Keywords
Protocolos antineoplásicos
Oncología por radiación
Metástasis de la neoplasia
Neoplasia residual
Invasividad neoplásica
Quimioterapia
Neutropenia febril
Oncología por radiación
Metástasis de la neoplasia
Neoplasia residual
Invasividad neoplásica
Quimioterapia
Neutropenia febril
How to Cite
Martínez Rueda, S. C., & Rueda Arenas, E. (2014). Eventos adversos y complicaciones del tratamiento antineoplásico administrados durante la infancia. Médicas UIS, 27(3), 77–88. Retrieved from https://revistas.uis.edu.co/index.php/revistamedicasuis/article/view/4887
Abstract
Childhood cancer is a life-threatening chronic disease, which represents a great impact not only for patients, but for their family. The child with cancer must face the emotional, physical, social, and psychological effects of the disease and its treatment impact. It is believed that 1 in every 640 young adults between the ages of 20 and 39 years had cancer in their infancy, this added to increased survival due to current treatments, causes complications that may arise in the treatment or their disease be a marker of long-term morbidity. Therefore children with cancer must face the acquired changes and complications of the disease and its treatment. All these factors can impair the quality of life of children with cancer diagnosis and ensure implementation of the proposed scheme antineoplastic therapy more difficult. The aim of this article is to review major complications and side effects that can occur in patients who are undergoing cancer treatments detailing complications systems, the complications of drugs and adverse events that occurred in the care of these patients. MÉD.UIS. 2014;27(3):77-88.
References
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2. Uribe C, Amado C, Ramírez A. Cáncer infantil en el área metropolitana de Bucaramanga 2003-2007. Medunab. 2011;14(2):86-93.
3. Bañeres J, Orrego C, Suñol R, Ureña V. Los sistemas de registro y notificación de efectos adversos y de incidentes: una estrategia para aprender de los errores. Rev Calidad Asistencial. 2005;20(4):216-22.
4. Instituto de Investigaciones Epidemiológicas, Academia Nacional de Medicina. Seguridad del paciente y error en medicina [en línea]. Disponible en: www.errorenmedicina.anm.edu.ar [con acceso el 1 de Julio de 2014].
5. Lois Van C, Muñoz C, Saavedra M, Riggs M, Bossert E. Symptoms in children with advanced cancer. Cancer Nurs. 2012;35(2):115-25.
6. Enska K, Bertero C. Young adult survivors of childhood cancer; experiences affecting self-image, relationships, and present life. Cancer Nurs. 2010;33(1):1-18.
7. International Agency for Research on Cancer, World Health Organization. GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012 [en línea]. Disponible en: http://globocan.iarc.fr/Pages/DataSource_and_methods.aspx [con acceso el 1 de Julio de 2014].
8. Martínez MJ, García A, Garaizar C; Asociación Española de Pediatría, Sociedad Española de Neurología Pediátrica. Tumores cerebrales infantiles: diagnóstico y semiología neurológica. Protocolos Diagnóstico Terapeúticos de la AEP: Neurología Pediátrica.2008:203-9.
9. Hui Chen M, Colan S, Diller L. Cardiovascular Disease Cause of Morbidity and Mortality in Adult Survivors of Childhood Cancers. Circ Res. 2011;108(5):619-28.
10. Pui CH, Evans WE. Treatment of Acute Lymphoblastic Leukemia. N Engl J Med. 2006;354:166-78.
11. Kudret C, Ali Varan A, Akyuz C, TezerKutluk S. Second neoplasms in pediatric patients treated for cancer: a center’s 30-year experience. J Pediatr Hematol Oncol. 2006;28(6):374-8.
12. Simon A, Ammann R, Bode U, Fleischhack G, Wenchel HM, Schwamborn D, et al. Healthcare-associated infections in pediatric cancer patients: results of a prospective surveillance study from university hospitals in Germany and Switzerland. BMC Infect Dis. 2008;8:70-9.
13. Nowak-Go U, Ahlke E, Fleischhack G, Schwabe D, Schobess R, Schumann C, et al. Thromboembolic events in children with acute lymphoblastic leukemia (BFM protocols): prednisone versus dexamethasone administration. Blood. 2003;101(7):2529-33.
14. Ross C, Visscher H, Rassekh S, Castro-Pastrana L, Shereck E, Carleton B, et al. Pharmacogenomics of serious adverse drug reactions In pediatric oncology. J Popul Ther Clin Pharmacol. 2011;18(1):134-51.
15. Ness K, Armenian S, Kadan-Lottick N, Gurney JG. Adverse effects of treatment in childhood acute lymphoblastic leukemia: general overview and implications for long-term cardiac health. Expert Rev Hematol. 2011;4(2):185–7.
16. Massimino M, Gandola L, Seregni E, Bongarzone I, Morosi C, Collini P. Thyroid iatrogenic sequelae after treatment of pediatric cancer. Q J Nucl Med Mol Imaging. 2009;53(5):526-35.
17. Salcedo C, Chaskel R. Impacto psicosocial del cáncer en niños y adolescentes. Precop SCP. 20098(3):5-18.
18. vanWaas M, Neggers S, van der Lelij AJ, Pieters R, van den Heuvel-Eibrink M. The metabolic syndrome in adult survivors of childhood cancer, a review. J Pediatr Hematol Oncol. 2010;32(3):171–9.
19. Aleman B, Van den Belt-Dusebout A, De Bruin M, Van’t Veer M, Baaijens M, Boer J, et al. Late cardiotoxicity after treatment for Hodgkin lymphoma. Blood. 2007;109(5):1878-86.
20. Myrehaug S, Pintilie M, Yun L, Crump M, Tsang R, Meyer R, et al. A population-based study of cardiac morbidity among Hodgkin lymphoma patients with preexisting heart disease. Blood. 2010;116(13):2237-40.
21. Myrehaug S, Pintilie M, Tsang R, Mackenzie R, Crump M, Chen Z, et al. Cardiac morbidity following modern treatment for Hodgkin lymphoma: supra-additive cardiotoxicity of doxorubicin and radiation therapy. Leuk Lymphoma. 2008;49(8):1486-93.
22. Hull M, Morris C, Pepine C, Mendenhall N. Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of Hodgkin lymphoma treated with radiation therapy. JAMA. 2003;290(21):2831-7.
23. Picot B, Levitt G, Sullivan I, Baxter L, Clegg A. Cardioprotection against the toxic effects of anthracyclines given to children with cancer: a systematic review. Health Technol Assess. 2007;11(27):1-84.
24. D’Ortencio A, Navigante A. Insuficiencia cardíaca relacionada a quimioterapia. Nuevo enfoque. Insuf Card. 2006;1(1):28-32.
25. Lipshultz S, Adams M, Colan S, Constine L, Herman E, Hsu D, et al. Long-term cardiovascular toxicity in children, adolescents, and young adults who receive cancer therapy: pathophysiology, course, monitoring, management, prevention, and research directions a scientific statement from the american heart association. Circulation. 2013;128:1927-95.
26. Chen M, Colan SD, Diller L. Cardiovascular disease cause of morbidity and mortality in adult survivors of childhood cancers. Circ Res. 2011;108:619-28.
27. Madre C, Orbach D, Baudouin V, Brisse H, Bessa F, Schleiermacher G, et al. Hypertension in Childhood Cancer A Frequent Complication of Certain Tumor Sites. J Pediatr Hematol Oncol. 2006;28(10):659-64.
28. Abratt R, Morgan G, Silvestri G, Willcox P. Pulmonary complications of radiation therapy. Clin Chest Med. 2004;25(1):167-77.
29. Marina N. Long-term survivors of childhood cancer. Pediatr Clin North Am. 1997;44:1021–42.
30. Adler R. Cancer treatment-induced bone loss. Current Opinion in Endocrinology. 2007;14:442–5.
31. Alvarez J, Armstrong M, Constined L, Friedmane D. Long-term effects of treatments for childhood cancers. Curr Opin in Pediatr. 2007;19(1):23–31.
32. Sklar C, Whitton J, Mertens A, Stovall M, Green D, Marina N, et al. Abnormalities of the thyroid in survivors of hodgkin’s disease: data from the childhood cancer survivor study. J Clin Endocrinol Metab. 2000;85(9):3227–32.
33. Pashankar F, Season J, McNamara J, Pashankar D. Acute Constipation in Children Receiving Chemotherapy for Cancer. J Pediatr Hematol Oncol. 2011;33(7):300–3.
34. Gallego C. La mucositis, un efecto del tratamiento quimioterapéutico: fisiopatología y manejo. Rev Fac Odont Antioq. 2007;18(2):84-92.
35. Figueiredo MC, Faustino-Silva DD, Pozatti S, Squef R. Mucositis oral en pacientes pediátricos: una revisión de literatura. Acta Odont Venez. 2011;49(4):1-7.
36. Patel S, Katz E, Richardson R, Rimmer M, Kilian S. Cognitive and problem solving training in cancer: a pilot project. J Pediatr Hematol Oncol. 2009;31(9):670-7.
37. Gerali M, Servitzoglou M, Paikopoulou D, Theodosopoulou H, Madianos M, Vasilatou-Kosmidis H. Psychological problems in children with cancer in the initial period of treatment. Cancer Nurs. 2011;34 (4):1-11.
38. Afify M, Elshahawib H, Adly A. Posttraumatic stress disorders in long-term Egyptian survivors after childhood cancer. MECPsych. 2012;19(1):40–7.
39. Hudson M. Reproductive Outcomes for Survivors of Childhood Cancer. Obstet Gynecol Int. 2010;116(5):1171-83.
40. Vargas P. Cáncer en pediatría. Aspectos generales. Rev chil pediatr. 2000;71(4):1-13.
41. López P, López E. Neutropenia Febril en Pediatría. Infect.2008; 12(1):291-7.
42. Rueda E, Trujillo ML, Díaz LA. La neutropenia severa febril en niños con cáncer. Estudio descriptivo en el Hospital Universitario de Santander. Salud UIS. 2010;42:103-11
43. Gudbjartsson T, Thoroddsen A, Petursdottir V, Hardarson S, Magnusson J, et al. Effect of incidental detection for survival of patients with renal cell carcinoma: results of population-based study of 701 patients. Urology. 2005;66(6):1186-91.
44. Collins L, Nayiager T, Doring N, Kennedy C, Webber C, et al. Nutritional Status at Diagnosis in Children with Cancer I. An Assessment by Dietary Recall Compared With Body Mass Index and Body Composition Measured by Dual Energy X-ray Absorptiometry. J Pediatr Hematol Oncol. 2010;32(8):299–3
45. Amat J, Torrent M. Urgencias oncológicas. Protocolos diagnóstico-terapéuticos de Urgencias Pediátricas SEUP-AEP 2010. 239-45.
46. Barbosa C, Nakamura C, Terreri M, Lee M, Petrilli A, et al. Musculoskeletal manifestations as the onset of acute leukemias in childhood. J Pediatr (Rio J). 2002;78(6):481-4.
47. Lawenda B, Gagne H, Gierga D, Niemierko A, Wong WM, et al. Permanent alopecia after cranial irradiation: dose-response relationship. Int J Radiat Oncol Biol Phys. 2004;60(3):879-87.
48. Ruhnke M, Böhme A, Buchheidt D, Cornely O, Donhuijsen K, Einsele K, et al. Diagnosis of invasive fungal infections in hematology and oncology—guidelines from the Infectious Diseases Working Party in Haematology and Oncology of the German Society for Haematology and Oncology (AGIHO). Ann Oncol. 2011;23:1-11
49. Barreto J, Beach C, Wolf R, Merten J, Tosh P, Wilson J, et al. The incidence of invasive fungal infections in neutropenic patients with acute leukemia and myelodysplastic syndromes receiving primary antifungal prophylaxis with voriconazole. Am J Hematol. 2013;88:283–88.
50. Koskenvuo M, Merja Mo Rahiala J, Ulla M, Pihkala S, Riikonen P, et al. Respiratory Viral Infections in Children with Leukemia. Pediatr Infect Dis J. 2008;27:974–80.
51. Castillo M. Evaluación de la validez de criterio de la Troponina T para el diagnóstico de cardiotoxicidad por antraciclinas. Hospital Universitario de Santander. Universidad Industrial de Santander. 2012.
52. Coradini P, Cigana M, Selistre S, Rosito L, Brunetto A . Ototoxicity From Cisplatin Therapy in Childhood Cancer. J Pediatr Hematol Oncol. 2007;29(6):355–60
53. Villani F, Viviani S, Bonfante V, De Maria P, et al. Late pulmonary effects in favorable stage I and IIA Hodgkin’s disease treated with radiotherapy alone. Am J Clin Oncol. 2000;23(1):18-21.
54. National Cancer Policy Board: WeinerSL, SimoneJV, HewittM, editors. Childhood cancer survivorship: Improving care and quality of life. Washington, DC: National Academy of Sciences 2003: 32
55. Pollock B, Krischer J, Vietti T. Interval between symptom onset and diagnosis of pediatric solid tumor. J Pediatr. 1991;119(5):725-32.
56. Centers for Disease Control and Prevention (CDC).Trends in childhood cancer mortality--United States, 1990-2004. MMWR Morb Mortal Wkly Rep. 2007; 56(48):1257-61.
57. Robison, L, Green, D, Hudson, M, Meadows, A, Mertens, A, Packer, R, et al. Long-term outcomes of adult survivors of childhood cancer. Cancer. 2005;104(11 suppl):2557–64.
58. Neglia JP, Friedman DL, Yasui Y, Mertens A, Hammond S, Stovall M, et al. Second malignant neoplasms in five-year survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Natl Cancer Inst. 2001;93(8): 618–29.
2. Uribe C, Amado C, Ramírez A. Cáncer infantil en el área metropolitana de Bucaramanga 2003-2007. Medunab. 2011;14(2):86-93.
3. Bañeres J, Orrego C, Suñol R, Ureña V. Los sistemas de registro y notificación de efectos adversos y de incidentes: una estrategia para aprender de los errores. Rev Calidad Asistencial. 2005;20(4):216-22.
4. Instituto de Investigaciones Epidemiológicas, Academia Nacional de Medicina. Seguridad del paciente y error en medicina [en línea]. Disponible en: www.errorenmedicina.anm.edu.ar [con acceso el 1 de Julio de 2014].
5. Lois Van C, Muñoz C, Saavedra M, Riggs M, Bossert E. Symptoms in children with advanced cancer. Cancer Nurs. 2012;35(2):115-25.
6. Enska K, Bertero C. Young adult survivors of childhood cancer; experiences affecting self-image, relationships, and present life. Cancer Nurs. 2010;33(1):1-18.
7. International Agency for Research on Cancer, World Health Organization. GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012 [en línea]. Disponible en: http://globocan.iarc.fr/Pages/DataSource_and_methods.aspx [con acceso el 1 de Julio de 2014].
8. Martínez MJ, García A, Garaizar C; Asociación Española de Pediatría, Sociedad Española de Neurología Pediátrica. Tumores cerebrales infantiles: diagnóstico y semiología neurológica. Protocolos Diagnóstico Terapeúticos de la AEP: Neurología Pediátrica.2008:203-9.
9. Hui Chen M, Colan S, Diller L. Cardiovascular Disease Cause of Morbidity and Mortality in Adult Survivors of Childhood Cancers. Circ Res. 2011;108(5):619-28.
10. Pui CH, Evans WE. Treatment of Acute Lymphoblastic Leukemia. N Engl J Med. 2006;354:166-78.
11. Kudret C, Ali Varan A, Akyuz C, TezerKutluk S. Second neoplasms in pediatric patients treated for cancer: a center’s 30-year experience. J Pediatr Hematol Oncol. 2006;28(6):374-8.
12. Simon A, Ammann R, Bode U, Fleischhack G, Wenchel HM, Schwamborn D, et al. Healthcare-associated infections in pediatric cancer patients: results of a prospective surveillance study from university hospitals in Germany and Switzerland. BMC Infect Dis. 2008;8:70-9.
13. Nowak-Go U, Ahlke E, Fleischhack G, Schwabe D, Schobess R, Schumann C, et al. Thromboembolic events in children with acute lymphoblastic leukemia (BFM protocols): prednisone versus dexamethasone administration. Blood. 2003;101(7):2529-33.
14. Ross C, Visscher H, Rassekh S, Castro-Pastrana L, Shereck E, Carleton B, et al. Pharmacogenomics of serious adverse drug reactions In pediatric oncology. J Popul Ther Clin Pharmacol. 2011;18(1):134-51.
15. Ness K, Armenian S, Kadan-Lottick N, Gurney JG. Adverse effects of treatment in childhood acute lymphoblastic leukemia: general overview and implications for long-term cardiac health. Expert Rev Hematol. 2011;4(2):185–7.
16. Massimino M, Gandola L, Seregni E, Bongarzone I, Morosi C, Collini P. Thyroid iatrogenic sequelae after treatment of pediatric cancer. Q J Nucl Med Mol Imaging. 2009;53(5):526-35.
17. Salcedo C, Chaskel R. Impacto psicosocial del cáncer en niños y adolescentes. Precop SCP. 20098(3):5-18.
18. vanWaas M, Neggers S, van der Lelij AJ, Pieters R, van den Heuvel-Eibrink M. The metabolic syndrome in adult survivors of childhood cancer, a review. J Pediatr Hematol Oncol. 2010;32(3):171–9.
19. Aleman B, Van den Belt-Dusebout A, De Bruin M, Van’t Veer M, Baaijens M, Boer J, et al. Late cardiotoxicity after treatment for Hodgkin lymphoma. Blood. 2007;109(5):1878-86.
20. Myrehaug S, Pintilie M, Yun L, Crump M, Tsang R, Meyer R, et al. A population-based study of cardiac morbidity among Hodgkin lymphoma patients with preexisting heart disease. Blood. 2010;116(13):2237-40.
21. Myrehaug S, Pintilie M, Tsang R, Mackenzie R, Crump M, Chen Z, et al. Cardiac morbidity following modern treatment for Hodgkin lymphoma: supra-additive cardiotoxicity of doxorubicin and radiation therapy. Leuk Lymphoma. 2008;49(8):1486-93.
22. Hull M, Morris C, Pepine C, Mendenhall N. Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of Hodgkin lymphoma treated with radiation therapy. JAMA. 2003;290(21):2831-7.
23. Picot B, Levitt G, Sullivan I, Baxter L, Clegg A. Cardioprotection against the toxic effects of anthracyclines given to children with cancer: a systematic review. Health Technol Assess. 2007;11(27):1-84.
24. D’Ortencio A, Navigante A. Insuficiencia cardíaca relacionada a quimioterapia. Nuevo enfoque. Insuf Card. 2006;1(1):28-32.
25. Lipshultz S, Adams M, Colan S, Constine L, Herman E, Hsu D, et al. Long-term cardiovascular toxicity in children, adolescents, and young adults who receive cancer therapy: pathophysiology, course, monitoring, management, prevention, and research directions a scientific statement from the american heart association. Circulation. 2013;128:1927-95.
26. Chen M, Colan SD, Diller L. Cardiovascular disease cause of morbidity and mortality in adult survivors of childhood cancers. Circ Res. 2011;108:619-28.
27. Madre C, Orbach D, Baudouin V, Brisse H, Bessa F, Schleiermacher G, et al. Hypertension in Childhood Cancer A Frequent Complication of Certain Tumor Sites. J Pediatr Hematol Oncol. 2006;28(10):659-64.
28. Abratt R, Morgan G, Silvestri G, Willcox P. Pulmonary complications of radiation therapy. Clin Chest Med. 2004;25(1):167-77.
29. Marina N. Long-term survivors of childhood cancer. Pediatr Clin North Am. 1997;44:1021–42.
30. Adler R. Cancer treatment-induced bone loss. Current Opinion in Endocrinology. 2007;14:442–5.
31. Alvarez J, Armstrong M, Constined L, Friedmane D. Long-term effects of treatments for childhood cancers. Curr Opin in Pediatr. 2007;19(1):23–31.
32. Sklar C, Whitton J, Mertens A, Stovall M, Green D, Marina N, et al. Abnormalities of the thyroid in survivors of hodgkin’s disease: data from the childhood cancer survivor study. J Clin Endocrinol Metab. 2000;85(9):3227–32.
33. Pashankar F, Season J, McNamara J, Pashankar D. Acute Constipation in Children Receiving Chemotherapy for Cancer. J Pediatr Hematol Oncol. 2011;33(7):300–3.
34. Gallego C. La mucositis, un efecto del tratamiento quimioterapéutico: fisiopatología y manejo. Rev Fac Odont Antioq. 2007;18(2):84-92.
35. Figueiredo MC, Faustino-Silva DD, Pozatti S, Squef R. Mucositis oral en pacientes pediátricos: una revisión de literatura. Acta Odont Venez. 2011;49(4):1-7.
36. Patel S, Katz E, Richardson R, Rimmer M, Kilian S. Cognitive and problem solving training in cancer: a pilot project. J Pediatr Hematol Oncol. 2009;31(9):670-7.
37. Gerali M, Servitzoglou M, Paikopoulou D, Theodosopoulou H, Madianos M, Vasilatou-Kosmidis H. Psychological problems in children with cancer in the initial period of treatment. Cancer Nurs. 2011;34 (4):1-11.
38. Afify M, Elshahawib H, Adly A. Posttraumatic stress disorders in long-term Egyptian survivors after childhood cancer. MECPsych. 2012;19(1):40–7.
39. Hudson M. Reproductive Outcomes for Survivors of Childhood Cancer. Obstet Gynecol Int. 2010;116(5):1171-83.
40. Vargas P. Cáncer en pediatría. Aspectos generales. Rev chil pediatr. 2000;71(4):1-13.
41. López P, López E. Neutropenia Febril en Pediatría. Infect.2008; 12(1):291-7.
42. Rueda E, Trujillo ML, Díaz LA. La neutropenia severa febril en niños con cáncer. Estudio descriptivo en el Hospital Universitario de Santander. Salud UIS. 2010;42:103-11
43. Gudbjartsson T, Thoroddsen A, Petursdottir V, Hardarson S, Magnusson J, et al. Effect of incidental detection for survival of patients with renal cell carcinoma: results of population-based study of 701 patients. Urology. 2005;66(6):1186-91.
44. Collins L, Nayiager T, Doring N, Kennedy C, Webber C, et al. Nutritional Status at Diagnosis in Children with Cancer I. An Assessment by Dietary Recall Compared With Body Mass Index and Body Composition Measured by Dual Energy X-ray Absorptiometry. J Pediatr Hematol Oncol. 2010;32(8):299–3
45. Amat J, Torrent M. Urgencias oncológicas. Protocolos diagnóstico-terapéuticos de Urgencias Pediátricas SEUP-AEP 2010. 239-45.
46. Barbosa C, Nakamura C, Terreri M, Lee M, Petrilli A, et al. Musculoskeletal manifestations as the onset of acute leukemias in childhood. J Pediatr (Rio J). 2002;78(6):481-4.
47. Lawenda B, Gagne H, Gierga D, Niemierko A, Wong WM, et al. Permanent alopecia after cranial irradiation: dose-response relationship. Int J Radiat Oncol Biol Phys. 2004;60(3):879-87.
48. Ruhnke M, Böhme A, Buchheidt D, Cornely O, Donhuijsen K, Einsele K, et al. Diagnosis of invasive fungal infections in hematology and oncology—guidelines from the Infectious Diseases Working Party in Haematology and Oncology of the German Society for Haematology and Oncology (AGIHO). Ann Oncol. 2011;23:1-11
49. Barreto J, Beach C, Wolf R, Merten J, Tosh P, Wilson J, et al. The incidence of invasive fungal infections in neutropenic patients with acute leukemia and myelodysplastic syndromes receiving primary antifungal prophylaxis with voriconazole. Am J Hematol. 2013;88:283–88.
50. Koskenvuo M, Merja Mo Rahiala J, Ulla M, Pihkala S, Riikonen P, et al. Respiratory Viral Infections in Children with Leukemia. Pediatr Infect Dis J. 2008;27:974–80.
51. Castillo M. Evaluación de la validez de criterio de la Troponina T para el diagnóstico de cardiotoxicidad por antraciclinas. Hospital Universitario de Santander. Universidad Industrial de Santander. 2012.
52. Coradini P, Cigana M, Selistre S, Rosito L, Brunetto A . Ototoxicity From Cisplatin Therapy in Childhood Cancer. J Pediatr Hematol Oncol. 2007;29(6):355–60
53. Villani F, Viviani S, Bonfante V, De Maria P, et al. Late pulmonary effects in favorable stage I and IIA Hodgkin’s disease treated with radiotherapy alone. Am J Clin Oncol. 2000;23(1):18-21.
54. National Cancer Policy Board: WeinerSL, SimoneJV, HewittM, editors. Childhood cancer survivorship: Improving care and quality of life. Washington, DC: National Academy of Sciences 2003: 32
55. Pollock B, Krischer J, Vietti T. Interval between symptom onset and diagnosis of pediatric solid tumor. J Pediatr. 1991;119(5):725-32.
56. Centers for Disease Control and Prevention (CDC).Trends in childhood cancer mortality--United States, 1990-2004. MMWR Morb Mortal Wkly Rep. 2007; 56(48):1257-61.
57. Robison, L, Green, D, Hudson, M, Meadows, A, Mertens, A, Packer, R, et al. Long-term outcomes of adult survivors of childhood cancer. Cancer. 2005;104(11 suppl):2557–64.
58. Neglia JP, Friedman DL, Yasui Y, Mertens A, Hammond S, Stovall M, et al. Second malignant neoplasms in five-year survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Natl Cancer Inst. 2001;93(8): 618–29.
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