Childhood Cancer: Occurrence, Treatment and Risk of Second Primary Malignancies

Abstract

Cancer represents the leading cause of disease-related death and treatment-associated morbidity in children with an increasing trend in recent decades worldwide. Nevertheless, the 5-year survival of childhood cancer patients has been raised impressively to more than 80% during the past decades, primarily attributed to improved diagnostic technologies and multiagent cytotoxic regimens. This strong benefit of more efficient tumor control and prolonged survival is compromised by an increased risk of adverse and fatal late sequelae. Long-term survivors of pediatric tumors are at the utmost risk for non-carcinogenic late effects such as cardiomyopathies, neurotoxicity, or pneumopathies, as well as the development of secondary primary malignancies as the most detrimental consequence of genotoxic chemo- and radiotherapy. Promising approaches to reducing the risk of adverse late effects in childhood cancer survivors include high precision irradiation techniques like proton radiotherapy or non-genotoxic targeted therapies and immune-based treatments. However, to date, these therapies are rarely used to treat pediatric cancer patients and survival rates, as well as incidences of late effects, have changed little over the past two decades in this population. Here we provide an overview of the epidemiology and etiology of childhood cancers, current developments for their treatment, and therapy-related adverse late health consequences with a special focus on second primary malignancies.

Biological Aspects of Inflamm-Aging in Childhood Cancer Survivors

“…Current anti-neoplastic treatments improve the survival of children with cancer, so that 80% of children treated for childhood cancer will become long-term survivors (>5 years) [1]. Although chemotherapy promotes the survival rate for childhood cancer patients, unfortunately it also predisposes the onset of different late pathological conditions [3][4][5]. In particular, in childhood cancer survivors (CCS) a premature aging process is observed which induces the damage of vital organs and, consequently, the onset of chronic age-related diseases, such as osteoporosis, cardiovascular diseases, obesity, and infertility [4,[37][38][39][40].…”

“…It is estimated that 80% of children treated for childhood achieve 5-year survival, becoming long-term survivors (>5 years) [1,2]. Although increased survival rates are encouraging, several late effects often accompany the advancements in childhood cancer patients' treatment [3][4][5]. The chronic late effects may increase over time and influence the physiological aging process, resulting in a premature alteration of vital organ system function during adulthood and predispose individuals to a major risk to prematurely develop chronic age-related health conditions, frequent hospitalization, and early mortality.…”

Intravenous opioids for chemotherapy‐induced severe mucositis pain in children: Systematic review and single‐center case series of management with patient‐ or nurse‐controlled analgesia (PCA/NCA)

“…The ability to recognize and manage potential dose-limiting toxicities is vital, as modification of treatment protocols may impair the recent advances in survival from pediatric cancer with newer multi-agent protocols and therapies, and reduce the potential prolonged benefit following stem cell transplants for nonmalignant conditions. 9,10,58,74 Following survival from childhood cancer, 12%-20% of adults reported chronic pain, 16.7% used prescription analgesics, and 21% attributed pain to cancer and treatment. 75 The impact of early life exposure to chemotherapy and pain, and the adequacy of acute pain control on long-term nociceptive processing and future pain response, requires ongoing evaluation.…”

Bibliometric Analysis of Oral Mucositis Research In Pediatric Oncology

“…As a result of today's advances in health technology and regulations in treatment protocols, the survival rate in childhood cancers increases, but there is an increase in the duration of hospitalization and the incidence of side effects in children [4]. While the therapies used in its treatment ght malignant cells, they also have devastating effects on healthy cells.…”