Schwartz Survivors of Childhood and Adolescent Cancer

360 Pages·2005·10.42 MB·English

by  Cindy L. Schwartz

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PEDIATRIC ONCOLOGY
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Cindy L.Schwartz · Wendy L.Hobbie
Louis S.Constine· Kathleen S.Ruccione
(Eds.)
Survivors
of Childhood
and
Adolescent
Cancer
A Multidisciplinary Approach
Second Edition
With 49 Figures and 61 Tables
123
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Library ofCongress
Control Number 2005920312
ISBN 3-540-40840-1
Springer Berlin Heidelberg NewYork
ISSN 1613-5318
Originally published in 1994 by Mosby-Year Book,Inc.,
St.Louis,Missouri,USA
Title: Survivors ofChildhood Cancer:
Assessment and Management
Cindy L.Schwartz This work is subject to copyright. All rights are reserved,
The Sidney Kimmel Cancer Center whether the whole or part ofthe material is concerned,specif-
ically the rights oftranslation,reprinting,reuse ofillustrations,
at Johns Hopkins
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Johns Hopkins Hospital
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V
Dedication
To the memory ofthose children
for whom our knowledge
was insufficient;
to those children who have been cured
but must approach adult life
with the residua oftreatment;
and to the children ofthe future
who will benefit from scientific advances
that may limit
treatment toxicity
so as to truly approachre cure.
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VII
Foreword
It was not long ago that clinicians would say,“study ed at the 1975 meeting revealed.Among them was
the late complications ofcancer treatments we give to one based on data collected by the Late Effects Study
children? You must be joking! We can start worrying Group, an international consortium that consisted
about that when we start curing them! Meanwhile, initially of five,then ten,pediatric centers.This was
cure must be our only aim.”These practitioners were the first large scale,cooperative unit of its kind,or-
only partially correct in what seemed to be a glaring ganized specifically for the purpose of studying the
truth, for, in fact, increasing numbers of children late effects of cancer therapy (the study of delayed
were beginning to survive their malignancy,and the complications had been included as part ofthe orig-
long-term consequences of therapy would soon be- inal design in the National Wilms Tumor Study
come critical. launched in 1969) [1].These historical notes demon-
It is well to remember that the delayed conse- strate that the epidemiologic,statistical and record-
quences of a cancer treatment delivered to develop- keeping mechanisms necessary for studying long-
ing organisms were first studied long ago.It has been term survivors effectively were in the process of be-
100 years since Perthes reported in 1903 that growth ing established decades before the meeting in 1975.
was impaired in juvenile creatures (chicks) that were History is fine, but one may still wonder: why
irradiated [6].During radiation therapy,strategies to should we study the late effects that might follow
circumvent this problem were set in motion,with the treatment ofchildren 30 years ago? Those treatments
judicious placement oftreatment fields as a first step are now antiquated,ifnot obsolete.The answer is that
[5]. these patients must be followed for a lifetime to as-
It was not,however,until the 1940s that chemical certain the true late effects oftheir therapies,and this
agent-induced remissions ofchildhood leukemia and is important regardless of what is being used today.
responses of solid tumors,such as nephroblastoma, The reason is because,even though treatments have
were reported [2,3].The focus,nonetheless,remained been refined,it does not follow that the lower doses of
the same,and rightly so:namely,finding how best to radiation therapy or ofthe various chemotherapeutic
integrate surgery,radiation and,later,chemotherapy agents currently used are free ofpotential late effects.
in ways that would curecancer.As strides were made Consider the cardiotoxic anthracyclines,for example.
with increasingly successful combined modality reg- While it is true that no congestive heart failure ex-
imens,short-term toxicities began to become the ob- cesses have been noted in patients given the current
ject of study,and soon they were identified.Contin- low doses ofdoxorubicin specified in certain current
ued advances in treatment resulted in dramatic in- Wilms tumor treatment regimens [4],the follow-up
creases in long-term survival, drawing attention to of these patients is relatively short, a maximum of
late effects. twenty years.What will happen in the next twenty
The first large-scale meeting to deal with issues re- years? Will 40-, 50- and 60-year olds who received
lated to toxicity was convened by the National Cancer therapy decades before show latent damage?
Institute in 1975 [7].Pediatric oncology had not been The evolution of late effect studies has been ex-
idle prior to this,ofcourse,as several papers present- tremely useful in working out in considerable detail
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VIII Foreword
practical and efficient research methods and tech- The ultimate goal ofpediatric oncology has been –
niques.Just as the treatments used in the past and and remains – to ensure not only the health,but also
those currently used have benefited from the early the psychosocial and economic well-being of chil-
studies,so,too,will future treatments benefit from dren cured ofmalignant diseases.Parents have ques-
current studies. It is very likely that in the future tions concerning all these issues,and what the future
many ofthe therapies will be completely new or very holds for their sons and daughters.So do the young
different from any currently in the armamentarium. men and women who themselves were treated suc-
The established epidemiologic and statistical tech- cessfully for cancer years before.
niques used to measure outcomes,and the means of This book provides answers to their many ques-
tracking long-term survivors for late follow-up ex- tions.
aminations, will be invaluable as the years roll by.
For,no matter how new the treatments,it is likely that Giulio J.D’Angio,MD
there will always be side effects,at least until the ulti- Hospital ofthe University ofPennsylvania,
mate discovery ofthe “magic bullets”that affect sin- Radiation Oncology,2 Donner Building,
gularly and precisely only the malignant cells,leaving 3400 Spruce Street,Philadelphia,PA 19104–4238
nearby normal cells unscathed.
Let us not lose sight ofthe reason these studies are
pursued:it is to inform the survivors themselves and References
their families of what to expect as the years go by.
1. Evans AE,Norkool P,Evans I,Breslow N,D’Angio GJ.Late
This volume brings together relevant invaluable ma-
effects oftreatment for Wilms tumor.A report from the Na-
terial in a practical,easily understood form,with in-
tional Wilms Tumor Study Group.Cancer 1991;67:331–336
formation extracted from the thousands of articles 2. Farber S,Diamond LK,Mercer RD,et al.Temporary remis-
dealing with the chronic adversities oftherapy.A re- sions in acute leukemia in children produced by folic acid
cent survey showed that more than twenty-five hun- antagonist, 4-aminopteroyl-glutamic acid (aminopterin).
NEJM 1948;328:787–793
dred articles concerned with late effects have been
3. Farber S,Toch R,Sears EM,Pinkel D.Advances in chemo-
published in the last five years alone.The readers of
therapy in cancer in man.Adv Cancer Res 1956;4:1
this volume,therefore,owe the editors a debt ofgrat- 4. Green DM,Grigoriev YA,Nan B,et al.Congestive heart fail-
itude for enlisting the multi-disciplinary array of ure after treatment for Wilms tumor.A report from the
contributing authors. Physicians, nurses, experts National Wilms Tumor Study Group. J Clin Oncol 2001;
19:1926–1934
from other professions and lay persons all have as-
5. Neuhauser, EBD, Wittenborg MH, Berman CZ, Cohen J.
sisted in condensing and bringing order out of this
Irradiation effects of roentgen therapy on the growing
very complex matrix ofinformation.These outstand- spine.Radiology 1952;59:637–650
ing authorities offer up-to-date information on many 6. Perthes G.Ueber den Einfluss der Roentgen-Strahlen auf
epithelial Gewebe insbensondere aufdas Carcinom.Archiv
different topics related to the late effects of juvenile
Fuer Klinische Chirurgie 1903;71:955–982
cancer treatments.Together,they afford the reader a
7. Proceedings ofthe National Cancer Institute Conference on
comprehensive, definitive overview of this com- the Delayed Consequences ofCancer Therapy.Proven and
pelling aspect ofpediatric oncology. Potential.Cancer 1976;37:999–1936
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IX
Acknowledgements
Ten years ago we embarked on the mission of creat- for children with cancer.We may provide advice,but
ing a text that would foster a more complete under- it is they who sit at the bedside after hours during the
standing ofthe long-term toxicity ofcancer therapy. child’s therapy,and it is they who,once the child is
Although progress has been impressive in the last cured,help him or her tackle the world.Their success
decade,and long-term survivorship programs have is now visible in the new cohort ofadvocates:the sur-
been established at most pediatric oncology institu- vivors themselves.One in 500 young adults had can-
tions, we still are on a journey toward the goal of cer before the age of20.These young adults not only
optimizing the quality of survival for children with support each other,they work together to ensure an
cancer. even better future for those now affected.
Our personal families have matured in the years In the previous edition we thanked our own men-
since the first edition was written.The joy we receive tors for teaching us the importance oflong-term sur-
from observing the achievements of our children vivorship and for supporting our efforts.Just as par-
(Jaffa,Adam,Tali,Jonathan,Sarah,Alysia,Joshua and ents nurture their children and are proud to watch
Daniel) encourage our work to provide all children them engage the future,we are proud to acknowledge
with the chance for a healthy life,filled with opportu- our appreciation ofthe many young physicians,nurs-
nity.Our spouses (Howard,Danny and Sally) contin- es,social workers and others who are focused on im-
ue to be the unwavering supports that have enabled proving the lives ofsurvivors ofchildhood and ado-
this work to proceed.As we have struggled to nurture lescent cancer.We hope that this second edition of
our children,we are also even more appreciative of our text will provide them with the background to
the role our own parents (Ruth, Jerry, Catrine, achieve even greater success.With their collective in-
Michael,Mike,Nancy and Louis) have played in our telligence,dedication and caring,we know that chil-
efforts to reach our goals. dren diagnosed with cancer in the next era can look
Indeed,it is often parents who are the greatest ad- forward to happier and more productive lives than
vocates for their children,and this is particularly true ever before.
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XI
Contents
1 Overview. . . . . . . . . . . . . . . . . . . . . . 1 5 Neuroendocrine Complications
Cindy L.Schwartz,Wendy L.Hobbie, of Cancer Therapy . . . . . . . . . . . . . . . 51
Louis S.Constine,Kathleen S.Ruccione Wing Leung,Susan R.Rose,Thomas E.Merchant
5.1 Pathophysiology . . . . . . . . . . . . . . . . . . 52
5.1.1 Normal Hypothalamic–Pituitary Axis . . . . 52
2 Algorithms of Late Effects
5.1.1.1 Growth Hormone. . . . . . . . . . . 53
by Disease. . . . . . . . . . . . . . . . . . . . . 5 5.1.1.2 Gonadotropins . . . . . . . . . . . . 53
Cindy L.Schwartz,Wendy L.Hobbie, 5.1.1.3 Thyroid-Stimulating
Louis S.Constine Hormone . . . . . . . . . . . . . . . 54
5.1.1.4 Adrenocorticotropin . . . . . . . . . 54
5.1.1.5 Prolactin . . . . . . . . . . . . . . . 54
3 Facilitating Assessment 5.1.2 Injury of the Hypothalamic–Pituitary Axis
in Patients with Cancer. . . . . . . . . . . . 56
of Late Effects by Organ System . . . . . 17
5.1.3 Contribution of Radiation
Cindy L.Schwartz,Wendy L.Hobbie, to Hypothalamic–Pituitary Axis Injury . . . 56
Louis S.Constine 5.2 Clinical Manifestations . . . . . . . . . . . . . . . 60
Chemotherapy. . . . . . . . . . . . . . . . . . . . 17 5.2.1 GH Deficiency . . . . . . . . . . . . . . . . . 60
Other Terms . . . . . . . . . . . . . . . . . . . . . 18 5.2.2 LH or FSH Deficiency . . . . . . . . . . . . . 60
5.2.3 Precocious
or Rapid Tempo Puberty . . . . . . . . . . . 63
4 Central Nervous System Effects. . . . . . 35 5.2.4 TSH Deficiency . . . . . . . . . . . . . . . . 64
Nina S.Kadan-Lottick,Joseph P.Neglia 5.2.5 ACTH Deficiency . . . . . . . . . . . . . . . 66
5.2.6 Hyperprolactinemia . . . . . . . . . . . . . 66
4.1 Introduction . . . . . . . . . . . . . . . . . . . . . 35
5.2.7 Diabetes Insipidus . . . . . . . . . . . . . . 66
4.2 Pathophysiology. . . . . . . . . . . . . . . . . . . 35
5.2.8 Osteopenia . . . . . . . . . . . . . . . . . . 66
4.2.1 Pre- and Post-Natal Brain Development . . 35
5.2.9 Hypothalamic Obesity . . . . . . . . . . . . 66
4.2.2 Disease Considerations. . . . . . . . . . . . 36
5.3 Detection and Screening . . . . . . . . . . . . . . 67
4.2.3 Radiation. . . . . . . . . . . . . . . . . . . . 37
5.3.1 Signs and Symptoms Prompting
4.2.4 Intrathecal Chemotherapy. . . . . . . . . . 39
Immediate Evaluation . . . . . . . . . . . . 67
4.2.5 Systemic Chemotherapy . . . . . . . . . . . 39
5.3.2 Surveillance of Asymptomatic Patients . . . 67
4.3 Clinical Presentations. . . . . . . . . . . . . . . . 40
5.3.3 GH Deficiency . . . . . . . . . . . . . . . . . 67
4.4 Moderators and Mediators
5.3.4 LH or FSH Deficiency . . . . . . . . . . . . . 67
of Central Nervous System Outcomes. . . . . . . 42
5.3.5 Precocious Puberty . . . . . . . . . . . . . . 68
4.5 Prevention and Intervention. . . . . . . . . . . . 43
5.3.6 TSH Deficiency . . . . . . . . . . . . . . . . 69
4.5.1 Prevention:Primary and Secondary . . . . . 43
5.3.7 ACTH Deficiency . . . . . . . . . . . . . . . 69
4.5.2 Interventions . . . . . . . . . . . . . . . . . . 46
5.3.8 Hyperprolactinemia . . . . . . . . . . . . . 70
4.6 Future Directions . . . . . . . . . . . . . . . . . . 46
5.3.9 Diabetes Insipidus . . . . . . . . . . . . . . 70
References . . . . . . . . . . . . . . . . . . . . . . . . . . 47
5.3.10Osteopenia . . . . . . . . . . . . . . . . . . 70
5.3.11Hypothalamic Obesity . . . . . . . . . . . . 70
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XII Contents
5.4 Management of Established Problems . . . . . . 71 6.8 Optic Nerve and Retina . . . . . . . . . . . . . . . 90
5.4.1 GH Deficiency. . . . . . . . . . . . . . . . . 71 6.8.1 Anatomy and Physiology . . . . . . . . . . 90
5.4.2 LH or FSH Deficiency . . . . . . . . . . . . . 73 6.8.2 Acute Radiation Effects. . . . . . . . . . . . 90
5.4.3 Precocious Puberty . . . . . . . . . . . . . . 74 6.8.3 Chronic Radiation Effects . . . . . . . . . . 90
5.4.4 Hypothyroidism. . . . . . . . . . . . . . . . 74 6.8.4 Chemotherapy . . . . . . . . . . . . . . . . 91
5.4.5 ACTH Deficiency . . . . . . . . . . . . . . . 75 6.8.5 Medical and Nursing Management . . . . . 92
5.4.6 Hyperprolactinemia . . . . . . . . . . . . . 76 6.9 Orbital Bones and Tissue . . . . . . . . . . . . . . 92
5.4.7 Diabetes Insipidus . . . . . . . . . . . . . . 76 6.9.1 Anatomy and Physiology . . . . . . . . . . 92
5.4.8 Osteopenia . . . . . . . . . . . . . . . . . . 76 6.9.2 Acute Radiation Effects. . . . . . . . . . . . 92
5.4.9 Hypothalamic Obesity . . . . . . . . . . . . 77 6.9.3 Chronic Radiation Effects . . . . . . . . . . 92
References . . . . . . . . . . . . . . . . . . . . . . . . . . 77 6.9.4 Chemotherapy . . . . . . . . . . . . . . . . 93
6.9.5 Medical and Nursing Management . . . . . 93
6.10 Conclusion . . . . . . . . . . . . . . . . . . . . . . 93
6 Ocular Complications due References . . . . . . . . . . . . . . . . . . . . . . . . . . 93
to Cancer Treatment. . . . . . . . . . . . . . 81
Michael Ober,Camille A.Servodidio,
7 Head and Neck . . . . . . . . . . . . . . . . . 95
David Abramson
Arnold C.Paulino,Mary Koshy,Della Howell
6.1 Introduction . . . . . . . . . . . . . . . . . . . . . 82
6.2 Eyelids,Periorbital Skin and Tear Film . . . . . . 82 7.1 Introduction . . . . . . . . . . . . . . . . . . . . . 95
6.2.1 Anatomy and Physiology . . . . . . . . . . 82 7.2 Pathophysiology . . . . . . . . . . . . . . . . . . 95
6.2.2 Acute Radiation Effects. . . . . . . . . . . . 83 7.2.1 Normal Organ Development . . . . . . . . 95
6.2.3 Chronic Radiation Effects . . . . . . . . . . 83 7.2.2 Organ Damage and Developmental Effects
6.2.4 Chemotherapy . . . . . . . . . . . . . . . . 84 of Cytotoxic Therapy . . . . . . . . . . . . . 96
6.2.5 Medical and Nursing Management . . . . . 84 7.2.2.1 Skin and Mucous Membranes . . . . 96
6.3 Conjunctiva . . . . . . . . . . . . . . . . . . . . . 85 7.2.2.2 Bone and Connective Tissue . . . . . 97
6.3.1 Anatomy and Physiology . . . . . . . . . . 85 7.2.2.3 Salivary Glands and Taste Buds. . . . 97
6.3.2 Acute Radiation Effects. . . . . . . . . . . . 85 7.2.2.4 Teeth . . . . . . . . . . . . . . . . . 97
6.3.3 Chronic Radiation Effects . . . . . . . . . . 85 7.2.2.5 Ear. . . . . . . . . . . . . . . . . . . 98
6.3.4 Chemotherapy . . . . . . . . . . . . . . . . 85 7.3 Clinical Manifestation of Late Effects . . . . . . . 98
6.3.5 Medical and Nursing Management . . . . . 85 7.3.1 Skin and Mucous Membranes . . . . . . . . 98
6.4 Cornea . . . . . . . . . . . . . . . . . . . . . . . . 86 7.3.2 Bone and Connective Tissue. . . . . . . . . 99
6.4.1 Anatomy and Physiology . . . . . . . . . . 86 7.3.3 Salivary Glands and Taste Buds . . . . . . . 100
6.4.2 Acute Radiation Effects. . . . . . . . . . . . 86 7.3.4 Teeth. . . . . . . . . . . . . . . . . . . . . . 101
6.4.3 Chronic Radiation Effects . . . . . . . . . . 86 7.3.5 Ear . . . . . . . . . . . . . . . . . . . . . . . 102
6.4.4 Chemotherapy . . . . . . . . . . . . . . . . 87 7.4 Detection and Screening . . . . . . . . . . . . . . 102
6.4.5 Medical and Nursing Management . . . . . 87 7.5 Management of Established Problems
6.5 Lens . . . . . . . . . . . . . . . . . . . . . . . . . . 87 and Rehabilitation . . . . . . . . . . . . . . . . . 104
6.5.1 Anatomy and Physiology . . . . . . . . . . 87 7.5.1 Oral Cavity. . . . . . . . . . . . . . . . . . . 104
6.5.2 Acute Radiation Effects. . . . . . . . . . . . 87 7.5.2 Bone and Connective Tissue Disease . . . . 104
6.5.3 Chronic Radiation Effects . . . . . . . . . . 87 7.5.3 Ears. . . . . . . . . . . . . . . . . . . . . . . 104
6.5.4 Chemotherapy . . . . . . . . . . . . . . . . 88 References . . . . . . . . . . . . . . . . . . . . . . . . . . 105
6.5.5 Medical and Nursing Management . . . . . 88
6.6 Uvea:Iris,Ciliary Body and Choroid . . . . . . . . 89
8 Adverse Effects
6.6.1 Anatomy and Physiology . . . . . . . . . . 89
6.6.2 Acute Radiation Effects. . . . . . . . . . . . 89 of Cancer Treatment on Hearing . . . . . 109
6.6.3 Chronic Radiation Effects . . . . . . . . . . 89 Wendy Landier,Thomas E.Merchant
6.6.4 Chemotherapy . . . . . . . . . . . . . . . . 89
8.1 Introduction . . . . . . . . . . . . . . . . . . . . . 109
6.6.5 Medical and Nursing Management . . . . . 89
8.2 Pathophysiology . . . . . . . . . . . . . . . . . . 109
6.7 Sclera . . . . . . . . . . . . . . . . . . . . . . . . . 90 8.2.1 Normal Anatomy and Physiology . . . . . . 109
6.7.1 Anatomy and Physiology . . . . . . . . . . 90
8.2.2 Ototoxic Effects of Tumor and Therapy:
6.7.2 Acute Radiation Effects. . . . . . . . . . . . 90
Risk Factors and Incidence . . . . . . . . . . 111
6.7.3 Chronic Radiation Effects . . . . . . . . . . 90
8.2.2.1 Surgery and Tumor . . . . . . . . . . 111
6.7.4 Chemotherapy . . . . . . . . . . . . . . . . 90
8.2.2.2 Radiation Therapy . . . . . . . . . . 112
6.7.5 Medical and Nursing Management . . . . . 90
8.2.2.3 Pharmacologic Therapy . . . . . . . 113
8.2.3 Preventive Measures . . . . . . . . . . . . . 114