Kombinierte Behandlungsstrategie bei über 200 Kindern mit Morbus Hodgkin: Abgestufte Chemotherapie, Involved-Field-Bestrahlung mit erniedrigten Dosen und selektive Splenektomie. Ein Bericht der kooperativen Therapiestudie DAL-HD-82*

Background Second malignant neoplasms (SMNs) have become a primary concern in evaluating long‐term effects of treatment in pediatric oncology. Thyroid carcinoma has proven to be a common SMN. Methods. In a multicenter study involving 58 hospitals in Germany, Austria and Switzerland, 18 of 239 (7.5%) SMNs documented following first malignant neoplasm (FMN) in childhood were thyroid carcinoma. Results. The age at diagnosis of FMN ranged from 1 to 15 years. Eleven patients were female. Six children had survived Hodgkin disease, seven acute leukemia, two Ewing sarcoma and three various other tumors. Fifteen of the 18 patients had been treated with radiotherapy to the head and neck region. The time interval between treatment and diagnosis of thyroid carcinoma ranged from 4 to 19 years (median 8 years). The carcinoma was papillary in 17 cases and follicular in one. Eleven patients had metastases in the regional lymph nodes at presentation. Discussion. Radiotherapy appears to be an important risk factor in secondary thyroid carcinoma, but it does not explain all cases. The current data are remarkable for the large proportion of patients who received only prophylactic cranial irradiation for ALL and for the three patients who received no irradiation to the head and neck region. Genetic determinants and chemotherapy must also be considered. Conclusions. Regular thyroid examination should be included in the long‐term follow‐up of survivors of childhood malignancy. Med. Pediatr. Oncol. 31:91–95, 1998. © 1998 Wiley‐Liss, Inc.

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“…Chemotherapy was also given in all six cases. The therapeutic protocols employed are summarized by Schellong et al [13].…”

Section: Resultsmentioning

confidence: 99%

Secondary thyroid carcinoma after treatment for childhood cancer

Black

Straaten

Gutjahr

1998

Med. Pediatr. Oncol.

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“…Overwhelming post-splenectomy infections (OPSI) A total of 335 patients of the original cohort were splenectomised at exploratory laparotomy. Whereas this was true for all patients of the first study (HD-78), splenectomies in later studies were reduced in a stepwise procedure [13,19] and completely abandoned in 1990 [16]. Table 3 (septic complications in 6 patients with secondary leukaemias/MDS are not included).…”

Section: Introductionmentioning

confidence: 99%

Late Effects after Therapy of Hodgkin's Disease: Update 2003/04 on Overwhelming Post-Splenectomy Infections and Secondary Malignancies

Schellong

Riepenhausen²

2004

Klin Padiatr

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The median follow-up period of patients at the date of last information was 11.1 years (max. 25.5 years), the median age was 23.7 years (max. 41.1 years). The present report is focused on three out of a wide range of problems evaluated, namely cause of death in 14 patients expired after 10-21 years' follow-up, overwhelming post-splenectomy infections (18 events, 11 fatal), and 46 secondary malignancies. The OS rate after 24 years is 87 % (SE 3 %) in the total group, 83 % (SE 3 %) in 335 asplenic patients, and 93 % (SE 2 %) in 910 non- or partially splenectomised patients. We have initiated activities to improve the prophylactic measures against overwhelming infections in this risk group of asplenic patients. The cumulative incidences of secondary malignancies (SM) after 22 years is 11 % (SE 2 %) for all SM, 10 % (SE 2 %) for solid tumours, 0.8 % (SE 0.5 %) for NHL, and 0.6 % (SE 0.3 %) for leukaemias. The cumulative incidence of breast cancer in female patients at the age of 35 years is 4.0 % (SE 2 %). The effect of reducing the radiotherapy doses in the studies HD-87/HD-90 will become evident within the next years.

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“…In Hodgkin's disease the frequent sites of subdiaphragmatic involvement are the paraaortic region including the splenic pedicle (124/156 patients (79%) stage Ill/IV HO 78/82: Kassner 1991) and the spleen (50/174 (with histological proof of involvement) patients (29%) all stages HO 82: Schellong et al 1986». The place for radiotherapy in these sites is increasing as a result of the abandonment of splenectomy, making the assessment of long-term radiation-related morbidity necessary.…”

Section: Introductionmentioning

confidence: 99%