Cancer in Adolescents and Young Adults (AYAs)


LONG-TERM EFFECTS FOR PEDIATRIC CANCER SURVIVORS

Associate Professor Kleebsabai Sanpakit, MD

Department of Pediatrics, Faculty of Medicine Siriraj Hospital/ Mahidol University, Bangkok, Thailand


SYNOPSIS

Incidence of newly diagnosed cancers in Thai children less than 15 years old is approximately 1,000-1,200 cases/year. Advances in cancer treatment improves outcome of these patients and as a consequence, the number of childhood cancer survivors continues to grow. From study of Thai Pediatric Oncology Group, the 5-year overall survival of these patients is 54.9% (95%CI: 53.0-56.9%) for all cancers. These long-term survivors of childhood cancer are at increased risk for therapy-related late effects and late mortality. The Childhood Cancer Survivor Study (CCSS); a large North American cohort study, revealed that 60% of long-term survivors had more than 1 chronic medical problems and 30-40% of them had 2 or more chronic medical problems. Moreover 30% of these survivors had a severe (grade 3) or life-threatening or disabling (grade 4) chronic condition. 

The most common organ specific late adverse effect is long-term neurological complication. Most neurological toxicity is related to central nervous system (CNS) tumors or cranial radiation and/or CNS-directed chemotherapy (intrathecal or high dose intravenous methotrexate or cytarabine). Long-term complications can affect many organs such as hepatic, renal, endocrine, cardiology, and pulmonary systems. Patients who are treated at younger age are more common and severe to acquire toxicities. Other risk factors for long-term complications depend on type of primary malignancy, modality of treatment, type and dose of chemotherapy, dose and field of radiation treatment, site and extent of surgery. Long-term follow up of growth, puberty, and psychosocial aspect is also important because these patients can have delay growth or puberty, problem at school, and behavioral or psychological problem. Another issue of concerning is second malignancy from chemotherapy or radiation which can occur many years after completion of treatment. 

In summary, prevalence of late effects after treatment of childhood cancer is significant. A long-term follow up program for survivors of childhood cancer is therefore needed.


SOFT TISSUE SARCOMA IN ADOLESCENTS AND YOUNG ADULTS (AYAs)

Associate Professor Piti Techavichit, MD

Division of Hematology and Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand


SYNOPSIS

Soft tissue sarcoma is a group of rare cancers comprise for less than 1% of all malignancies but account roughly 10% of all cancers among patients who diagnosed during adolescent and young adult (AYA) ages. Importantly, over half of all soft tissue sarcoma diagnoses occur in the AYA age group. Survival from soft tissue sarcoma among AYAs is inferior to younger patients even in the same histology subtype. Soft tissue sarcoma-related survival is low compared with other malignancies in AYAs, and AYAs diagnosed with late stage sarcomas have poorer survival.

Several studies have suggested that outcomes for soft tissue sarcoma are improved when treated by pediatric inspired protocol with multidisciplinary team approach. Neoadjuvant and adjuvant chemotherapy follow by surgery are wildly recommended for bone sarcoma and Ewing family tumor. While radiation therapy is indicated for Ewing family tumor. Chemotherapy is considered the standard care for rhabdomyosarcomas, synovial sarcoma, and desmoplastic small round cell tumors, but is not standard for other nonrhabdomyosarcoma subtypes, which local control is the mainstay.

Event Hours(1)

  • Lotus 1-2.

    11:30 am – 12:00 pm

    Speakers:
    1. Assoc. Prof. Kleebsabai Sanpakit (SI)
    2. Dr. Piti Techawichit (CU)
    3. Assoc. Prof. Preeda Vanichsetakul (CRA)
    4. Assoc.Prof. Samart Pakakasama (Rama)

    Moderator:
    Prof. Suradej Hongeng (Rama)