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Grazie al progresso delle terapie oncologiche, il numero di giovani adulti guariti da tumori dell’età pediatrica (i cosiddetti childhood cancer survivors) è in costante aumento. Numerose evidenze dimostrano che questi soggetti possono andare incontro all’insorgenza precoce di patologie, soprattutto cardiovascolari e oncologiche, tipiche dell’età avanzata, facendo ipotizzare che le terapie anti-tumorali possano determinare un’accelerazione dei fisiologici meccanismi di invecchiamento. Questa rassegna riassume le principali evidenze sul ruolo dell’infiammazione cronica all’interno dei meccanismi di ageingprematuro che caratterizzano i childhood cancer survivors.

•Infertility and hypogonadism are frequent after allogeneic stem cell transplantation.•Erectile dysfunction is commonly reported after allogeneic stem cell transplantation.•Chronic graft-versus-host disease is related to an elevated risk of erectile dysfunction.•Alterations in all domains of sexuality are often reported, even after remission.

Purpose: Despite a good prognosis, thyroid cancer (TC) survivors often report psychological distress and decreased quality of life. This longitudinal study aims to evaluate TC survivors’ levels of distress, anxiety, depression and unmet needs, checking potential life events. Methods: Distress Thermometer, Hospital Anxiety Depression Scale, Supportive Care Need Survey (short form) and Interview for Recent Life Events were administered to 73 TC survivors (T0) and 44 of them were re-tested one year later (T1). Participants were at 0–5, 5–10 or >10 years from the end of their cancer-related treatments. Results: At T0, distress, anxiety and depression mean scores were 6.4, 6.8 and 5.3, while at T1 they were 5.5, 4.8 and 5.1. Only anxiety scores decreased significantly between T0 and T1. 50.7% of patients had unmet psychological needs at T0 and 50.0% at T1. Most participants were satisfied in the communicative/ informative (T0:79.5%; T1: 77.3%) and social/health care areas (T0:74.0%; T1:75.0%). The most experienced stressful events detected concerned their working areas. Conclusions: Results confirmed that patients reported distress, anxiety and depression concerns even many years after the end of treatments. Both medical and psychological surveillance are relevant to improving TC survivors’ wellbeing.

Grazie ai progressi compiuti dall’oncologia negli ultimi decenni, oggi le percentuali di guarigione dei bambini e dei giovani adulti affetti da tumore si attestano intorno all’80%. Tuttavia, anche con i moderni protocolli di terapia oltre il 50% dei giovani pazienti sviluppa nel tempo infertilità, nella maggior parte dei casi dovuta a danno gonadico diretto. La proposta di preservare la fertilità, in un momento così critico della vita, diviene quindi essenziale di fronte a trattamenti che possono ledere in modo irreversibile la capacità fecondante dell’individuo. Esistono per entrambi i sessi metodi consolidati e approcci ancora sperimentali per salvaguardare le potenzialità procreative cui si deve ricorrere nel contesto dell’inquadramento oncologico iniziale poiché, tuttora, non esistono parametri per poter prevedere con certezza l’entità dell’effetto gonadotossico dei vari trattamenti oncologici. I problemi attualmente emergenti sono relativi alla preservazione della fertilità nei prepuberi e su tale aspetto si sta soprattutto orientando la ricerca biomedica.

Treatment options for recurrent or metastatic differentiated thyroid cancer (DTC) refractory to radioactive iodine (RAI) are inadequate. Multitargeted kinase inhibitors have recently shown promising results in phase 2–3 studies. This retrospective study aimed to document our clinical experience on the effects of sorafenib in the setting of daily clinical practice. Retrospective study evaluating the efficacy and safety of sorafenib in a cohort of patients consecutively treated with sorafenib at a single center. Twenty patients with advanced RAI-refractory thyroid carcinoma were enrolled (March 2011–March 2014). Patients generally started with 400 mg of sorafenib twice daily, tapering the dose in case of side effects. Radiological response and toxicity were measured during follow-up, together with safety parameters. CT scans were performed by a single experienced radiologist every 3–4 months. Five patients stopped sorafenib within 90 days due to severe toxicities. Median progression-free survival was 248 days. Five patients had a partial response (PR), achieved in all cases within 3 months, whereas 5 had stable disease (SD) at 12 months. Durable response rate (PR plus SD) for at least 6 months was 50 %, among those who received sorafenib for at least 3 months. Commonest adverse events included skin toxicity, gastrointestinal and constitutional symptoms. In our cohort of patients with advanced RAI-refractory thyroid carcinoma, sorafenib confirmed antitumor activity leading to SD or PR in the majority of cases, at the expense of clinically relevant side effects. More effective and tolerable agents are still needed in the treatment of RAI-refractory DTC.

BackgroundChildhood cancer survivors (CCSs) have an increased risk of overweight and dyslipidaemia, but the distribution and the potential relationships between anticancer therapies and cardiovascular risk factors have been heterogeneously and not prospectively described.MethodsAll consecutive CCSs with primary cancer diagnosed between 1973–2007 and subsequently referred to our outpatient clinic were enrolled. Hypercholesterolaemia (total cholesterol >200 and/or low density lipoprotein (LDL)>160 mg/dl) was the primary end point, hypertriglyceridaemia (triglycerides >200 mg/dl) and body mass index >30 kg/m2the secondary end points. Cox multivariate adjustments were performed to account for differences in cancer and treatments.ResultsA total of 340 patients were included (197 male, 143 female; mean age at last follow-up 24.1 ± 3.2). The most common diagnosis were haematological malignancies (n = 227) and brain tumours (n = 51). After a median follow-up of 16.1 years, hypercholesterolaemia was diagnosed in 67 CCSs (20%), hypertriglyceridaemia in 20 CCSs (6%) and obesity in 28 CCSs (8%). Total body irradiation and growth hormone deficiency increased the risk of both hypercholesterolaemia (hazard ratio (HR) = 2.7; confidence interval (CI) 1.2–4.4 and HR = 2.3; CI 1.1–4.9; all p < 0.05) and hypertriglyceridaemia (HR = 6.5; CI 1.4–31 and HR = 7.2; CI 1.1–43; all p < 0.05). The risk of hypercholesterolaemia was also higher in CCSs who underwent autologous haematopoietic stem cell transplantation (HR = 3.2; CI 1.7–5.9; p < 0.001) or platinum-based chemotherapy (HR = 2.7; CI 1.5–4.9; p < 0.001), whereas a previous diagnosis of brain tumour (HR = 10; CI 1.2–45; p < 0.05) and anthracyclines exposure (HR = 1.3; CI 1.2–26; p < 0.05) significantly predicted obesity.ConclusionCCSs show a high and variable risk for developing dyslipidaemia and obesity, depending on cancer diagnosis and treatments. Therefore, they need accurate and tailored control of their cardiovascular risk profile.

Oggi il paziente oncologico ha probabilità di guarigione molto più elevate che in passato, soprattutto in ambito pediatrico. L’aumentata efficacia dei protocolli di terapia si paga però, non di rado, in termini di late effects, cioè di malattie causate dalle terapie antitumorali che insorgono o persistono dopo più di cinque anni dalla guarigione del tumore. Per quanto questi late effectspossano interessare qualsiasi organo o apparato, le complicanze endocrinologiche sono certamente tra le più frequenti, arrivando a interessare oltre la metà dei cancer survivors. Per questo motivo, l’endocrinologo riveste un ruolo di primo piano nel monitoraggio clinico a lungo termine dei pazienti guariti da un tumore.