP > 90 Torr was found in 10.2% of patients and SBP > 135 Torr in 8.3%, all of them above the age of 15 years. ECHO did not reveal any pathology even in patients treated by ATC. Plasma cholesterol, LDL, HDL, triglycerides were outside the recommended range in two or more parameters in 28.9% of the cohort. Lipoprotein Lp(a) > 500 mg. l– 1 (more than 200% higher than the upper limit) was found in 15.2%. Low peak oxygen consumption (VO2 peak) was found in 40% of the cohort. Scoliosis (Sc) was anamnestically found in 46%. Prevalence of Sc according to the age of treatment has a similar trend as the reduced use of the RTA. Pulmonary function test showed a moderate increase in the functional residual capacity (the average Z‑ score of 1.35). VO2 peak correlates positively with the inspiratory capacity (p < 0.05).
Conclusion:
Based on the found pathologies and known risks, a schedule of late effect prevention and monitoring of patients in long‑term NFB remission was established. It should include clinical examination, kidney function and blood pressure monitoring, sonographic and echocardiography examination, long‑term physiotherapeutic care and prevention of cardiovascular diseases.
Key words:
nephroblastoma – late effects – cancer survivorship – children – adolescents – prevention – second cancer
Zdroje
1. Tournade MF, Com‑ Nougué C, De Kraker J et al. International Society of Pediatric Oncology Nephroblastoma Trial and Study Committee. Optimal duration of preoperative therapy in unilateral and nonmetastatic Wilms‘ tumor in children older than 6 months: Results of the ninth International Society of Pediatric Oncology Wilms tumor trial and study. J Clin Oncol 2001; 19(2): 488– 500.
2. Lemerle J, Voûte PA, Tournade MF et al. Pre‑operative versus post‑operative radiotherapy, single versus multiple courses of actinomycin D in the treatment of Wilms’ tumor. Preliminary results of a controlled clinical trial conducted by the International Society of Paediatric Oncology (SIOP). Cancer 1976; 38(2): 647– 654.
3. Lemerle J, Voûte PA, Tournade MF et al. Effectiveness of pre‑operative chemotherapy in Wilms’ tumor: Results of an International Society of Pediatric Oncology (SIOP) clinical trial. J Clin Oncol 1983; 1(10): 604– 609.
4. Tournade MF, Com‑ Nougué C, Voûte PA et al. Results of the Sixth International Society of Pediatric Oncology Wilms’ Tumor Trial and Study: A risk‑adapted therapeutic approach in Wilms’ tumor. J Clin Oncol 1993; 11(6): 1014– 1023.
5. D’Angio GJ, Evans AE, Breslow N et al. The treatment of Wilms’ Tumor: Results of the National Wilms’ Tumor Study. Cancer 1976; 38(2): 633– 646.
6. D’Angio GJ, Evans AE, Breslow N et al. The treatment of Wilms’ tumor: Results of the Second National Wilms’ Tumor Study. Cancer 1981; 47(9): 2302– 2311.
7. D’Angio JG, Breslow N, Beckwith JB et al. The treatment of Wilms’ tumor: Results of the Third National Wilms’ Tumor Study. Cancer 1989; 64(2): 466– 479.
8. Green DM, Breslow NE, Beckwith JB et al. Comparison between single‑dose and divided dose administration of dactinomycin and doxorubicin for patients with Wilms’tumor: A report from the National Wilms’ Tumor Study Group. J Clin Oncol 1998; 16(1): 237– 245.
9. Eckschlager T, Radvanska J, Slaby K et al. Changes of blood count, lymphocyte subpopulations and immunoglobulin levels in nephroblastoma long term survivors. Neoplasma 2009; 56(1): 9– 12.
10. Jenkinsin C, Layte R, Wright, L et al. The U.K. SF‑ 36: An analysis an interpretation manual. Oxford: Health Services. Research Unit 1996.
11. First T, Skovranek J. Normal values of M‑ mode echocardiographic parameters in children. Cesk Pediatr 1984; 39(12): 699– 708.
12. Appleton CP, Hatle LK. The Natural History of Left Ventricular Filling Abnormalities: Assessment by Two‑ Dimensional and Doppler Echocrdiography. Echocardiography 1992; 9(4): 437– 457.
13. Elbl L. Poškození srdce protinádorovou léčbou. 1. vyd. Praha: Grada Publishing 2002.
14. Niederle P, Aschermann M, Elbl L et al (eds). Echokardiografie. Praha: Triton 2002.
15. Rate WR, Butler MS, Robertson WW et al. Late orthopedic effects in children with Wilms‘ tumor treated with abdominal irradiation. Med Pediatr Oncol 1991; 19(4): 265– 268.
16. Mäkipernaa A, Koskimies O, Jääskelainen J et al. Renal growth and function 11– 28 years after treatment of Wilms‘ tumour. Eur J Pediatr 1991; 150(6): 444– 447.
17. Finklestein JZ, Norkool P, Green DM et al. Diastolic hypertension in Wilms‘ tumor survivors: a late effect of treatment? A report from the National Wilms‘ Tumor Study Group. Am J Clin Oncol 1993; 16(3): 201– 205.
18. Carli M, Frascella E, Tournade MF et al. Second malignant neoplasms in patients treated on SIOP Wilms tumour studies and trials 1, 2, 5, and 6. Med Pediatr Oncol 1997; 29(4): 239– 244.
19. Benoist MR, Lemerle J, Jean R et al. Effects of pulmonary function of whole lung irradiation for Wilm‘s tumour in children. Thorax 1982; 37(3): 175– 180.
20. Evans AE, Norkool P, Evans I et al. Late effects of treatment for Wilms‘ tumor. A report from the National Wilms‘ Tumor Study Group. Cancer 1991; 67(2): 331– 336.
21. Breslow NE, Ou SS, Beckwith JB et al. Doxorubicin for favorable histology, Stage II– III Wilms tumor: results from the National Wilms Tumor Studies. Cancer 2004; 101(5): 1072– 1080.
22. Paulino AC, Wen BC, Brown CK et al. Late effects in children treated with radiation therapy for Wilms‘ tumor. Int J Radiat Oncol Biol Phys 2000; 46(5): 1239– 1246.
23. Oeffinger KC, Eshelman DA, Tomlinson GE et al. Grading of late effects in young adult survivors of childhood cancer followed in an ambulatory adult setting. Cancer 2000; 88(7): 1687– 1695.
24. Kobesova A, Morris CE, Lewit K et al. Twenty‑year‑ old pathogenic „active“ postsurgical scar: a case study of a patient with persistent right lower quadrant pain. J Manipulative Physiol Ther 2007; 30(3): 234– 238.
25. Lewit K, Olsanska S. Clinical importance of active scars: abnormal scars as a cause of myofascial pain. J Manipulative Physiol Ther 2004; 27(6): 399– 402.
26. Kolář P, Lewit K. Význam hlubokého stabilizačního systému v rámci vertebrogenních obtíží. Neurologie pro praxi 2005; 6(5): 270– 275.
27. Kolář P. Vertebrogenní obtíže a stabilizační funkce svalů – diagnostika. Rehabilitace a fyzikální lékařství 2006; 13(4): 155– 170.
28. Mladosievičová B, Kaiserová E, Foltinová A et al. Dlhodobé nežiaduce účinky terapie u pacientov vyliečených z detskej malignity. Klin Onkol 2007; 20(1): 18– 22.
29. Kasiske BL, Ma JZ, Louis TA et al. Long‑term effects of reduced renal mass in humans. Kidney Int. 1995; 48(3): 814– 819.
30. Seeman T. Arterial hypertension in children and adolescents. Cas Lek Cesk 2006; 145(8): 625– 632; discussion 632– 634.
31. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114(2 Suppl 4th Report): 555– 576.
32. Nawrot TS, Hoppenbrouwers K, Den Hond E et al. Prevalence of hypertension, hypercholesterolemia, smoking and overweight in older Belgian adolescents. Eur J Public Health 2004; 14(4): 361– 365.
33. Antal M, Nagy K, Regoly‑ Mérei A et al. Assessment of cardiovascular risk factors among Hungarian university students in Budapest. Ann Nutr Metab 2006; 50(2): 103– 107.
34. Janda J, Koutecky J, Lukes M et al. The solitary kidney in patients after nephrectomy in Wilm‘s tumor. Cesk Pediatr 1993; 48(10): 577– 580.
35. Bailey S, Roberts A, Brock C et al. Nephrotoxicity in survivors of Wilms‘ tumours in the North of England. Br J Cancer 2002; 87(10): 1092– 1098.
36. Eckschlager T, Prusa R, Hladikova M et al. Lymphocyte subpopulations and immunoglobulin levels in Hodgkin‘s disease survivors. Neoplasma 2004; 51(4): 261– 264.
37. Eckschlager T, Radvanská J, Slabý K et al (eds). Změny krevního obrazu, hladin imunoglobulinů a lymfocytárních subpopulací u osob vyléčených z nádorů dětského věku. Edukační sborník, XXX. Brněnské onkologické dny; 2008.
38. Pawlicki M, Zuchowska‑ Vogelgesang B, Ziobro M et al. Late hematologic status after chemotherapy observed in patients 3 to 10 years after treatment. Przegl Lek 1995; 52(7): 344– 346.
Štítky
Paediatric clinical oncology Surgery Clinical oncologyČlánok vyšiel v časopise
Clinical Oncology
2010 Číslo 4
- Spasmolytic Effect of Metamizole
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole in perioperative treatment in children under 14 years – results of a questionnaire survey from practice
- Current Insights into the Antispasmodic and Analgesic Effects of Metamizole on the Gastrointestinal Tract
- Obstacle Called Vasospasm: Which Solution Is Most Effective in Microsurgery and How to Pharmacologically Assist It?
Najčítanejšie v tomto čísle
- Merkel Cell Skin Carcinoma
- Metastatic Breast Cancer in 28 Years Old Man
- Bile Duct Malignancies
- Targeted Therapy with an EGFR Tyrosine Kinase Inhibitor in Bronchioloalveolar Carcinoma of the Lung: A Literature Review and a Case Study of Clinically Prompt and Intensive Response to Erlotinib.