Late Effects of Treatment for Sarcomas in Children
| Status: | Completed |
|---|---|
| Conditions: | Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 7 - Any |
| Updated: | 4/21/2016 |
| Start Date: | November 2000 |
| End Date: | November 2011 |
Late Effects of Treatment in Survivors of Pediatric Sarcomas
This study will examine late effects of treatment for sarcoma (bone and soft tissue cancers)
in children. Survival of patients with these diseases has improved over the years, but
long-term adverse effects of treatment have also been noted.
Patients previously treated for sarcoma in the NCI's Pediatric Oncology Branch who are in
their first remission from sarcoma after completion of therapy and who have had no further
cancer treatment (chemotherapy, radiation therapy, cancer related surgery or immunotherapy)
for at least 24 months may be eligible for this 3- to 4-day study. It will review the
incidence and extent of the following late effects of therapy.
- Heart problems-The chemotherapy drug doxorubicin can cause acute and late injuries to
the heart muscle. Patients will undergo magnetic resonance imaging (MRI) of the heart
to look for changes and compare the findings with information obtained by standard
echocardiogram (ultrasound test of the heart) and by MUGA (nuclear medicine scan of the
heart).
- Gonadal dysfunction-The chemotherapy drug cyclophosphamide may affect sex hormone
production, leading to infertility, early menopause or brittle bones. Low sex hormone
levels may also increase the risk for heart attack, obesity or fracture. Patients will
have blood tests to measure hormone levels as well as mineral levels, lipid levels and
blood cell counts. They will also have a DEXA scan to measure bone mineral density and
a CT scan of the abdomen to evaluate the distribution of fatty tissue in the abdomen.
Males will be offered a semen analysis as part of the fertility evaluation.
- Psychosocial problems- Cancer diagnosis and treatment pose a major life stress that can
lead to problems with personal relationships, jobs, insurance, education, health care,
and personal and professional goal setting. Some patients may become depressed or
develop a psychiatric illness. Patients will fill out a questionnaire about their
treatment, recovery, and aspects of their current life and will meet with a
psychologist and psychiatrist.
- Changes in bodily function and capabilities-Patients who undergo surgery and radiation
to treat sarcoma treatment may experience muscle, bone and joint changes. Patients will
be interviewed about their performance of daily activities, physical limitations, and
changes in skill levels. They will do a series of exercises and will have measurements
of strength, mobility and physical skills, focusing on the parts of the body that were
affected by the sarcoma and subsequent local therapy.
- Exposure to viruses-A number of patients received blood transfusions as part of their
cancer treatment. Some transfusions were given before HIV screening became available.
Patients will be tested for this virus as well as the hepatitis virus and HTLV-1 (human
T-cell leukemia virus-1), for which there are also small transfusion-associated risks.
- Kidney function-The chemotherapy drug ifosfamide may affect kidney function. Patients
will provide a urine specimen for kidney function tests.
- Immune function-Chemotherapy affects the function of infection-fighting immune cells
called T-lymphocytes. A blood sample will be drawn for studies of the time involved in
recovering full immune function.
in children. Survival of patients with these diseases has improved over the years, but
long-term adverse effects of treatment have also been noted.
Patients previously treated for sarcoma in the NCI's Pediatric Oncology Branch who are in
their first remission from sarcoma after completion of therapy and who have had no further
cancer treatment (chemotherapy, radiation therapy, cancer related surgery or immunotherapy)
for at least 24 months may be eligible for this 3- to 4-day study. It will review the
incidence and extent of the following late effects of therapy.
- Heart problems-The chemotherapy drug doxorubicin can cause acute and late injuries to
the heart muscle. Patients will undergo magnetic resonance imaging (MRI) of the heart
to look for changes and compare the findings with information obtained by standard
echocardiogram (ultrasound test of the heart) and by MUGA (nuclear medicine scan of the
heart).
- Gonadal dysfunction-The chemotherapy drug cyclophosphamide may affect sex hormone
production, leading to infertility, early menopause or brittle bones. Low sex hormone
levels may also increase the risk for heart attack, obesity or fracture. Patients will
have blood tests to measure hormone levels as well as mineral levels, lipid levels and
blood cell counts. They will also have a DEXA scan to measure bone mineral density and
a CT scan of the abdomen to evaluate the distribution of fatty tissue in the abdomen.
Males will be offered a semen analysis as part of the fertility evaluation.
- Psychosocial problems- Cancer diagnosis and treatment pose a major life stress that can
lead to problems with personal relationships, jobs, insurance, education, health care,
and personal and professional goal setting. Some patients may become depressed or
develop a psychiatric illness. Patients will fill out a questionnaire about their
treatment, recovery, and aspects of their current life and will meet with a
psychologist and psychiatrist.
- Changes in bodily function and capabilities-Patients who undergo surgery and radiation
to treat sarcoma treatment may experience muscle, bone and joint changes. Patients will
be interviewed about their performance of daily activities, physical limitations, and
changes in skill levels. They will do a series of exercises and will have measurements
of strength, mobility and physical skills, focusing on the parts of the body that were
affected by the sarcoma and subsequent local therapy.
- Exposure to viruses-A number of patients received blood transfusions as part of their
cancer treatment. Some transfusions were given before HIV screening became available.
Patients will be tested for this virus as well as the hepatitis virus and HTLV-1 (human
T-cell leukemia virus-1), for which there are also small transfusion-associated risks.
- Kidney function-The chemotherapy drug ifosfamide may affect kidney function. Patients
will provide a urine specimen for kidney function tests.
- Immune function-Chemotherapy affects the function of infection-fighting immune cells
called T-lymphocytes. A blood sample will be drawn for studies of the time involved in
recovering full immune function.
Childhood cancers mark a relatively infrequent disease entity with an annual age adjusted
rate in children age 0-14 years of 14 per 100,000. Over the last 30 years a striking
increase in survival due to improved diagnosis and aggressive treatment approaches has
vastly enhanced the outlook in this patient population. 75% of children under 15 years age
of can be expected to survive the diagnosis of cancer for more than 5 years. However,
reports of improved survival have been followed by increasing awareness of a multitude of
long-term treatment-related side effects, in addition to an overall death rate 9.6 times
higher than in the sex- and age-matched general population. Over the last 35 years, patients
with pediatric sarcomas have been treated in the Pediatric Oncology Branch (POB) of the
National Cancer Institute. Since 1971 adriamycin and cyclophosphamide in escalating doses
have been incorporated in all multimodality treatment protocols. Ifosfamide became an
integral part of therapy in 1986. The survival rate of patients with these diseases has
improved over this period of time. Accordingly there exists a group of long-term survivors
of therapy employed in a series of POB sarcoma protocols who represent a valuable source of
information on treatment-associated late-effects, e.g. cardiotoxicity, gonadal dysfunction,
growth delay and stress-related neuroendocrine abnormalities. In addition there may be
evaluable rehabilitative impairments and alterations in psychosocial behavior that may only
manifest over time, and prove to be characteristic for this population. This protocol will
systematically enumerate and describe the incidence and extent of treatment related
long-term toxicities in this patient population.
rate in children age 0-14 years of 14 per 100,000. Over the last 30 years a striking
increase in survival due to improved diagnosis and aggressive treatment approaches has
vastly enhanced the outlook in this patient population. 75% of children under 15 years age
of can be expected to survive the diagnosis of cancer for more than 5 years. However,
reports of improved survival have been followed by increasing awareness of a multitude of
long-term treatment-related side effects, in addition to an overall death rate 9.6 times
higher than in the sex- and age-matched general population. Over the last 35 years, patients
with pediatric sarcomas have been treated in the Pediatric Oncology Branch (POB) of the
National Cancer Institute. Since 1971 adriamycin and cyclophosphamide in escalating doses
have been incorporated in all multimodality treatment protocols. Ifosfamide became an
integral part of therapy in 1986. The survival rate of patients with these diseases has
improved over this period of time. Accordingly there exists a group of long-term survivors
of therapy employed in a series of POB sarcoma protocols who represent a valuable source of
information on treatment-associated late-effects, e.g. cardiotoxicity, gonadal dysfunction,
growth delay and stress-related neuroendocrine abnormalities. In addition there may be
evaluable rehabilitative impairments and alterations in psychosocial behavior that may only
manifest over time, and prove to be characteristic for this population. This protocol will
systematically enumerate and describe the incidence and extent of treatment related
long-term toxicities in this patient population.
- INCLUSION CRITERIA:
Diagnosis of sarcoma.
Previous enrollment on one of the POB protocols or enrollment on the Natural History
protocol and treated according to POB outlines for the treatment of sarcomas.
Chemotherapy delivered according to one of previous POB trials.
Patients must be either in first continued remission from sarcoma after completion of
therapy, or in continued remission of more than 5 years after completion of salvage
therapy for disease relapse.
Patients must have had no chemotherapy, radiation therapy, cancer related surgery and/or
immunotherapy for at least 24 months.
Patients must have had stable disease greater than 24 months or be NED by history.
Must be able to travel to NCI/POB. Alternatively, subjects may consent on a separate
consent document to the mail-in questionnaire component of the study only, which will not
require travel to the NIH.
Must be able to understand and sign consent. Minors must be accompanied by a parent or
guardian legally permitted to give consent. Written assent will be obtained from all
minors age 12 years or older.
Patients who elect to complete the mail-in questionnaire must be greater than or equal to
18 years old.
Negative pregnancy test in all female patients. Pregnant or lactating women are ineligible
for study enrollment while they are pregnant or lactating, but may be enrolled at a later
point once these conditions have ceased to exist. For eligible subjects consenting to
participation in the mail-in questionnaire component of the study only, a urine pregnancy
test will not be required.
We found this trial at
1
site
9000 Rockville Pike
Bethesda, Maryland 20892
Bethesda, Maryland 20892
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