Abstract
Introduction With the recent improvements in the prognosis of pediatric malignancies, the number
of patients surviving long-term after surgery has been increasing. Therefore, the
late effects of cancer treatments are important issues. In this study, we analyzed
the problems associated with the treatment of pediatric patients during the long-term
follow-up after surgery.
Patients and Methods A total of 64 patients with pediatric malignancies who underwent surgical treatment
and were followed up for more than 5 years and who were older than 13 years of age
were included in this study. The average age was 20.8 (13–33) years, and the follow-up
ranged from 5 to 31 years (mean, 17.7 years). Twenty-one patients (32.3%) received
high-dose chemotherapy (HDC) and nine (14.1%) received radiotherapy.
Results In this study, 46 patients (71.9%) developed at least one problem during the follow-up
period. With regard to the surgical problems, 14 patients underwent nephrectomy, and
1 of them developed renal failure. One patient received cystectomy with urinary tract
reconstruction. One patient received a partial vaginectomy. Two cases with ovarian
tumors received oophorectomy, one of whom also received partial hysterectomy. Other
complications such as ileus, scoliosis, and leg length discrepancies were seen in
some patients. In terms of the medical problems, 15 patients showed growth retardation
and 2 were treated with growth hormone therapy. Gonadal dysfunction was observed in
23 patients, and 8 of them were treated with hormone replacement therapy. Six patients
developed hypothyroidism, two of whom were treated with thyroid hormone replacement
therapy. Other medial issues, such as hearing impairment, low bone mineral density,
and hepatitis, were seen in some patients. The rate of growth retardation, gonadal
dysfunction, and hypothyroidism were significantly higher in the patients who received
HDC (p < 0.05). There was one case of second malignancy of the parotid gland.
Conclusion Various treatment-related complications may occur even many years after treatment,
especially in patients who receive HDC. Medical problems, especially endocrine disorders,
appear to be more serious than surgery-related problems. Lifetime medical surveillance
and continuous follow-up by not only pediatric surgeons but also by various specialists,
such as pediatric oncologists, pediatric endocrinologists, urologists, and gynecologists,
are necessary.
Keywords
childhood cancer survivor - late effect - chemotherapy - surgery - radiation therapy
