Endocrine late effects of cancer treatment

Czech version

Authors: M. Kosák
Authors‘ workplace: Interní klinika 1. LF UK a ÚVN, Praha
Published in: Klin Onkol 2021; 34(6): 440-449
Category: Review
doi: https://doi.org/10.48095/ccko2021440

Overview

Background: Endocrine disorders are one of the common late complications of cancer treatment in childhood and adulthood. The incidence is more common in individuals who underwent oncology treatment in childhood in whom the estimated prevalence of these disorders is 20–50%. With improving treatment, there is an increasing number of people with a history of cancer treatment and thus persons who are potentially at risk of developing endocrine disorders. In adults, the prevalence of disorders is lower compared to those who had treatment in their childhood; however, endocrinological complications are relatively common even here, although the diagnosis is given less attention in adults compared to children. Endocrine disorders are possible complications of practically all treatment modalities used in oncology (radiotherapy, chemotherapy and immunotherapy). In terms of the type of disorders, these mainly include hypofunction or – more rarely – hyperfunction of the endocrine glands and secondary endocrine neoplasms, especially radiotherapy-induced thyroid tumors. The disadvantages of endocrine disorders are often non-specific and slowly developing symptoms. In addition to a clinical examination with an assessment of the presence of possible clinical manifestations, regular laboratory tests should also be performed to allow for early detection. The level of risk of developing endocrine disorders varies and depends on a number of factors, including the age at which the individual underwent treatment as well as the type of treatment: radiation dose, type of chemotherapy, etc. Based on these data, individualized monitoring plan for the individual needs should be made, allowing an early detection of these disorders. The advantage of endocrinological consequences is the fact that if properly and timely diagnosed, they are relatively easy to treat and the treatment often allows for full restitution of the condition. Purpose: The purpose of this article is to present a brief overview about broad spectrum of various possible endocrine complications of cancer treatment, how to diagnose and treat them, aiming to increase awareness about this topic among the health care professionals who treat these patients.

Keywords:

hypopituitarism – endocrine late effects – hypogonadism – secondary neoplasm

Sources

1. Brignardello E, Felicetti F, Castiglione A et al. Endocrine health conditions in adult survivors of childhood cancer: the need for specialized adult-focused follow-up clinics. Eur J Endocrinol 2013; 168 (3): 465–472. doi: 10.1530/EJE-12-1043.

2. Robison LL, Mertens AC, Boice JD et al. Study design and cohort characteristics of the Childhood Cancer Survivor Study: a multi-institutional collaborative project. Med Pediatr Oncol 2002; 38 (4): 229–239. doi: 10.1002/mpo.1316.

3. Hoppe RT, Advani RH, Ai WZ et al. Hodgkin lymphoma version 1.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2017; 15 (5): 608–638. doi: 10.6004/jnccn.2017.0064.

4. Belada D, Trněný M, Campr V et al. Diagnostické a léčebné postupy u nemocných s maligními lymfomy. Hradec Králové: HK CREDIT s. r. o. 2018.

5. Chang LS, Barroso-Sousa R, Tolaney SM et al. Endocrine toxicity of cancer immunotherapy targeting immune checkpoints. Endocr Rev 2019; 40 (1): 17–65. doi: 10.1210/er.2018-00006.

6. Ferlay J, Soerjomataram I, Dikshit R et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136 (5): E359–E386.

7. Winther JF, Kenborg L, Byrne J et al. Childhood cancer survivor cohorts in Europe. Acta Oncol 2015; 54 (5): 655–668. doi: 10.1002/ijc.29210.

8. Kamran SC, Berrington de Gonzalez A, Ng A et al. Therapeutic radiation and the potential risk of second malignancies. Cancer 2016; 122 (12): 1809–1821. doi: 10.1002/cncr.29841.

9. Kutanzi KR, Lumen A, Koturbash I et al. Pediatric exposures to ionizing radiation: carcinogenic considerations. Int J Environ Res Public Health 2016; 13 (11): 1057. doi: 10.3390/ijerph13111057.

10. Kaya E, Keskin L, Aydogdu I et al. Oxidant/antioxidant parameters and their relationship with chemotherapy in Hodgkin‘s lymphoma. J Int Med Res 2005; 33 (6): 687–692. doi: 10.1177/147323000503300611.

11. Shalet SM. Irradiation-induced growth failure. Clin Endocrinol Metab 1986; 15 (3): 591–606. doi: 10.1016/s0300-595x (86) 80011-1.

12. Shalet SM. Radiation and pituitary dysfunction. N Engl J Med 1993; 328 (2): 131–133. doi: 10.1056/NEJM199301143280211.

13. Littley MD, Shalet SM, Beardwell CG. Radiation and hypothalamic-pituitary function. Baillieres Clin Endocrinol Metab 1990; 4 (1): 147–175. doi: 10.1016/s0950-351x (05) 80321-0.

14. Agha A, Sherlock M, Brennan S et al. Hypothalamic-pituitary dysfunction after irradiation of nonpituitary brain tumors in adults. J Clin Endocrinol Metab 2005; 90 (12): 6355–6360. doi: 10.1210/jc.2005-1525.

15. Clement SC, Schouten-van Meeteren AY, Boot AM et al. Prevalence and risk factors of early endocrine disorders in childhood brain tumor survivors: a nationwide, multicenter study. J Clin Oncol 2016; 34 (36): 4362–4370. doi: 10.1200/JCO.2016.67.5025.

16. Madaschi S, Fiorino C, Losa M et al. Time course of hypothalamic-pituitary deficiency in adults receiving cranial radiotherapy for primary extrasellar brain tumors. Radiother Oncol 2011; 99 (1): 23–28. doi: 10.1016/j.radonc.2011.02.015.

17. Lam KSL, Tse VKC, Wang C et al. Effects of cranial irradiation on hypothalamic-pituitary fiction – a 5-year longitudinal study in patients with nasopharyngeal carcinoma. Q J Med 1991; 78 (286): 165–176.

18. Rose SR, Lustig RH, Pitukcheewanont P et al. Diagnosis of hidden central hypothyroidism in survivors of childhood cancer. J Clin Endocrinol Metab 1999; 84 (12): 4472–4479. doi: 10.1210/jcem.84.12.6097.

19. Chemaitilly W, Sklar CA. Endocrine complications in long-term survivors of childhood cancers. Endocr Relat Cancer 2010; 17 (3): R141–R159. doi: 10.1677/ERC-10-0002.

20. Kyriakakis N, Lynch J, Orme SM et al. Pituitary dysfunction following cranial radiotherapy for adult-onset nonpituitary brain tumours. Clin Endocrinol (Oxf) 2016; 84 (3): 372–379. doi: 10.1111/cen.12969.

21. Ogilvy-Stuart AL, Ryder WD, Gattamaneni HR et al. Growth hormone and tumour recurrence. BMJ 1992; 304 (6842): 1601–1605. doi: 10.1136/bmj.304.6842.1601.

22. Swerdlow AJ, Reddingius RE, Higgins CD et al. Growth hormone treatment of children with brain tumors and risk of tumor recurrence. J Clin Endocrinol Metab 2000; 85 (12): 4444–4449. doi: 10.1210/jcem.85.12.7044.

23. Sklar CA, Mertens AC, Mitby P et al. Risk of disease recurrence and second neoplasms in survivors of childhood cancer treated with growth hormone: a report from the Childhood Cancer Survivor Study. J Clin Endocrinol Metab 2002; 87 (7): 3136–3141. doi: 10.1210/jcem.87.7.8606.

24. Kikawa Y, Takeuchi M, Sudo M et al. Development of primary hypothyroidism with antithyroglobulin, antiperoxidase, and blocking-type thyrotropin receptor antibodies after radiation therapy for neuroblastoma. J Pediatr 1996; 129 (6): 909–912. doi: 10.1016/s0022-3476 (96) 70037-9.

25. Sklar C, Boulad F, Small T et al. Endocrine complications of pediatric stem cell transplantation. Front Biosci 2001; 6: G17–G22. doi: 10.2741/a714.

26. Kreze A Jr, Stáhalová V, Zadrazilová A et al. Treatment with sunitinib and hypothyroidism – a case report and overview of literature. Klin Onkol 2009; 22 (4): 176–178.

27. Lechner MG, Vyas CM, Hamnvik OR et al. Hypothyroidism during tyrosine kinase inhibitor therapy is associated with longer survival in patients with advanced nonthyroidal cancers. Thyroid 2018; 28 (4): 445–453. doi: 10.1089/thy.2017.0587.

28. Iglesias ML, Schmidt A, Ghuzlan AA et al. Radiation exposure and thyroid cancer: a review. Arch Endocrinol Metab 2017; 61 (2): 180–187. doi: 10.1590/2359-3997000000257.

29. Haugen BR, Alexander EK, Bible KC et al. American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016; 26 (1): 1–133. doi: 10.1089/thy.2015. 0020.

30. Tward JD, Wendland MM, Shrieve DC et al. The risk of secondary malignancies over 30 years after the treatment of non-Hodgkin lymphoma. Cancer 2006; 107 (1): 108–115. doi: 10.1002/cncr.21971.

31. Tao L, Clarke CA, Rosenberg AS et al. Subsequent primary malignancies after diffuse large B-cell lymphoma in the modern treatment era. Br J Haematol 2017; 178 (1): 72–80. doi: 10.1111/bjh.14638.

32. McMullen T, Bodie G, Gill A et al. Hyperparathyroidism after irradiation for childhood malignancy. Int J Radiat Oncol Biol Phys 2009; 73 (4): 1164–1168. doi: 10.1016/j.ijrobp.2008.06.1487.

33. Huddart RA, Norman A, Moynihan C et al. Fertility, gonadal and sexual function in survivors of testicular cancer. Br J Cancer 2005; 93 (2): 200–207. doi: 10.1038/sj.bjc.6602677.

34. Gebauer J, Higham C, Langer T et al. Long-term endocrine and metabolic consequences of cancer treatment: a systematic review. Endocr Rev 2019; 40 (3): 711–767. doi: 10.1210/er.2018-00092.

35. Levine JM, Whitton JA, Ginsberg JP et al. Nonsurgical premature menopause and reproductive implications in survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Cancer 2018; 124 (5): 1044–1052. doi: 10.1002/cncr.31121.

36. Sklar CA, Mertens AC, Mitby P et al. Premature menopause in survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Natl Cancer Inst 2006; 98 (13): 890–896. doi: 10.1093/jnci/djj243.

37. van Dorp W, Mulder RL, Kremer LC et al. Recommendations for premature ovarian insufficiency surveillance for female survivors of childhood, adolescent, and young adult cancer: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCareSurFup Consortium. J Clin Oncol 2016; 34 (28): 3440–3450. doi: 10.1200/JCO.2015.64.3288.

38. Ataya KM, McKanna JA, Weintraub AB et al. A luteinizing hormone-releasing hormone agonist for the prevention of chemotherapy-induced ovarian follicular loss in rats. Cancer Res 1985; 45 (8): 3651–3656.

39. Orgel E, Mueske NM, Wren TA et al. Early injury to cortical and cancellous bone from induction chemotherapy for adolescents and young adults treated for acute lymphoblastic leukemia. Bone 2016; 85: 131–137. doi: 10.1016/j.bone.2016.01.027.

40. Bongers EM, Haasbeek CJ, Lagerwaard FJ et al. Incidence and risk factors for chest wall toxicity after risk-adapted stereotactic radiotherapy for early-stage lung cancer. J Thorac Oncol 2011; 6 (12): 2052–2057. doi: 10.1097/JTO.0b013e3182307e74.

41. Voroney JP, Hope A, Dahele MR et al. Chest wall pain and rib fracture after stereotactic radiotherapy for peripheral non-small cell lung cancer. J Thorac Oncol 2009; 4 (8): 1035–1037. doi: 10.1097/JTO.0b013e3181ae2962.

42. Baxter NN, Habermann EB, Tepper JE et al. Risk of pelvic fractures in older women following pelvic irradiation. JAMA 2005; 294 (20): 2587–2593. doi: 10.1001/jama.294.20.2587.

43. Housman D, Savage C, Zelefsky M et al. Pelvic fracture after radiation therapy for localized prostate cancer: a population based study. Int J Rad Onc Biol Phys 2010; 78 (3): S64.

44. Mogil RJ, Kaste SC, Ferry RJ Jr et al. Effect of low-magnitude, high-frequency mechanical stimulation on BMD among young childhood cancer survivors: a randomized clinical trial. JAMA Oncol 2016; 2 (7): 908–914. doi: 10.1001/jamaoncol.2015.6557.

45. Dalla Via J, Daly RM, Fraser SF. The effect of exercise on bone mineral density in adult cancer survivors: a systematic review and meta-analysis. Osteoporos Int 2018; 29 (2): 287–303. doi: 10.1007/s00198-017-4237-3.

46. Datta M, Schwartz GG. Calcium and vitamin D supplementation and loss of bone mineral density in women undergoing breast cancer therapy. Crit Rev Oncol Hematol 2013; 88 (3): 613–624. doi: 10.1016/j.critrevonc.2013.07.002.

47. Datta M, Schwartz GG. Calcium and vitamin D supplementation during androgen deprivation therapy for prostate cancer: a critical review. Oncologist 2012; 17 (9): 1171–1179. doi: 10.1634/theoncologist.2012- 0051.

48. Landier W, Bhatia S, Eshelman DA et al. Development of risk-based guidelines for pediatric cancer survivors: the Children‘s Oncology Group Long-Term Follow-Up Guidelines from the Children‘s Oncology Group Late Effects Committee and Nursing Discipline. J Clin Oncol 2004; 22 (24): 4979–4990. doi: 10.1200/JCO.2004.11.032.

49. Ruggiero S, Gralow J, Marx RE et al. Practical guidelines for the prevention, diagnosis, and treatment of osteonecrosis of the jaw in patients with cancer. J Oncol Pract 2006; 2 (1): 7–14. doi: 10.1200/JOP.2006.2.1.7.