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Brignardello E.,Transition Unit for Childhood Cancer Survivors
European journal of endocrinology / European Federation of Endocrine Societies | Year: 2013

Survival rates among childhood cancer survivors (CCS) have enormously increased in the last 40 years. However, this improvement has been achieved at the expense of serious late effects that frequently involve the endocrine system. To evaluate the cumulative incidence of endocrine diseases in a cohort of long-term CCS. We analyzed the clinical data of 310 adults, followed for a median time of 16.0 years after the first cancer diagnosis. The monitoring protocols applied to each patient were personalized on the basis of cancer diagnosis and previous treatments, according to the Children's Oncology Group guidelines. The cumulative incidence of endocrine late effects steadily increased over time. At the last follow-up visit available, 48.46% of females and 62.78% of males were affected by at least one endocrine disease. The most common disorders were gonadal dysfunction, primary hypothyroidism, and GH deficiency (GHD). The main risk factors for endocrine disease were male sex (hazard ratio (HR)=1.45, 95% confidence interval (95% CI) 1.05-1.99), radiotherapy (HR=1.91, 95% CI 1.28-2.84), hematopoietic stem cells transplantation (HR=3.11, 95% CI 2.23-4.34), and older age at cancer diagnosis (HR=1.89, 95% CI 1.25-2.85). Male sex was associated with a higher risk of gonadal disorders, whereas radiotherapy specifically increased the risk of GHD and thyroid dysfunction. Endocrine disorders among CCS have a high prevalence and increase over time. Thus, endocrinologists need to cope with an increasing demand for health care in a field that is still little developed and that, in perspective, could also be extended to some selected types of adult cancer survivors. Source


Brignardello E.,Transition Unit for Childhood Cancer Survivors | Felicetti F.,Transition Unit for Childhood Cancer Survivors | Castiglione A.,University of Turin | Gallo M.,Oncological Endocrinology Unit | And 6 more authors.
European Journal of Cancer | Year: 2016

Introduction The optimal surveillance strategy to screen for thyroid carcinoma childhood cancer survivors (CCS) at increased risk is still debated. In our clinical practice, beside neck palpation we routinely perform thyroid ultrasound (US). Here we describe the results obtained using this approach. Methods We considered all CCS referred to our long term clinic from November 2001 to September 2014. One hundred and ninety-seven patients who had received radiation therapy involving the thyroid gland underwent US surveillance. Thyroid US started 5 years after radiotherapy and repeated every 3 years, if negative. Results Among 197 CCS previously irradiated to the thyroid gland, 74 patients (37.5%) developed thyroid nodules, and fine-needle aspiration was performed in 35. In 11 patients the cytological examination was suspicious or diagnostic for malignancy (TIR 4/5), whereas a follicular lesion was diagnosed in nine. Patients with TIR 4/5 cytology were operated and in all cases thyroid cancer diagnosis was confirmed. The nine patients with TIR 3 cytology also underwent surgery and a carcinoma was diagnosed in three of them. Prevalence of thyroid cancer was 7.1%. Tumour size ranged between 4 and 25 mm, but six (43%) were classified T3 because of extra-thyroidal extension. Six patients had nodal metastases; in eight patients the tumour was multifocal. At the time of the study all patients are disease free, without evidence of surgery complications. Conclusion Applying our US surveillance protocol, the prevalence of radiation-induced thyroid cancer is high. Histological features of the thyroid cancers diagnosed in our cohort suggest that most of them were clinically relevant tumours. © 2015 Elsevier Ltd. All rights reserved. Source


Felicetti F.,Transition Unit for Childhood Cancer Survivors | Manicone R.,Pediatric Hematology Oncology Unit | Corrias A.,Pediatric Endocrinology | Manieri C.,University of Turin | And 4 more authors.
Journal of Cancer Research and Clinical Oncology | Year: 2011

Purpose: To evaluate the effects of total body irradiation (TBI) on the endocrine system in adults treated with hematopoietic cell transplantation (HCT) during childhood. Methods: We studied 40 patients who underwent HCT between 1988 and 2004, mainly for childhood cancer. In 23 patients, the conditioning regimen consisted of high-dose chemotherapy and TBI (TBI+). In the other 17 patients, who did not receive TBI (TBI-), HCT was performed after high-dose chemotherapy alone. Results: Overall, 34% of patients in the TBI+ group showed growth hormone deficiency, compared with none of the patients in the TBI-group (P < 0.05). Leydig cell failure was found in 23% of patients in the TBI+ group and in 0% of the patients in the TBI-group. Elevated FSH levels, suggesting spermatogenesis damage, were found in all the patients receiving TBI and in 36% of the patients in the TBI-group (P < 0.001). Also, primary hypothyroidism was more common in TBI+ (34%) than in TBI-(5.8%) patients (P < 0.05). Conclusions: Our data indicate that endocrine late effects after HCT are more frequent in patients who received TBI, an observation that should be considered, even if the choice of the conditioning regimen is determined by the underlying condition in most cases. © Springer-Verlag 2011. Source


Felicetti F.,Transition Unit for Childhood Cancer Survivors | Felicetti F.,University of Turin | D'Ascenzo F.,Citta della Salute e della Science Hospital | Moretti C.,Citta della Salute e della Science Hospital | And 7 more authors.
European Journal of Preventive Cardiology | Year: 2015

Background: Childhood cancer survivors (CCSs) have an increased risk of overweight and dyslipidaemia, but the distribution and the potential relationships between anticancer therapies and cardiovascular risk factors have been heterogeneously and not prospectively described. Methods: All consecutive CCSs with primary cancer diagnosed between 1973-2007 and subsequently referred to our outpatient clinic were enrolled. Hypercholesterolaemia (total cholesterol <200 and/or low density lipoprotein (LDL)<160 mg/dl) was the primary end point, hypertriglyceridaemia (triglycerides <200 mg/dl) and body mass index <30 kg/m<2< the secondary end points. Cox multivariate adjustments were performed to account for differences in cancer and treatments. Results: A total of 340 patients were included (197 male, 143 female; mean age at last follow-up 24.1±3.2). The most common diagnosis were haematological malignancies (n=227) and brain tumours (n=51). After a median follow-up of 16.1 years, hypercholesterolaemia was diagnosed in 67 CCSs (20%), hypertriglyceridaemia in 20 CCSs (6%) and obesity in 28 CCSs (8%). Total body irradiation and growth hormone deficiency increased the risk of both hypercholesterolaemia (hazard ratio (HR)=2.7; confidence interval (CI) 1.2-4.4 and HR=2.3; CI 1.1-4.9; all p>0.05) and hypertriglyceridaemia (HR=6.5; CI 1.4-31 and HR=7.2; CI 1.1-43; all p>0.05). The risk of hypercholesterolaemia was also higher in CCSs who underwent autologous haematopoietic stem cell transplantation (HR=3.2; CI 1.7-5.9; p>0.001) or platinum-based chemotherapy (HR=2.7; CI 1.5-4.9; p>0.001), whereas a previous diagnosis of brain tumour (HR=10; CI 1.2-45; p>0.05) and anthracyclines exposure (HR=1.3; CI 1.2-26; p>0.05) significantly predicted obesity. Conclusion: CCSs show a high and variable risk for developing dyslipidaemia and obesity, depending on cancer diagnosis and treatments. Therefore, they need accurate and tailored control of their cardiovascular risk profile. © 2014 The European Society of Cardiology. Source


Felicetti F.,Transition Unit for Childhood Cancer Survivors | Felicetti F.,Oncological Endocrinology Unit | Fortunati N.,Transition Unit for Childhood Cancer Survivors | Fortunati N.,Oncological Endocrinology Unit | And 8 more authors.
Journal of Cancer Research and Clinical Oncology | Year: 2015

Purpose: Childhood cancer survivors (CCS) treated with cranial radiation therapy (CRT) are at risk of developing meningiomas. The aim of this study was to evaluate the cumulative incidence of meningiomas in a cohort of CCS who previously underwent CRT. Methods: We considered all CCS who received CRT and were followed up at the “Transition Unit for Childhood Cancer Survivors” in Turin. Even though asymptomatic, they had at least one brain computed tomography or magnetic resonance imaging performed at a minimum interval of 10 years after treatment for pediatric cancer. Results: We identified 90 patients (median follow-up 24.6 years). Fifteen patients developed meningioma (median time from pediatric cancer, 22.5 years). In four patients, it was suspected on the basis of neurological symptoms (i.e., headache or seizures), whereas all other cases, including five giant meningiomas, were discovered in otherwise asymptomatic patients. Multiple meningiomas were discovered in four CCS. Ten patients underwent surgical resection. An atypical meningioma (grade II WHO) was reported in four patients. One patient with multiple meningiomas died for a rapid growth of the intracranial lesions. A second neoplasm (SN) other than meningioma was diagnosed in five out of the 15 patients with meningioma and in ten out of the 75 CCS without meningioma. Cox multivariate analysis showed that the occurrence of meningioma was associated with the development of other SNs, whereas age, sex, or CRT dose had no influence. Conclusions: CCS at risk of the development of meningioma deserve close clinical follow-up, especially those affected by other SNs. © 2015, Springer-Verlag Berlin Heidelberg. Source

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