RESUMO
BACKGROUND: Endocrine complications after acute lymphoblastic leukemia (ALL) are common. METHODS: Final height, GH/IGF-1 axis, and body mass index were analyzed after 13.7 (7.0-20.7) years from diagnosis in 34 boys aged <12 years at diagnosis and 41 girls <10 years at diagnosis. A modified German BFM-83 ALL protocol included (n = 42) or did not include (n = 33) prophylactic cranial irradiation. In 27 patients, GH after insulin tolerance test, IGF-1, cortisol, free T(4) and estradiol/testosterone were determined. RESULTS: Final height was significantly reduced (mean Z-score for height between final height and diagnosis, ΔHAZ = -0.61, p = 0.0001). At that point, 3 patients were obese (4%) and 17 were overweight (22.7%). Patients aged ≤ 4 years at diagnosis and those irradiated had a greater loss in final height (p = 0.001 and p = 0.008, respectively). Abnormalities in GH/IGF-1 axis were observed in 4 patients: 3 had a GH peak <6 ng/ml and 1 had a serum IGF-1 concentration <25 ng/ml. Growth deficit was significantly higher in patients with hormonal deficiency (p = 0.006). CONCLUSIONS: Treatment of ALL during childhood is associated with final height deficit. Young age at diagnosis and radiotherapy were the major risk factors. GH/IGF-1 deficiency was found particularly in irradiated patients, even though it was detected in 1 non-irradiated patient.
Assuntos
Transtornos do Crescimento/etiologia , Hormônio do Crescimento/fisiologia , Fator de Crescimento Insulin-Like I/fisiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/fisiopatologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Radioterapia/efeitos adversos , Transdução de Sinais/fisiologia , Fatores Etários , Estatura/fisiologia , Índice de Massa Corporal , Pré-Escolar , Terapia Combinada , Irradiação Craniana/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Seguimentos , Transtornos do Crescimento/epidemiologia , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
O câncer de mama é a segunda neoplasia mais frequente no mundo e a mais comum entre as mulheres. Apesar de ser considerado um câncer de bom prognóstico se diagnosticado e tratado oportunamente, as taxas de mortalidade continuam elevadas no Brasil; muito provavelmente porque a doença ainda é diagnosticada em estádios avançados. No presente artigo, os autores apresentam definições acerca do câncer de mama e discutem o seu tratamento locorregional.
The breast cancer is the second most frequent tumor in the world and the most common among women. Although it is considered a good prognostic cancer if diagnosed and treated in time, the rates of mortality keep high in Brazil, probably because the disease is still diagnosed in advanced stage. In this article, the authors present definitions about breast cancer and discuss the local treatment.