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Study links cancer therapies and risks of late ocular complications in children
Pediatr Blood Cancer. 2010;54(1):103-109.
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Five-year survivors of childhood cancer face a high risk of ocular complications, particularly cataract, after exposure to glucocorticoids and cranial radiation, a study showed.
"Approximately 80% of children currently survive 5 years following diagnosis of their cancer. Studies based on limited data have implicated certain cancer therapies in the development of ocular sequelae in these survivors," the study authors said. "Long-term follow-up is needed to evaluate potential progression of ocular deficits and impact on quality of life."
The Childhood Cancer Survivor Study, a retrospective cohort study of health outcomes of cancer patients surviving 5 years or more, included 14,362 cancer survivors and 3,901 siblings. Patients were treated between 1970 and 1986. Patient outcomes were compared with those of the sibling cohort.
A baseline questionnaire was designed to record the first occurrence of six possible ocular complications after cancer treatment. Relative risk scores for ocular complications were calculated based on survey data.
Study results showed that at 5 years or longer after diagnosis, cancer survivors had a 10.8 relative risk of cataracts, a 2.5 relative risk of glaucoma, a 2.6 relative risk of legal blindness, a 4.1 relative risk of double vision and a 1.9 relative risk of dry eyes. Risks were correlated with radiation dosage levels.
Radiation of more than 3,000 cGy to the posterior fossa was associated with an 8.4 relative risk of cataract, and the same level of radiation applied to the temporal lobe had a 9.4 relative risk of cataract. Exposure to prednisone had a 2.3 relative risk of cataract, the authors said.
There is great interest in the management of ocular cancers and particularly those in childhood. Tremendous strides in the use of chemotherapy and radiotherapy for intraocular retinoblastoma and orbital rhabdomyosarcoma in children have occurred over the past 20 years. Patients are surviving these deadly cancers. Most reports have focused on success of cancer treatment. In this report, the authors take a different point of view and look at late side effects following therapy for ocular cancers. They found that children who survive their cancer continue to have problems such as cataracts, glaucoma, and blindness. When compared to their normal siblings, a treated patient was 2.6 times a greater risk for legal blindness. Part of this might be related to the location of the cancer itself, but part of this could be related to the therapy. It is important when developing new therapeutic strategies for pediatric cancers that we keep in mind the long-term side effects. Unlike adults who may have one or two decades to live, children often have seven or eight decades, during which time they may develop visually disabling side effects.
– Carol L. Shields, MD
Co-Director,
Oncology Service, Wills Eye Institute, Philadelphia