Abstract
Background. Hemoblastoses treatment success in children made it possible to cure the vast majority of patients. The follow-up period exceeds tens of years, during which the problem of second tumors (ST) becomes urgent. The objective of the study was to characterize ST in patients who underwent a malignant tumor of hematopoietic and lymphoid tissues at the age of 0 to 18 years.Materials and methods. The study included 64 patients with ST development in the period from 1 to 38 years.Results. Most frequently ST developed after treatment of Hodgkin's lymphoma (45.3 %) and acute lymphoblastic leukemia (35.9 %), supported by high cumulative doses of alkylating agents and radiation therapy. Among STs, in 35.9 % of cases, thyroid cancer was diagnosed, in 10.9 % - acute leukemia, in 9.4 % - tumors of the central nervous system. The results of ST treatment are significantly worse than those of primary tumors. Thus, of 64 patients with ST, 46 (71.9 %) are alive, death from ST progression was noted in 18 (28.1 %) cases.Conclusion. Improvement of modern treatment protocols aimed at reducing the indications for radiation therapy and cumulative doses of alkylating agents, along with the development of effective follow-up programs for children cured of hematological malignancies, will probably help reduce the ST incidence.
Highlights
Hemoblastoses treatment success in children made it possible to cure the vast majority of patients
Improvement of modern treatment protocols aimed at reducing the indications for radiation therapy and cumulative doses of alkylating agents, along with the development of effective follow-up programs for children cured of hematological malignancies, will probably help reduce the second tumors (ST) incidence
В структуре вторых опухолей (ВО) у пациентов с первичным ОЛЛ пре обладал рак щитовидной желе зы (РЩЖ) (n = 10), возникший в сроки 4–13 лет, в среднем интервал между первичным диагнозом ОЛЛ и РЩЖ составил 7 ± 3,4 года
Summary
Н. Михайлова2 1ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования»; Россия, 125993 Москва, ул. Совершенствование методов терапии гемобластозов у детей привело к тому, что в большинстве случаев болезнь удается излечить. Катамнестический период наблюдения превышает десятки лет, в течение которых становится актуальной проблема развития вторых опухолей (ВО). Цель исследования – характеристика ВО у пациентов, перенесших в возрасте от 0 до 18 лет злокачественную опухоль гемопоэтической и лимфоидной тканей. Результаты лечения ВО существенно хуже, чем первичных опухолей. Совершенствование современных программ лечения гемобластозов, направленное на редукцию показаний к лучевой терапии и уменьшение суммарных курсовых доз алкилирующих агентов, наряду с разработкой эффективных катамнестических программ наблюдения за детьми, излеченными от гемобластозов, вероятно, поможет снизить частоту развития ВО. Н. Проблема развития вторых опухолей у детей с гемобластозами.
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