Evaluation of acute organ toxicity, biochemical and metabolic changes in pediatric oncology patients

Abstract

Introduction: Organ toxicity is common in childhood cancers and can cause delays in chemotherapy and worsening of prognosis. In this study, we aimed to evaluate organ toxicities, biochemical and metabolic abnormalities associated with the tumor and/or chemotherapy in the acute phase of treatment in children with cancer.Materials and Methods: The data of 305 patients with lymphoma and solid tumors who received chemotherapy between 01.01.2010 and 31.12.2015 in a tertiary healthcare facility were retrospectively evaluated. The effects of age, gender, cancer stage, chemotherapy group, surgery and radiotherapy on organ toxicity in the first 30 days of treatment were analyzed.Results: The mean age of the patients at admission was 97 months, and the male/female ratio was 1.5. The most common diagnoses were lymphomas (27.6%), CNS and spinal canal tumors (12.5%) and neuroblastoma (11.8%). Chemotherapy was applied to all the patients, surgery to 61.3% (n=187), and radiotherapy to 13.1% (n=40). Organ toxicity was detected in 59% (n=180) of the patients. The use of alkylating agents, antimetabolites, plant products, and no surgery were risk factors for hepatotoxicity (p<0.05). The only risk factor for nephrotoxicity was antimetabolite drug use (p<0.05). The most common electrolyte disorder was hyponatremia, observed in 56.7% (n=173) of the patients. Two patients died during the study period, which were not due to organ toxicity, metabolic disease, or electrolyte disturbance.Conclusion: The rate of organ toxicity as well as biochemical, electrolyte, and metabolic abnormalities were found to be high. These high rates were thought to be related to the excessive tumor burden and organ involvement and the intensity of the combined chemotherapies applied. No associated mortality was observed despite these high rates. Early detection of these pathologies, close follow-up and immediate treatment with the multidisciplinary approach to treatment were described as the reason for the absence of mortality.