1
|
Latoch E, Zubowska M, Młynarski W, Stachowicz-Stencel T, Stefanowicz J, Sławińska D, Kowalczyk J, Skalska-Sadowska J, Wachowiak J, Badowska W, Czajńska-Deptuła A, Dembowska-Bagińska B, Garus K, Skoczeń S, Pobudejska-Pieniążek A, Szczepański T, Machnik K, Panasiuk A, Sęga-Pondel D, Malesza I, Raciborska A, Zielezińska K, Urasiński T, Mizia-Malarz A, Wawrzeńczyk A, Karolczyk G, Kołtan A, Wysocki M, Wołowiec M, Matysiak M, Krawczuk-Rybak M. Late effects of childhood cancer treatment in long-term survivors diagnosed before the age of 3 years - A multicenter, nationwide study. Cancer Epidemiol 2022; 80:102209. [PMID: 35868173 DOI: 10.1016/j.canep.2022.102209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The effect of age on the incidence of late sequelae that occur after anticancer treatment in childhood is still not fully elucidated. In this multicenter study of long-term survivors diagnosed before age of three, we investigated the prevalence of late effects many years after treatment. METHODS The study group (n = 561) was selected from the Polish National Childhood Cancer Survivors Registry (n = 1761) created in 2007. A survivor was defined as an individual who has survived at least 5 years after completion of anticancer treatment. All children were diagnosed between 1991 and 2016, mean age at diagnosis was 1.82 years (range 0.03-2.99) and median follow up time - 9.85 years (range 5.0-23.6). They were treated in accordance with international protocols approved by the Polish Pediatric Leukemia and Lymphoma Group and Polish Solid Tumor Group. Chemotherapy alone was used in 192 (34.2%), chemotherapy and radiotherapy - 56 (10%), chemotherapy and surgery - 176 (31.4%), chemotherapy, radiotherapy, and surgery - 79 (14.1%), and surgery alone in 58 patients (10.3%). RESULTS Of all patients enrolled to the study, only 94 (16.8%) had normal function of all organs. Seventy-six (13.5%) children developed dysfunction in one organ, another 83 (14.8%) had symptoms or complaints suggestive of dysfunction in two organs or systems, 88 (15.7%) had abnormalities in three organs, and 220 (39.2%) had at least four or more dysfunctions. In the entire study group, dysfunctions most frequently (> 20% of cases) involved the following organs/systems: circulatory - 21.8%, urinary - 30.8%, gastrointestinal - 20.8%, immune - 23.5%, vision - 20.7%, hearing - 21.8%, and oral and masticatory dysfunction - 26.9%. We did not find any significant differences in organ dysfunction between children diagnosed under the age of 1 and those diagnosed at the age of 1-3, except for a lower incidence of thyroid abnormalities (p = 0.007) and the higher prevalence of liver dysfunction in youngest patients. In the subset with longer follow-up period (> 10 years) more frequent thyroid abnormalities (p = 0.019), male (p = 0.002) and female (p = 0.026) gonads dysfunction, as well as musculoskeletal problems (p < 0.001) were observed. Among subjects who received radiotherapy compared to those who did not, short stature (p = 0.001), and dysfunction of the following systems/organs - circulatory (p = 0.049), urinary (p = 0.012), thyroid gland (p < 0.0001), nervous (p = 0.007), immunological (p = 0.002), liver (p = 0.03), dental or chewing difficulties (p = 0.001), hearing (p = 0.001) and musculoskeletal (p = 0.026) were more frequently reported. When multimodal therapy was applied (chemotherapy, radiotherapy, and surgery) a higher incidence of short stature (p = 0.007), urinary system disorders (p < 0.0001), thyroid dysfunction (p < 0.0001), hearing loss (p < 0.0001), and skin problems (p = 0.031) were observed. CONCLUSION This study confirms that radiotherapy and some specific toxicity of cytostatics are the most important factors affecting organ function. Apart from a higher incidence of liver dysfunction in the youngest patients, there were no significant differences in organ and system toxicities between children diagnosed under the age of 1 and those diagnosed at the age of 1-3. We have shown that this group requires systematic, careful and long-term follow-up.
Collapse
Affiliation(s)
- Eryk Latoch
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Poland.
| | - Małgorzata Zubowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Łódź, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Łódź, Poland
| | | | - Joanna Stefanowicz
- Department of Paediatrics, Haematology and Oncology, Medical University of Gdańsk, Poland
| | - Dorota Sławińska
- Department of Paediatric Haematology and Oncology and Transplantology, Medical Univeristy of Lublin, Poland
| | - Jerzy Kowalczyk
- Department of Paediatric Haematology and Oncology and Transplantology, Medical Univeristy of Lublin, Poland
| | - Jolanta Skalska-Sadowska
- Department of Paediatric Oncology, Hematology and Hematopietic Stem Cell Transplantation, Poznań University of Medical Science, Poland
| | - Jacek Wachowiak
- Department of Paediatric Oncology, Hematology and Hematopietic Stem Cell Transplantation, Poznań University of Medical Science, Poland
| | - Wanda Badowska
- Clinical Department of Pediatric Oncology and Hematology, School of Medicine, University of Warmia and Mazury in Olsztyn, Poland
| | | | | | - Katarzyna Garus
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Szymon Skoczeń
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | | | - Tomasz Szczepański
- Department of Pediatric Hematology and Oncology, Medical University of Silesia, Katowice, Poland
| | | | - Anna Panasiuk
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Poland; Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Poland
| | - Dorota Sęga-Pondel
- Department of Paediatric Bone Marrow Transplantation, Oncology and Hematology, Wroclaw Medical University, Poland
| | - Iwona Malesza
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
| | - Anna Raciborska
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, Warsaw, Poland
| | - Karolina Zielezińska
- Department of Pediatrics Hematology-Oncology, and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Urasiński
- Department of Pediatrics Hematology-Oncology, and Gastroenterology, Pomeranian Medical University, Szczecin, Poland
| | - Agnieszka Mizia-Malarz
- Department of Pediatric Oncology, Haematology and Chemotherapy, Upper Silesia Children's Care Heatlh Centre, Medical University of Silesia, Katowice, Poland
| | - Anna Wawrzeńczyk
- Pediatric Department of Hematology and Oncology, Regional Polyclinic Hospital in Kielce, Poland
| | - Grażyna Karolczyk
- Pediatric Department of Hematology and Oncology, Regional Polyclinic Hospital in Kielce, Poland
| | - Andrzej Kołtan
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Poland
| | - Mariusz Wysocki
- Department of Pediatric Hematology and Oncology, Collegium Medicum in Bydgoszcz, Poland
| | - Magdalena Wołowiec
- Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw, Poland
| | - Michał Matysiak
- Department of Pediatrics, Hematology and Oncology, Medical University of Warsaw, Poland
| | - Maryna Krawczuk-Rybak
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, Poland
| |
Collapse
|