Garrè M L, Gandus S, Cesana B, Haupt R, De Bernardi B, Comelli A, Ferrando A, Stella G, Vitali M L, Picco P
Department of Hematology and Oncology, Istituto Giannina Gaslini (IGG), Genova, Italy.
Am J Pediatr Hematol Oncol. 1994 May;16(2):143-52.
This study aims at defining the frequency and severity of late effects in a series of 288 long-term survivors of childhood cancer treated from 1962 to 1982 at the Giannina Gaslini Children's Research Hospital of Genoa, Italy.
All cases with a diagnosis of malignancy in childhood and a minimum of 2.5 years from discontinuation of treatment were considered eligible. For all cases the study included physical, endocrinological, and psychological examination. Groups of patients selected according to treatment underwent cardiac, pulmonary, orthopedic, and ophthalmologic evaluation. The sequelae observed were scored according to a grading system in which asymptomatic subclinical defects are distinguished from those that are sufficiently symptomatic to require some type of corrective measure.
Overall, 200 of 288 cases (69.4%) presented with some kind of abnormality. Symptomatic changes were present in 92 cases (42%); in these, severe and life-threatening late toxicity was reported in 61 (21.2%) and 12 cases (4.2%), respectively. The major risk factors appeared to be irradiation, type of tumor, and whether the patient had received therapy before 1974.
In our experience, this study demonstrates that there was a true excess of morbidity caused by the disease and its treatment in long-term survivors from almost any kind of childhood cancer. It also sheds light on how to prevent, diagnose, and adequately treat these patients and proposes specific criteria for the evaluation of the severity of delayed toxicity in long-term survivors of cancer in childhood.
本研究旨在确定1962年至1982年在意大利热那亚吉安尼娜·加斯利尼儿童研究医院接受治疗的288名儿童癌症长期幸存者中远期效应的发生率和严重程度。
所有童年时期被诊断为恶性肿瘤且治疗结束后至少2.5年的病例均被视为符合条件。对所有病例进行了体格、内分泌和心理检查。根据治疗方法选择的患者组接受了心脏、肺部、骨科和眼科评估。观察到的后遗症根据分级系统进行评分，其中无症状的亚临床缺陷与有足够症状需要某种纠正措施的缺陷区分开来。
总体而言，288例病例中有200例（69.4%）出现了某种异常。92例（42%）出现了有症状的变化；其中，分别有61例（21.2%）和12例（4.2%）报告了严重且危及生命的远期毒性。主要风险因素似乎是放疗、肿瘤类型以及患者是否在1974年之前接受过治疗。
根据我们的经验，本研究表明，几乎任何类型的儿童癌症的长期幸存者中，由疾病及其治疗导致的发病率确实过高。它还阐明了如何预防、诊断和充分治疗这些患者，并提出了评估儿童癌症长期幸存者延迟毒性严重程度的具体标准。
