Very late nonfatal consequences of fractionated TBI in children undergoing bone marrow transplant

Maura Faraci, Salvina Barra, Amnon Cohen, Edoardo Lanino, Francesca Grisolia, Maurizio Miano, Franca Foppiano, Oliviero Sacco, Manlio Cabria, Riccardo De Marco, Gilberto Stella, Sandro Dallorso, Francesca Bagnasco, Vito Vitale, Giorgio Dini, Riccardo Haupt

Research output: Contribution to journalArticle

Abstract

Purpose: To describe long-term late consequences in children who received total body irradiation (TBI) for hematopoietic stem cell transplantation 10 years earlier. Methods and Materials: A cohort of 42 children treated with TBI between 1985 and 1993, still alive at least 10 years after fractionated TBI (FTBI), was evaluated. Twenty-five patients received FTBI at 330 cGy/day for 3 days (total dose 990 cGy), whereas 17 children were administered fractions of 200 cGy twice daily for 3 days (total dose 1200 cGy). Twenty-seven patients received autologous and 16 allogeneic hematopoietic stem cell transplantation. Median age at TBI was 6.3 years, and 18.4 years at most recent follow-up. Results: Cataract was diagnosed in 78% of patients after a median of 5.7 years. Hypothyroidism was detected in 12%, whereas thyroid nodules were observed in 60% of our population after a median interval of 10.2 years. Patients treated with 990 cGy developed thyroid nodules more frequently than those treated with 1200 cGy (p = 0.0002). Thyroid carcinoma was diagnosed in 14% of the total population. Females who received FTBI after menarche more frequently developed temporary ovarian dysfunction than those treated before menarche, but cases of persistent ovarian dysfunction did not differ between the two groups. Indirect signs of germinal testicular dysfunction were detected in 87% of males. Restrictive pulmonary disease was observed in 74% of patients. Osteochondroma was found in 29% of patients after a median interval of 9.2 years. This latter complication appeared more frequently in patients irradiated before the age of 3 years (p <0.001). Conclusions: This study shows that late effects that are likely permanent, although not fatal, are frequent in survivors 10 years after TBI. However, some of the side effects observed shortly after TBI either disappeared or remained unchanged without signs of evolution. Monitoring is recommended to pursue secondary prevention strategies and counseling on family planning.

Original languageEnglish
Pages (from-to)1568-1575
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume63
Issue number5
DOIs
Publication statusPublished - Dec 1 2005

Keywords

  • Hematopoietic stem cell transplantation
  • Late effects
  • Total body irradiation

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

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