الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 185 |  |  |
| | | from | 185 | | |
Abstract
Children suffering from malignancies represent a growing cohort of our society. Fortunately, we are witnessing great improvements in management of patients suffering from childhood cancer, including early diagnosis, multimodal therapy and hospital supportive care. These improvements eventually lead to increasing the survival rate and treatment outcome of patients suffering of cancer. However, childhood cancer survivors are at increased risk of facing chronic health problems, some of which appear during or soon after treatment whereas others manifest years after therapy.
These chronic health problems may limit physical performance, and, in turn, interfere with functional capacity and participation in work and social activity, which eventually affect their life quality negatively.
Cardiovascular disease is one of the leading causes of morbidity and mortality in long-term cancer survivors. Cardiovascular complications related to cancer treatment may arise after long time of end of therapy. So it is very important to regularly follow up survivors for early detection and management of such conditions.
Cardiac dysfunction, in childhood cancer survivors, related to anthracycline treatment is initially subclinical and unfortunately passes unnoticed in regular cardiac assessment by conventional echocardiographic methods. Early detection of cardiac dysfunction plays a crucial role in management of the condition before developing a life threatening health issue. Therefore, it is becoming a priority for cardiologists and oncologists to develop new modalities and techniques directed for early detection of subclinical cardiac dysfunction. Speckle tracking echocardiography (STE) and cardiac magnetic resonance (CMR)
imaging are giving impressing results regarding cardiac assessment in childhood cancer survivors.
The objective of this study was:
To study the traditional risk factors for atherosclerosis and changes in left ventricular mechanics in CCS. In addition to study the ability of Speckle-Tracking Echocardiography (STE) to detect the early subclinical impairment of left ventricular mechanics in CCS caused by the received cardiotoxic drugs during their treatment.
This study was held on 60 children 40 of them complete their anti-cancer therapy and attending for regular follow up (24 of them were males and 16 were females) and 20 were healthy children of matched age and sex as control. The age of our survivors ranged from 4 to 17 years.
Patients were subjected to the followings:
1. Full history taking.
2. Thorough clinical examination.
3. Laboratory evaluation in the form of (CBC, liver and kidney function tests, iron and lipid profile, electrolytes and fasting blood sugar level).
4. Cardiac imaging assessment by conventional 2D echocardiography and 2D speckle tracking echocardiography.
Results showed that:
Most of the survivors (25 children) were diagnosed as ALL, 8 as NHL and 7 as HL. Their age at diagnosis of cancer ranged between 2 and 16 years. The most frequent clinical presentation at diagnosis was fever in 26 survivors followed by pallor in 23, lymphadenopathy in 21, hepatomegaly in 17, splenomegaly and bleeding each in 14, respiratory infection in 13, abdominal mass in 6, then lastly mediastinal mass in 2 of
survivors. All of our survivors were treated with anthracycline based protocols of chemotherapy and the cumulative dose of anthracycline ranged between 75 and 400 mg/m2.
The weight and BMI of the survivors were statistically higher than that of the control group indicates the prevalence of obesity and overweight among survivors while regarding height, it was significantly lower in the survivors group than the control group. Regarding the blood pressure, the systolic and diastolic blood pressures were significantly higher in the survivors group than the control group while there was no significant difference regarding heart rate.
Regarding laboratory investigations of both groups, Hb, HCT, TIBC, transferrin saturation, D. bilirubin, T. bilirubin, Ca, K, Na, Albumin, BUN and Creatinine were of no significant difference between survivors and control but there was a significant increase in ALT, AST, serum iron, serum ferritin and fasting glucose level in the survivors group more than the control. Regarding to the lipid profile, there was significant increase in serum Cholesterol, TGs and LDL while there was significant decrease in serum HDL in the survivors group more than the control group.
Comparing conventional Echocardiographic data of survivors and control groups, the EF and FS (which represents the LV systolic function) were significantly lower in the survivors group than the control group though still within the normal values while no significant difference in LVEDD and LVESD. Also, the mitral E/A ratio (which represents the LV diastolic function) was significantly lower in the survivors group than the control group.
Regarding the data of STE of survivors and control groups, GLPS-A4C, the GLPS-A2C, GLPS-LAX and the GLPS-Avg were significantly lower in the survivors group than the control group.
There was no significant correlation between GLPS-Avg and each of the following: age at study, age at diagnosis, gender, duration of chemotherapy, cumulative dose of Adriamycin, height, weight, BMI, Hb, serum ferritin, creatinine, glucose, lipid profile, LVEDD, LVESD, EF%, FS% & E/A ratio.
from this study, it is concluded that:-
1- Childhood cancer survivors are in higher risk of developing chronic health conditions which may arise after long time of end of therapy. So it is very important to regularly follow up our survivors at cancer survivor clinic.
2- They are at increased risk of liver dysfunction and iron overload.
3- They showed an increase in the cardiovascular risk factors including obesity, elevated blood pressure, dyslipidemia and elevated glucose level.
4- The two-dimensional speckle tracking echocardiography (2DSTE) was more sensitive than conventional 2D echocardiography in identifying the impairment of left ventricular mechanics in childhood cancer survivors.
from this study, it is recommended that:-
1- Childhood cancer survivors should be routinely evaluated for height, weight, BMI and blood pressure.
2- Childhood cancer survivors should be routinely screened for fasting levels of blood glucose or levels of HbA 1c, liver functions,
iron profile and lipid profile at least every 1 year (or more frequently if indicated).
3- All cancer children should have an echocardiographic assessment before starting chemotherapy in order to identify any pre-existing heart condition and to evaluate the need for adriamycin dose modification or the need of cardioprotection.
4- 2-D Speckle Tracking Echocardiography is a sensitive tool in early detection of cardiac dysfunction in childhood cancer survivors, so it should be added to the follow up studies of CCS.
5- Further studies on larger scale are recommended to allow more clinical application for 2-D STE.
Finally, continued follow-up and screening will remain an important aspect of care for many chronic conditions that affect childhood cancer survivors.