WASHINGTON, DC USA (UroToday.com) - Dr. Michael Ritchey focused on the long-term risks of secondary neoplasms, secondary gu malignancies, impact on fertility, renal failure and bladder dysfunction in children with a history of treated urologic malignancies.
With respect to secondary neoplasms radiation therapy and alkylating agents are risk factors. The risk of developing a secondary malignancy increases over time and these children will require monitoring over the long term. The risk of secondary malignancy may vary with site that underwent radiation such as increased risk of breast cancer with prior thorax radiation.
Renal cell carcinoma is a GU secondary malignancy seen in survivors treated for neuroblastoma and Wilms’ Tumor. Fertility may be impacted by surgical damage, neurologic impairment, cranial irradiation, gonadal irradiation and chemotherapy. In females with a prior history of abd/pelvic XRT, a higher rate of miscarriage, increase risk of prematurity and low birth weights have been noted. Fertility preservation can be achieved in the pubertal male with semen preservation and in the female and prepubertal male by tissue bx and preservation.
Bladder dysfunction may result from surgery, neurological impairment, chemotherapy (cytoxan) and radiation. Renal failure in Wilms' patients is most commonly related to bilateral nephrectomy for bilateral disease, however in pts with unilateral disease there is an increase risk of renal failure in patients with Deny-Drash syndrome (presence of abnormal WT-1 gene) as well as those children with aniridia and other GU anomalies. The presence of WT-1 gene anomalies is associated with increased risk of renal failure. Areas where renal sparing surgery may be beneficial in children with Wilms Tumor include bilateral Wilms’ tumor, increased risk of bilateral disease (syndromic patients, those with nephrogenic rests and/or multicentric disease) and those at increase risk for renal failure. Dr. Ritchey concluded that there needs to be more education for physicians, patients and parents regarding these long-term risks.
Presented by Michael Ritchey, MD at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Pamela I. Ellsworth, MD, Associate Professor Surgery (Urology), Alpert Medical School of Brown University.
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