ESPE Yearbook of Paediatric Endocrinology

Preface: Survival rates of childhood cancer have been steadily improving over the past 3 decades, with 5-year overall survival now approaching 85% in Western countries. These changes have shifted parental and patients’ concerns. While survival was previously the primary concern, the late effects of cancer treatment are now becoming major healthcare issues. Epidemiological studies in childhood cancer survivors (CCS) have shown a significant decrease in male fertility when compared to their healthy siblings. Low sperm count or azoospermia are the most common characteristics of infertility in these patients. Studies of sperm from adult cancer patients showed that cancer itself and its treatment are able to induce sperm aneuploidy, chromatin damage, and epigenetic changes that persist for years post chemotherapy. In childhood cancer, it is still unclear whether the sperm produced years after the completion of cancer treatment may still contain chromatin and DNA damage.

The increasing awareness of severe late health effects includes subsequent malignant neoplasms. These neoplasms occur after an initial cancer treatment or HSCT, and represent histologically distinct primary malignancies. They account for nearly one-half of CCS non-relapse mortality. Previous treatment with radiotherapy is a major risk factor for second neoplasias. Thyroid cancer accounts for 10–20% of subsequent malignant neoplasia in CCS.

Finally, the impairment of cardiometabolic fitness and the increased risk of cardiovascular disease (CVD) are major emerging concerns in CCS. Several cohort studies from the USA and Europe have shown that young adult CCS have an up to 8-fold higher risk of death from CVD, compared to age- and sex-matched individuals. Endothelial dysfunction and chronic low-grade inflammation are supposed to be the first steps in the development of early atherosclerosis leading to CVD. New insights in CVD pathogenesis have allowed the detection of sensitive and noninvasive biomarkers of a pre-atherosclerotic status in young adult CCS.