RESUMO
BACKGROUND: Due to the devastating late effects associated with cranial irradiation in young children with central nervous system (CNS) tumors, treatment for these patients has evolved to include the use of intensive chemotherapy to either avoid or postpone irradiation. While survival outcomes have improved, late effects data in survivors treated on such regimens are needed. OBJECTIVE: This multi-institutional study comprehensively describes late effects in survivors treated on the Head Start I/II protocols. METHODS: Survivors of CNS tumors treated on Head Start I/II protocols were enrolled. Late effects data were collected using a validated parent-report questionnaire. Social, emotional, and behavioral functioning and quality of life were assessed using parent-report on the BASC-2 and CHQ-PF50 questionnaires. RESULTS: Twenty-one survivors (medulloblastoma = 13, sPNET = 4, ATRT = 1, ependymoma = 3) were enrolled. Ten (48%) were irradiation-free. Late effects (frequency; median time of onset since diagnosis) included ≥ grade III hearing loss (67%; 3.9 years), vision (67%; 4.1 years), hypothyroidism (33%; 4 years), growth hormone (GH) deficiency (48%; 4.7 years), dental (52%; 7.1 years), and no cases of secondary leukemia. Irradiation-free (vs. irradiated) survivors reported low rates of hypothyroidism (0/10 vs. 7/11; P = 0.004) and GH deficiency (2/10 vs. 8/11; P = 0.03). The BASC-2 and CHQPF-50 mean composite scores were within average ranges relative to healthy comparison norms. Neither age at diagnosis nor irradiation was associated with these scores. CONCLUSIONS: Irradiation-free Head Start survivors have lower risk of hypothyroidism and GH deficiency. Secondary leukemias are not reported. With extended follow-up, survivors demonstrate quality of life, social, emotional, and behavioral functioning within average ranges.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias do Sistema Nervoso Central/tratamento farmacológico , Transtornos do Crescimento/induzido quimicamente , Perda Auditiva/induzido quimicamente , Hipotireoidismo/induzido quimicamente , Sobreviventes , Transtornos da Visão/induzido quimicamente , Adolescente , Adulto , Neoplasias do Sistema Nervoso Central/complicações , Criança , Pré-Escolar , Feminino , Seguimentos , Transtornos do Crescimento/diagnóstico , Transtornos do Crescimento/mortalidade , Perda Auditiva/diagnóstico , Perda Auditiva/mortalidade , Humanos , Hipotireoidismo/diagnóstico , Hipotireoidismo/mortalidade , Lactente , Masculino , Prognóstico , Inquéritos e Questionários , Taxa de Sobrevida , Transtornos da Visão/diagnóstico , Transtornos da Visão/mortalidade , Adulto JovemRESUMO
A patient with kinesigenic focal motor seizures induced by tongue-jaw movement had a grade III astrocytoma clearly co-localizing with the epileptic network in the appropriate peri-rolandic, motor-sensory, lingual-jaw cortical area. The clinical seizure phenomena were time-locked with the EEG epileptic activity. [Published with video sequences].
Assuntos
Astrocitoma/complicações , Encéfalo/patologia , Encéfalo/fisiopatologia , Neoplasias do Sistema Nervoso Central/complicações , Epilepsia Reflexa/etiologia , Movimento , Idoso , Eletroencefalografia , Epilepsia Reflexa/fisiopatologia , Lateralidade Funcional , Humanos , Arcada Osseodentária/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Língua/fisiopatologiaRESUMO
BACKGROUND: Childhood cancer survivors may have experienced a high number of invasive medical and dental procedures which are known to be risk factors for dental anxiety. AIM: The aim of this study was to examine the prevalence of dental anxiety among children who have survived cancer. DESIGN: In a cross-sectional study, we examined 51 6- to 14-year-old children who had been treated for cancer at Aalborg Hospital, and 192 children without cancer. All children answered the Dental Subscale of the Children's Fear Survey Schedule. Dental anxiety was defined as a dental anxiety score exceeding the mean dental anxiety score + 1 standard deviation for the children without cancer. RESULTS: Children with cancer did not have an increased prevalence of dental anxiety compared with children without cancer: the prevalence ratio was 0.41 [95% confidence interval (CI): 0.10-1.24]. The mean dental anxiety score was 23.1 (95% CI: 21.2-25.0) among children who had been treated for cancer, and 24.7 (95% CI: 23.4-26.0) among children without cancer (mean difference: 1.6; 95% CI: 1.1-4.3). CONCLUSION: Cancer and cancer treatment during childhood were not associated with an increased risk of dental anxiety in this population.
Assuntos
Neoplasias do Sistema Nervoso Central/psicologia , Ansiedade ao Tratamento Odontológico/epidemiologia , Leucemia/psicologia , Linfoma/psicologia , Sobreviventes/psicologia , Adolescente , Estudos de Casos e Controles , Neoplasias do Sistema Nervoso Central/complicações , Criança , Estudos Transversais , Dinamarca/epidemiologia , Ansiedade ao Tratamento Odontológico/complicações , Ansiedade ao Tratamento Odontológico/psicologia , Feminino , Humanos , Leucemia/complicações , Linfoma/complicações , Masculino , Prevalência , Valores de ReferênciaRESUMO
The depot formulation of liposomal cytarabine (DepoCyte) has proven to be useful as intrathecal (IT) treatment of neoplastic and lymphomatous meningitis. We report the results of compassionate use of DepoCyte in 6 patients diagnosed with acute leukemia (AL) and CNS involvement. Two patients had CNS involvement at diagnosis and the remaining 4 had CNS relapse. Three patients received DepoCyte as adjuvant therapy and achieved complete response whereas 2 out of the remaining 3 cases treated with DepoCyte as the only drug showed sustained response. The side effects were mild and manageable in all patients. These findings justify the development of clinical trials to evaluate the efficacy and safety of IT depot cytarabine in meningeal involvement of AL.