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2.
J Natl Cancer Inst ; 57(3): 675-82, 1976 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-185402

RESUMO

Case reports of neuroblastoma revealed that some individuals are genetically predisposed and that this genetic predisposition may have other consequences. According to a mutation model, two classes of individuals could acquire neuroblastoma. One (prezygotic) was a rare class that carried a dominant gene imparting high risk of the tumor. The other (postzygotic) comprised all other individuals, each at low risk. The model related tumor incidence to germinal and somatic mutation rates and thereby carried implications for environmental modification of tumorigenesis and demographic variation in incidence. Case reports also revealed associations of neuroblastoma with congenital defects and a susceptibility to second tumors. Analogy with retinoblastoma and Wilms' tumor of the kidney suggested that these associations could result from action of a neuroblastoma gene or from chromosomal aberration. One known dominantly inherited condition, von Recklinghausen's disease, could dispose to neuroblastoma and create some associations. According to the two-mutation model, neuroblastoma may have been a single recessive gene disorder at the level of the cell. The phenomena of aganglionosis, neuroblastoma in situ, maturation of neuroblastoma to ganglioneuroma, and spontaneous regression suggested that such a neuroblastoma gene interfered with normal developmental processes. The specificities of this gene and of those for von Recklinghausen's disease and pheochromocytoma suggested that the functiof a membrane macromolecule.


Assuntos
Genes , Modelos Biológicos , Neuroblastoma/genética , Carcinoma in Situ/genética , Criança , Pré-Escolar , Anormalidades Congênitas/complicações , Demografia , Feminino , Gânglios Autônomos/anormalidades , Ganglioneuroma/genética , Humanos , Lactente , Iris/anormalidades , Masculino , Mutação , Neoplasias Primárias Múltiplas/genética , Neuroblastoma/complicações , Neurofibromatose 1/complicações , Feocromocitoma/genética , Tumor de Wilms/complicações
3.
J Natl Cancer Inst ; 76(1): 31-6, 1986 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-3079844

RESUMO

Usefulness of an etiologic questionnaire was examined in an interview study of 503 children with cancer. The medical records of the children were abstracted, and their parents responded to a questionnaire-interview to identify genetic and environmental causes of cancer. Among 1,123 siblings of the index patients, 10 developed cancer as compared with 2 expected on the basis of cancer rates for the general population. Cancer risk factors were identified in individual patients with predisposing genetic and congenital disorders: neurofibromatosis (brain tumor), hereditary immunodeficiency (lymphoma), Down's syndrome (leukemia), XY gonadal dysgenesis (germ cell tumor), giant nevus (melanoma), and meningocele (sacral teratocarcinoma). Environmental causes of childhood cancer were difficult to discern because prior exposures were numerous, diverse, and usually ill defined. The questionnaire yielded more data than the medical record on gestational and family history and helped identify patients with exceptionally high cancer risk for additional investigation. Although the findings provide anecdotal confirmation of several associations, few original etiologic hypotheses were generated for formal testing with conventional epidemiologic techniques.


Assuntos
Neoplasias/etiologia , Adolescente , Criança , Pré-Escolar , Anormalidades Congênitas/complicações , Análise Custo-Benefício , Dietilestilbestrol/toxicidade , Feminino , Humanos , Masculino , Neoplasias/genética , Gravidez , Complicações na Gravidez , Fumar , Inquéritos e Questionários
4.
J Natl Cancer Inst ; 78(5): 797-804, 1987 May.
Artigo em Inglês | MEDLINE | ID: mdl-3471992

RESUMO

A matched case-control study of prenatal risk factors for neuroblastoma was conducted, including 104 cases diagnosed over the period 1970-79 in the Greater Delaware Valley. Significantly elevated odds ratios (ORs) were associated with maternal use of a neurally active drug during pregnancy (OR = 2.83), sex hormone exposure 3 months prior to or during pregnancy (OR = 2.25), frequent alcohol consumption during pregnancy (OR = 9.0), and maternal use of diuretic drugs during pregnancy (OR = 5.75). Significantly more case mothers than control mothers reported use of hair coloring products during pregnancy (OR = 3.0). No association was found between cigarette smoking, coffee consumption, or medical irradiation and case-control status.


Assuntos
Feto/efeitos dos fármacos , Neuroblastoma/etiologia , Consumo de Bebidas Alcoólicas , Antieméticos/efeitos adversos , Café/efeitos adversos , Diuréticos/efeitos adversos , Feminino , Feto/efeitos da radiação , Hormônios Esteroides Gonadais/efeitos adversos , Tinturas para Cabelo/efeitos adversos , Humanos , Lactente , Neuroblastoma/genética , Fenobarbital/efeitos adversos , Gravidez , Risco , Fumar
5.
J Natl Cancer Inst ; 70(1): 49-55, 1983 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-6571921

RESUMO

Incidence rates of cancer among children aged 0-14 for the period 1970-79 have been generated with the use of data from the Greater Delaware Valley (GDV) Pediatric Tumor Registry. This population-based registry covers a 31-county area and has a pediatric base population of 2 million. During the period, approximately 2,300 cases of childhood cancer were diagnosed in the region. Incidence rates for all histologic types combined are similar to rates from other large surveys conducted in the United States and Western Europe. However, certain histology-specific rates in the GDV vary by race. In the GDV nonwhites relative to whites have higher rates of Wilms' tumor, soft tissue sarcomas other than rhabdomyosarcoma, and retinoblastoma. These contrasts are supported by surveys in African populations showing relatively higher rates of these tumors among African black children. GDV whites exceed nonwhites in incidence of acute leukemia, neuroblastoma, and Ewing's sarcoma. African black children also experience low rates of these tumors. The frequency of central nervous system tumors is similar for GDV whites and nonwhites, despite reports of a rarity of these neoplasms in African blacks. Variations in incidence rates reveal population subgroups with particular tumor susceptibilities and may provide clues as to the relative influence of heredity and environment on patterns observed.


Assuntos
Neoplasias/etiologia , Sistema de Registros , Adolescente , População Negra , Criança , Pré-Escolar , Delaware , Feminino , Humanos , Lactente , Masculino , Pennsylvania , Fatores Sexuais , População Branca
6.
J Natl Cancer Inst ; 78(3): 459-64, 1987 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-3469460

RESUMO

The risk of leukemia was evaluated in 9,170 2-or-more-year survivors of childhood cancer in the 13 institutions of the Late Effects Study Group. Secondary leukemia occurred in 22 nonreferred individuals compared to 1.52 expected, based on general population rates [relative risk (RR) = 14; 95% confidence interval (CI), 9-22]. The influence of therapy for the first cancer on subsequent leukemia risk was determined by a case-control study conducted on 25 cases and 90 matched controls. Treatment with alkylating agents was associated with a significantly elevated risk of leukemia (RR = 4.8; 95% CI, 1.2-18.9). A strong dose-response relationship was also observed between leukemia risk and total dose of alkylating agents, estimated by an alkylator score. The RR of leukemia reached 23 in the highest dose category. Radiation therapy, however, did not increase risk. Although doxorubicin was also identified as a possible risk factor, the excess risk of leukemia following treatment for childhood cancer appears almost entirely due to alkylating agents.


Assuntos
Alquilantes/efeitos adversos , Leucemia/induzido quimicamente , Neoplasias/tratamento farmacológico , Alquilantes/uso terapêutico , Criança , Pré-Escolar , Relação Dose-Resposta a Droga , Doxorrubicina/efeitos adversos , Doxorrubicina/uso terapêutico , Feminino , Seguimentos , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/radioterapia , Humanos , Lactente , Leucemia Induzida por Radiação , Masculino , Neoplasias/radioterapia , Risco
7.
J Natl Cancer Inst ; 93(8): 618-29, 2001 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-11309438

RESUMO

BACKGROUND: Because survival rates among childhood cancer patients are increasing, assessing the risk of second and subsequent malignant neoplasms (SMNs) is ever more important. Using the Childhood Cancer Survivor Study cohort, we identified the risk of SMNS: METHODS: A retrospective cohort of 13 581 children diagnosed with common cancers before age 21 years and surviving at least 5 years was constructed with the use of data from patients treated at 25 U.S. and Canadian institutions. SMNs were ascertained through self-administered questionnaires and verified by pathology reports. Information on therapeutic exposures was abstracted from medical records. The risk of SMN was evaluated by standardized incidence ratios (SIRs) and excess absolute risk. Poisson multiple regression models were used to assess the impact of host and therapy factors on the risk of developing SMNS: All statistical tests were two-sided. RESULTS: In 298 individuals, 314 SMNs were identified (SIR = 6.38; 95% confidence interval [CI] = 5.69 to 7.13). The largest observed excess SMNs were bone and breast cancers (SIR = 19.14 [95% CI = 12.72 to 27.67] and SIR = 16.18 [95% CI = 12.35 to 20.83], respectively). A statistically significant excess of SMNs followed all childhood cancers. In multivariate regression models adjusted for therapeutic radiation exposure, SMNs of any type were independently associated with female sex (P<.001), childhood cancer at a younger age (P for trend <.001), childhood Hodgkin's disease or soft-tissue sarcoma (P<.001 and P =.01, respectively), and exposure to alkylating agents (P for trend =.02). Twenty years after the childhood cancer diagnosis, the cumulative estimated SMN incidence was 3.2%. However, only 1.88 excess malignancies occurred per 1000 years of patient follow-up. CONCLUSIONS: Success in treating children with cancer should not be overshadowed by the incidence of SMNS: However, patients and health-care providers must be aware of risk factors for SMNs so that surveillance is focused and early prevention strategies are implemented.


Assuntos
Segunda Neoplasia Primária/epidemiologia , Adolescente , Adulto , Criança , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco
8.
J Natl Cancer Inst ; 81(5): 370-4, 1989 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-2915374

RESUMO

We studied peripheral blood lymphocyte karyotypes of 203 patients with retinoblastoma. Twelve (5.9%) had a constitutional chromosomal abnormality involving 13q, of whom six had unilateral and six had bilateral disease. Two patients had mosaic deletions, eight had nonmosaic deletions, one had a de novo translocation, and one had a 13q14 deletion and a de novo direct insertion (10;6). Of the total, 4.9% of unilateral and 7.5% of bilateral patients had 13q abnormalities. None of 19 familial retinoblastoma patients had a visible cytogenetic abnormality. The unilateral patients with 13q abnormalities represent prezygotically determined (potentially heritable) cases which would have been classified as postzygotic (sporadic) without cytogenetic analysis. The observed 1% frequency of mosaic deletions is lower than that previously reported.


Assuntos
Aberrações Cromossômicas/epidemiologia , Cromossomos Humanos Par 13 , Neoplasias Oculares/genética , Retinoblastoma/genética , Criança , Pré-Escolar , Deleção Cromossômica , Transtornos Cromossômicos , Feminino , Humanos , Cariotipagem , Masculino , Mosaicismo , Fatores Sexuais
9.
Cancer Res ; 49(3): 725-9, 1989 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-2535965

RESUMO

Parental occupational exposures for Wilms' tumor were investigated in a pair-matched case-control study. The timing of the exposures in relation to the child's conception and birth was studied, as were the two forms of Wilms' tumor: genetic (prezygotic origin) and nongenetic (postzygotic origin). Cases who were under 15 yr of age at diagnosis during 1970 to 1983 were identified through the registries of three main hospitals treating childhood cancer in the Greater Philadelphia area. Controls were selected by random digit dialing and were matched to cases on race, birth date, and telephone area code and exchange. Because of a low participation rate among blacks, results are reported only for the 88 white matched pairs whose parents participated in telephone interviews. Children whose fathers held jobs in a job cluster that consisted mostly of machinists and welders were at significantly increased risk. The increase was highest for preconception exposure (odds ratio = 5.3, P = 0.006). The effect of preconception exposure was higher for the 26 genetic cases than for the 42 nongenetic cases. The other 20 cases were excluded from the subgroup analyses for various reasons. Further analyses did not elucidate an exposure common to machinists and welders that might explain the findings.


Assuntos
Neoplasias Renais/etiologia , Ocupações , Pais , Tumor de Wilms/etiologia , Adulto , Criança , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Fatores de Risco
10.
Cancer Res ; 52(4): 782-6, 1992 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-1737337

RESUMO

Parental occupations were investigated as possible risk factors for astrocytoma, the most frequently occurring brain tumor in children. A case-control study of 163 pairs was performed. Cases under 15 years of age at diagnosis in 1980-1986 were identified through the tumor registries of eight hospitals in Pennsylvania, New Jersey, and Delaware. Controls were selected by random-digit dialing and were matched to cases on age, race, and telephone area code. Occupations before the child's conception, during the pregnancy, and after the child's birth were studied separately. We did not observe any strong associations. Significantly more fathers of cases were electrical or electronic repairmen, a subgroup of an occupational category previously associated with increased risk. An excess of case mothers employed as nurses was observed, which was significant for mothers of children diagnosed before 5 years of age. Elevated although not significant odds ratios were observed for some white collar and professional occupations in case parents; for paternal exposure to paint and paternal occupation in the paper and pulp mill industry, both in the period after the child's birth; and for maternal occupation as a hairdresser. The lack of strong associations may have resulted from low statistical power for some job groupings. Our study, unlike previous studies, focused on a single type of brain tumor: childhood astrocytoma. Thus our results suggest that some parental occupations associated with childhood brain tumors in previous studies may not be risk factors for childhood astrocytoma.


Assuntos
Astrocitoma/epidemiologia , Ocupações , Pais , Adolescente , Estudos de Casos e Controles , Criança , Delaware/epidemiologia , Demografia , Feminino , Humanos , Entrevistas como Assunto , Masculino , New Jersey/epidemiologia , Pennsylvania/epidemiologia , Gravidez , Sistema de Registros , Fatores de Risco , Fatores Socioeconômicos
11.
Cancer Res ; 38(10): 3241-6, 1978 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-210931

RESUMO

Approximately 30 banded karyotypes per subject from the lymphocytes of 66 childhood cancer patients and 14 noncancer control subjects have been analyzed in an attempt to gauge the late effects of anticancer chemotherapy and chemotherapy plus radiotherapy on the genetic material, i.e., the chromosomes. The frequencies (f) of aberrant cells were: f = 1/306 among cells from noncancer controls; f = 1/377 from cancer patients prior to therapy, f = 1/15 from patients currently on chemotherapy; and f = 1/32 from posttherapy patients (range, 3 months to 22 years poattherapy). The frequency of chromosomally aberrant cells did not appear to change with time among posttherapy patients, and the majority of aberrations detected in subjects from this group were balanced rearrangements. This was not the case for the on-therapy group where unbalanced rearrangements and unstable aberrations predominated.


Assuntos
Antineoplásicos/efeitos adversos , Aberrações Cromossômicas , Neoplasias/terapia , Lesões por Radiação/etiologia , Criança , Feminino , Humanos , Neoplasias Renais/terapia , Leucemia Linfoide/terapia , Linfócitos/ultraestrutura , Masculino , Mutação , Neoplasias/genética , Neoplasias Primárias Múltiplas/etiologia , Fatores de Tempo , Tumor de Wilms/terapia
12.
Cancer Res ; 50(9): 2608-12, 1990 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-2328486

RESUMO

Gestational and familial risk factors were investigated for their association with astrocytoma, the most frequently occurring brain tumor in children. A case-control study of 163 matched pairs was performed. Cases under 15 years of age at diagnosis in 1980-1986 were identified through the tumor registries of 8 hospitals in Pennsylvania, New Jersey, and Delaware. Controls were selected by random digit dialing and were matched to cases for age, race, and telephone area code and exchange. Maternal antinausea medications increased the risk of childhood astrocytoma [OR (odds ratio) = 2.0, P = 0.04]. Cured meat consumption during pregnancy was more common among cases (OR = 1.9, P = 0.07), and a significant trend with increasing frequency of consumption was observed (P = 0.04). Results for gestational exposure to marijuana (OR = 2.8, P = 0.07) were of borderline significance. Gestational exposure to neurally active medications, alcohol, and tobacco were not risk factors. There was a significant trend for cases to be of higher birth weight (P = 0.03). Mental retardation (OR = 3.0, P = 0.04) and cancer (OR = 1.7, P = 0.02) in a relative of the child significantly increased the risk of astrocytoma. Significantly increased risks were observed for brain tumors in relatives of children 0-4 years of age at diagnosis (OR = 6/0, P = 0.04). A significant protective effect was observed for maternal history of miscarriage or stillbirth (OR = 0.5, P = 0.01). The results of this study suggest that some gestational and familial factors may increase the risk of childhood astrocytoma.


Assuntos
Astrocitoma/etiologia , Neoplasias Encefálicas/etiologia , Adolescente , Antieméticos/efeitos adversos , Astrocitoma/genética , Peso ao Nascer , Neoplasias Encefálicas/genética , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Abuso de Maconha/complicações , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Fatores de Risco
13.
Cancer Res ; 47(11): 2972-7, 1987 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-3032418

RESUMO

Gestational risk factors for Wilms' tumor were investigated in a pair-matched case-control study. Cases who were under 15 years of age at diagnosis during 1970-1983 were identified through the registries of the three main hospitals treating childhood cancer in the greater Philadelphia area. Controls were selected by random digit dialing and were matched to cases on race, birth date, and telephone area code and exchange. Because of a low participation rate among nonwhites, results are reported only for the 88 white matched pairs whose parents were interviewed by telephone. Of the hypothesized risk factors, maternal use of hair-coloring products in the year prior to the index child's birth (odds ratio, 3.6; P = 0.003) and hypertension or fluid retention during pregnancy (odds ratio, 5.0, P = 0.01) were significantly associated with increased risk of Wilms' tumor. Use of hair-coloring products was strongly associated with cases in which Wilms' tumor was diagnosed before 2 years of age (odds ratio, 15; P = 0.001). For two other gestational factors, tea drinking and vaginal infection, the odds ratios were significantly elevated for all cases and the effects were concentrated among the nongenetic cases. Bilateral cases had a significantly higher mean birth weight than did their controls. Older maternal age was significantly associated with the genetic form of Wilms' tumor. Adjustment for possible confounders and consideration of the time interval between the index pregnancy and the interview did not substantially alter the findings.


Assuntos
Neoplasias Renais/etiologia , Tumor de Wilms/etiologia , Feminino , Humanos , Neoplasias Renais/embriologia , Neoplasias Renais/genética , Masculino , Risco , Tumor de Wilms/embriologia , Tumor de Wilms/genética
14.
Cancer Res ; 50(22): 7129-33, 1990 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-2224847

RESUMO

A matched case-control study was conducted by the Children's Cancer Study Group to investigate the role of parental occupation in the etiology of sporadic heritable and nonheritable retinoblastoma. Eligible cases were those patients with retinoblastoma diagnosed in 1982-1985 at any of the Children's Cancer Study Group member hospitals. Telephone interviews of 201 parents of cases and their pair-matched controls selected by random digit dialing were completed. Of the 201 cases, 19 were familial, 67 were sporadic heritable, and 115 were nonheritable. The 19 familial cases were excluded from the analysis. Paternal employment in the military [odds ratio (OR) 2.8, 95% confidence interval (CI) 1.1-8.8, P = 0.04] and in the metal industry (OR infinity, 95% CI 1.4-infinity, P = 0.02) was associated with sporadic heritable retinoblastoma (N = 67). For nonheritable retinoblastoma (N = 115), a significant association was observed for a job cluster consisting mostly of welders and machinists (OR 4.0, 95% CI 1.1-22.1, P = 0.04). Occupations of maternal grandparents were also studied and an association was observed with farming and nonheritable retinoblastoma (OR 10.0, 95% CI 1.4-433, P = 0.02). Many comparisons were made and the number of significant findings did not exceed that expected by chance. Thus, the results need to be interpreted very cautiously. However, the findings related to metal exposure corroborate observations on other childhood cancers.


Assuntos
Retinoblastoma/genética , Estudos de Casos e Controles , Exposição Ambiental , Humanos , Metais , Ocupações , Pais
15.
Cancer Res ; 49(20): 5730-5, 1989 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-2790788

RESUMO

A matched case-control study of retinoblastoma was conducted by the Children's Cancer Study Group (CCSG) to investigate the hypotheses that postconception exposures affect the risk of the nonheritable (post-zygotic origin) form of this disease and that preconception exposures affect the risk of the sporadic heritable (prezygotic origin) form. Eligible cases were those patients with retinoblastoma diagnosed in 1982-1985 at any of the CCSG member hospitals. Cases were classified as familial heritable, sporadic heritable, or nonheritable based on family history, tumor laterality, and cytogenetic analysis. Telephone interviews of parents of 201 cases and their pair-matched controls selected by random digit dialing were completed. Analysis of possible risk factors for the 67 sporadic heritable cases and the 115 nonheritable cases was performed. (The 19 familial cases were excluded). For the nonheritable group, gestational exposure to X-ray [odds ratio (OR) = 2.3, P = 0.08] and morning sickness medication (OR = 2.8, P = 0.02) and low maternal educational level (OR = 5.5, P = 0.03) were associated with increased risk; anemia (OR = 0.3, P = 0.02) and multivitamin use (OR = 0.4, P = 0.03) during pregnancy and periconceptional use of barrier contraceptive (OR = 0.1, P = 0.02) or spermicide (OR = 0.2, P = 0.02) were associated with decreased risk. In the sporadic heritable group, observations included a negative association with multivitamins during pregnancy (OR = 0.2, P = 0.02) and nonsignificant positive associations with preconception gonadal X-ray (maternal, OR = 2.0, P = 0.30; paternal, OR = 1.8, P = 0.42) and older parental age (case-control difference 1.0-1.2 years, P = 0.24-0.27). Many of the associations support study hypotheses, although the possibility of recall bias and chance findings suggest cautious interpretation.


Assuntos
Retinoblastoma/genética , Estudos de Casos e Controles , Anticoncepcionais/efeitos adversos , Dispositivos Anticoncepcionais/efeitos adversos , Feminino , Humanos , Modelos Logísticos , Idade Materna , Análise Multivariada , Paridade , Gravidez , Complicações na Gravidez , Fatores de Risco , Fatores Socioeconômicos , Raios X/efeitos adversos
16.
J Clin Oncol ; 8(2): 304-12, 1990 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-2299373

RESUMO

A model is presented to predict adult stature in children treated successfully for cancer outside the CNS. The model is based on radiation dose in Gray adjusted for location of therapy and attained stature (GALA); ideal adult stature (IAS), assuming the patient had not developed cancer, calculated by the Roche-Wainer-Thissen (RWT) method (which uses patient stature and weight before developing cancer, and parent stature data); a femur correction if both the acetabula or heads of both femurs were irradiated (FEMUR); and sex. The model was constructed using data from 49 patients with a mean time from completion of therapy to follow-up of 8.9 years (range, 3.3 to 15.4 years). Thirteen patients received no radiotherapy. All model coefficients were highly significant (P less than .001), and the model appears to be an excellent predictor of adult stature, with a multiple correlation coefficient of 0.84 (R2 = .74) between corrected adult stature (CAS) based on the most recent follow-up stature available for the patient projected to final adult stature, compared with the model's predicted adult stature (MPAS), based only on initial data at presentation and subsequent radiation treatment. Patients who did not receive radiotherapy did not have loss of stature, ie, there was no significant difference between IAS and CAS, (P less than .71; n = 13), but patients who received radiotherapy had shorter statures than would be expected from the healthy population model (P less than .0004; n = 36). The magnitude of the loss in stature appears to be well explained by the dose and location of radiation, the stature already achieved at the time of radiotherapy, along with IAS, FEMUR, and sex. We believe this model will help clinicians to predict the growth effects of radiotherapy in children with cancer not involving the CNS.


Assuntos
Estatura/efeitos da radiação , Neoplasias/radioterapia , Acetábulo/efeitos da radiação , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Cabeça do Fêmur/efeitos da radiação , Seguimentos , Humanos , Masculino , Modelos Biológicos , Análise Multivariada , Probabilidade , Análise de Regressão , Coluna Vertebral/efeitos da radiação
17.
J Clin Oncol ; 2(8): 917-23, 1984 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-6086850

RESUMO

This study examines differences between cancer centers (CC) and noncancer centers (NCC) in terms of management procedures and outcomes for three pediatric solid tumors: Wilms' tumor (N = 147), rhabdomyosarcoma (N = 87), and medulloblastoma (N = 76). Data were derived for the period 1970-1979 from the population-based Greater Delaware Valley Pediatric Tumor Registry maintained at the Children's Cancer Research Center, which routinely collects data on all childhood neoplasms that occur in a 31-county region. Management measures reviewed included the degree to which important pretreatment evaluations were performed, types of therapy used, and extent of follow-up examinations conducted. Outcome variables were three-year disease-free survival and frequency of deaths related to complications of therapy. Differences in three-year disease-free survival between CC and NCC were noted for medulloblastoma (52% v 24%) and rhabdomyosarcoma (48% v 10%), but not for Wilms' tumor (79% v 68%). Among medulloblastoma patients, differences were detected in the frequency of pretreatment evaluations and in the therapy used. The principal management contrast found in rhabdomyosarcoma was that multiagent chemotherapy was used less often in NCC. Wilms' tumor patients were evaluated and treated similarly in the community versus the CC, except for some contrasts in the surgical approach and the frequency of follow-up for the detection of late complications.


Assuntos
Neoplasias Cerebelares/terapia , Neoplasias Renais/terapia , Meduloblastoma/terapia , Rabdomiossarcoma/terapia , Tumor de Wilms/terapia , Adolescente , Institutos de Câncer , Neoplasias Cerebelares/diagnóstico , Neoplasias Cerebelares/mortalidade , Criança , Pré-Escolar , Hospitais Comunitários , Hospitais Universitários , Humanos , Lactente , Neoplasias Renais/diagnóstico , Neoplasias Renais/mortalidade , Meduloblastoma/diagnóstico , Meduloblastoma/mortalidade , Prognóstico , Rabdomiossarcoma/diagnóstico , Rabdomiossarcoma/mortalidade , Fatores de Tempo , Tumor de Wilms/diagnóstico , Tumor de Wilms/mortalidade
18.
J Clin Oncol ; 18(10): 2017-25, 2000 May.
Artigo em Inglês | MEDLINE | ID: mdl-10811665

RESUMO

PURPOSE: To examine the impact of initial CNS involvement on outcome and patterns of failure in patients with disseminated small noncleaved-cell lymphoma and B-cell leukemia who were treated in four successive Children's Cancer Group trials. PATIENTS AND METHODS: Of 462 patients with disseminated disease, 49 (10.6%) had CNS disease at diagnosis (CNS+). CNS disease included meningeal disease or CNS parenchymal masses with or without cranial neuropathies (CSF+/Mass; CNPs) in 36 patients and isolated CNPs in 13. Of the CNS+ patients, 28 had M2 (5% to 25% blasts) or M3 (> 25% blasts) bone marrow involvement. All patients received protocol-based systemic and intrathecal chemotherapy. Thirty-six patients also received CNS irradiation. RESULTS: Relapses occurred in 21 (43%) of 49 patients, predominantly in the CNS (71%) and bone marrow (52%). The 3-year event-free survival +/- SE for all patients with CNS+ disease was 45% +/- 7%. Patients with CSF+/Mass had a nominally higher treatment failure rate compared with patients with CNS- after adjusting for marrow status and lactate dehydrogenase (LDH) diagnosis, with a relative failure rate (RFR) of 1.52 (95% confidence interval [CI], 0.88 to 2.6; P =.15). In comparison, the RFRs for patients with M2 or M3 marrow and for those with LDH levels greater than 500 IU/L after adjusting for CNS disease were 1.4 (95% CI, 0.96 to 2.0; P =.029) and 2.2 (95% CI, 1.5 to 3.0; P <.001), respectively. The RFR for patients with isolated CNPs was 0.87 (95% CI, 0.36 to 2.1; P =.76). CONCLUSION: We conclude that, with the treatments used during the period covered by these studies, the presence of CSF+/Mass CNS disease at diagnosis was associated with a nominally worse outcome independent of initial bone marrow status and LDH level, but the effect was not statistically significant.


Assuntos
Neoplasias do Sistema Nervoso Central/patologia , Leucemia de Células B/patologia , Linfoma não Hodgkin/patologia , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Sistema Nervoso Central/mortalidade , Neoplasias do Sistema Nervoso Central/terapia , Criança , Pré-Escolar , Terapia Combinada , Ciclofosfamida/uso terapêutico , Intervalo Livre de Doença , Doxorrubicina/uso terapêutico , Feminino , Humanos , Lactente , Leucemia de Células B/tratamento farmacológico , Leucemia de Células B/mortalidade , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/mortalidade , Masculino , Metotrexato/uso terapêutico , Prednisona/uso terapêutico , Modelos de Riscos Proporcionais , Análise de Sobrevida , Resultado do Tratamento , Vincristina/uso terapêutico
19.
J Clin Oncol ; 15(2): 547-56, 1997 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-9053476

RESUMO

PURPOSE: To determine psychologic outcome, with the focus on emotional or mood state, of young adult survivors of childhood acute lymphoblastic leukemia (ALL) compared with sibling controls and to identify vulnerable subgroups at highest risk for negative mood. PATIENTS AND METHODS: Adult survivors (n = 580), aged > or = 18 years, who were treated before age 20 years on Children's Cancer Group (CCG) protocols for ALL and 396 sibling controls were administered a structured telephone interview and the Profile of Moods State (POMS), a standardized measure of affective state. RESULTS: Survivors had higher total mood scores (which indicates greater negative mood) than sibling controls (P<.01) and reported more tension (P< .01), depression (P<.01), anger (P<.01), and confusion (P<.01), but not more fatigue or less vigor. Female, minority, and unemployed survivors reported the highest total mood disturbance. Overall, survivors were more likely to be unemployed (P<.05) or working less than half-time (P<.01) compared with controls. CONCLUSION: This large, sibling-controlled, multisite study of young adult survivors of childhood ALL treated on CCG protocols after 1970 found significant increased negative mood in survivors, not accounted for by reported energy level differences, which suggests that these emotional effects are not likely the result of current illness. Survivors are less likely to be fully employed. Female, minority, and unemployed survivors are at greatest risk for emotional sequelae, a finding that indicates the need for targeted, preventive intervention.


Assuntos
Afeto , Leucemia-Linfoma Linfoblástico de Células Precursoras/psicologia , Adulto , Ira , Ansiedade , Estudos de Casos e Controles , Confusão , Depressão , Emprego , Fadiga , Feminino , Humanos , Masculino , Estado Civil , National Institutes of Health (U.S.) , Núcleo Familiar/psicologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/etnologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Religião , Inquéritos e Questionários , Resultado do Tratamento , Estados Unidos
20.
J Clin Oncol ; 3(4): 532-8, 1985 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-2984346

RESUMO

This paper presents an update from the Late Effects Study Group on 292 cases of second malignant neoplasms (SMN) occurring in individuals who were diagnosed with their first neoplasm in childhood. Data are presented regarding the types of first and second neoplasm, the therapy administered, and the predisposing factors. Of the 292 cases (308 SMN), the most common primary was retinoblastoma followed by Hodgkin's disease, soft-tissue sarcomas, and Wilms' tumor. This is not similar to the relative frequency of these cancers in children but rather reflects specific risk factors. Bone sarcomas were the most common SMN among the 208 SMN developing in previously irradiated sites while acute leukemia was the most common SMN unassociated with radiation. Known predisposing conditions to cancer were present in 73 cases; retinoblastoma was the most common of these, followed by neurofibromatosis. There were ten patients with three and three patients with four malignant neoplasms. In 14 patients, the cause of SMN was not suggested by known risk factors as these patients had negative family histories and received no radiation or chemotherapy. We note, therefore, that although most cases of SMN in survivors of childhood cancer can be attributed to radiation, genetic disease, chemotherapy, or combinations of these, unrecognized predisposition or chance may also play a role.


Assuntos
Neoplasias Primárias Múltiplas/etiologia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Pré-Escolar , Terapia Combinada , Neoplasias Oculares/radioterapia , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/radioterapia , Humanos , Lactente , Neoplasias Renais , Neoplasias Primárias Múltiplas/genética , Neoplasias Induzidas por Radiação , Retinoblastoma/radioterapia , Tumor de Wilms
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