title: Pediatric Survivors of Retinoblastoma Are at Risk for Altered Bone Metabolism After Chemotherapy Treatment Early in Life.
abstract: Survivors of childhood cancer frequently suffer from endocrine late effects, which are, at least partly, attributed to toxic effects of chemotherapy. Treatment of retinoblastoma typically involves chemotherapy at a very young age. The authors conducted a cross-sectional study to assess bone health in a pediatric cohort of 33 survivors of retinoblastoma (mean age: 4.4 years) who had undergone chemotherapy treatment at an especially young age (mean age: 0.76 years). Of these patients, 14 had unilateral and 19 bilateral retinoblastoma. Polychemotherapy consisted of treatment with cyclophosphamide, etoposide, vincristine, and carboplatin. Ten patients had undergone external beam radiotherapy. Clinical and biochemical parameters of growth, pubertal development, and bone health were obtained. A vitamin D deficiency was found in 51.7% of the patients, and 13.7% of patients displayed severe vitamin D deficiency. Secondary hyperparathyroidism and altered readings for bone formation or resorption markers were present in 15%. Nine percent reported bone pain or experienced fractures of the long bones after primary diagnosis. No difference between children with bilateral and unilateral disease or irradiated versus nonirradiated children was observed. The parameters of thyroid function, growth, and pubertal development were within age-appropriate norms in almost all children. In conclusion, altered parameters of bone health can be present in survivors of retinoblastoma at a young age and warrant regular follow-up in these children. The endocrine hypothalamic-pituitary axes, however, were not impaired at this early age in this group of survivors of retinoblastoma.
authors.affiliation: a Department of Pediatric Hematology and Oncology, Kinderklinik III , Universitätsklinikum- Essen and the University of Duisburg-Essen , Essen, Germany.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Schündeln
authors.affiliation: a Department of Pediatric Hematology and Oncology, Kinderklinik III , Universitätsklinikum- Essen and the University of Duisburg-Essen , Essen, Germany.
authors.forename: Pia K
authors.initials: PK
authors.lastname: Hauffa
authors.affiliation: d Department of Ophthalmology , Universitätsklinikum-Essen and the University of Duisburg-Essen , Essen, Germany.
authors.forename: Jens J
authors.initials: JJ
authors.lastname: Bauer
authors.affiliation: a Department of Pediatric Hematology and Oncology, Kinderklinik III , Universitätsklinikum- Essen and the University of Duisburg-Essen , Essen, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Temming
authors.affiliation: b Department of Pediatric Endocrinology and Diabetology, Kinderklinik II , Universitätsklinikum-Essen and the University of Duisburg-Essen , Essen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Sauerwein
authors.affiliation: c Department of Radiation Oncology , Universitätsklinikum-Essen and the University of Duisburg-Essen , Essen, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Biewald
authors.affiliation: c Department of Radiation Oncology , Universitätsklinikum-Essen and the University of Duisburg-Essen , Essen, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Bornfeld
authors.affiliation: d Department of Ophthalmology , Universitätsklinikum-Essen and the University of Duisburg-Essen , Essen, Germany.
authors.forename: Berthold P
authors.initials: BP
authors.lastname: Hauffa
authors.affiliation: d Department of Ophthalmology , Universitätsklinikum-Essen and the University of Duisburg-Essen , Essen, Germany.
authors.forename: Corinna
authors.initials: C
authors.lastname: Grasemann
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000139:chemically induced / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008297:Male; D012175:Retinoblastoma / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D012307:Risk Factors; D017741:Survivors; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects; D014808:Vitamin D Deficiency / Q000139:chemically induced / Q000378:metabolism / Q000473:pathology
chemical_list: D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D016190:Carboplatin
keywords: bone health; chemoreduction; childhood cancer; late effects; pediatric endocrinology; pediatric oncology; polychemotherapy; retinoblastoma; survivorship; vitamin D