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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p class="elsevierStyleSimplePara elsevierViewall">El c&#225;ncer es el resultado final de la interacci&#243;n multifactorial de dos clases de determinantes&#44; el gen&#233;tico &#40;end&#243;geno&#41; y el ambiental &#40;ex&#243;geno&#41;&#46; El progreso evidenciado por la oncolog&#237;a pedi&#225;trica&#44; durante las &#250;ltimas d&#233;cadas&#44; tambi&#233;n se ha reflejado en los tumores &#243;seos malignos &#40;TOM&#41;&#46; Estos avances se centran en los aspectos diagn&#243;sticos y terap&#233;uticos&#44; pero no en los factores de riesgo &#40;FR&#41; implicados en su etiopatogenia&#46;</p> <span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">La presente revisi&#243;n tiene tres objetivos&#58; <span class="elsevierStyleItalic">a&#41;</span> actualizar el conocimiento de los FR asociados con los TOM durante la &#233;poca pedi&#225;trica y adulta&#59; <span class="elsevierStyleItalic">b&#41;</span> divulgar entre todos nuestros compa&#241;eros los principales FR relacionados a los TOM&#44; para fomentar su investigaci&#243;n&#44; diagn&#243;stico y futura prevenci&#243;n&#44; y <span class="elsevierStyleItalic">c&#41;</span> solicitar la ayuda de nuestros colegas para el proyecto de investigaci&#243;n <span class="elsevierStyleItalic">Medio ambiente y c&#225;ncer pedi&#225;trico</span>&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Revisi&#243;n bibliogr&#225;fica sistem&#225;tica&#44; de los &#250;ltimos 30 a&#241;os&#44; de los FR implicados en la etiopatogenia de los TOM&#44; obtenida del Medline&#44; Cancerlit&#44; Index Citation Science y Embase&#46; Los perfiles de b&#250;squeda utilizados han sido&#58; <span class="elsevierStyleItalic">pediatric&#47; childhood malignant bone tumors&#44; pediatric&#47;childhood bone cancer&#47;neoplasm&#44; osteosarcoma&#47;bone sarcoma&#47; Ewing&#39;s sarcoma and risk factors&#47;etiology&#47;epidemiology</span>&#46; Se han seleccionado los art&#237;culos m&#225;s interesantes y de sus referencias&#44; las m&#225;s relevantes&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Los TOM constituyen el 6-7&#37; de los c&#225;nceres pedi&#225;tricos&#46; Las dos variedades m&#225;s frecuentes son el osteosarcoma &#40;OTS&#41; y el sarcoma de Ewing &#40;SE&#41;&#44; con el 56 y el 34&#37; de los casos&#44; respectivamente&#46; Los FR asociados con el OTS son los siguientes&#58; <span class="elsevierStyleItalic">a&#41;</span> patolog&#237;as &#243;seas preexistentes &#40;enfermedad de Paget&#41;&#59; <span class="elsevierStyleItalic">b&#41;</span> factores gen&#233;tico-familiares &#40;retinoblastoma hereditario&#44; s&#237;ndrome de Li-Fraumeni&#44; syndrome de Rothmund-Thompson&#44; s&#237;ndrome de Bloom&#44; OTS familiar y anemia de Diamond-Blackfan&#41;&#59; <span class="elsevierStyleItalic">c&#41;</span> factores qu&#237;micos &#40;sustancias antineopl&#225;sicas&#41;&#59; <span class="elsevierStyleItalic">d&#41;</span> factores f&#237;sicos &#40;radiaci&#243;n ionizante&#41;&#59; <span class="elsevierStyleItalic">e&#41;</span> factores biol&#243;gicos&#59; <span class="elsevierStyleItalic">f&#41;</span> ocupaciones parentales&#44; y <span class="elsevierStyleItalic">g&#41;</span> otros factores &#40;implantes &#243;seos artificiales y traumatismos&#41;&#46; Los FR asociados con el SE son los siguientes&#58; <span class="elsevierStyleItalic">a&#41;</span> &#233;tnico-culturales &#40;raza blanca&#41;&#59; <span class="elsevierStyleItalic">b&#41;</span> factores gen&#233;ticos&#59; <span class="elsevierStyleItalic">c&#41;</span> ocupaciones parentales &#40;exposiciones laborables a herbicidas&#44; pesticidas y fertilizantes&#41;&#59; <span class="elsevierStyleItalic">d&#41;</span> antecedents obst&#233;tricos maternos&#44; y <span class="elsevierStyleItalic">e&#41;</span> otros factores &#40;tabaquismo parental y hernias inguinales&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La mayor&#237;a de las causas de los TOM son desconocidas&#46; Los principales FR implicados&#44; con mayor o menor evidencia cient&#237;fica&#44; en la etiopatogenia del OTS son&#58; enfermedad de Paget&#44; retinoblastoma hereditario&#44; s&#237;ndrome de Li-Fraumeni&#44; sustancias antineopl&#225;sicas y radiaci&#243;n ionizante&#46; Los principales FR asociados al SE son&#58; raza blanca&#44; exposiciones ocupacionales parentales&#44; tabaquismo parental y antecedente de hernia inguinal intervenida&#46; Las principales dificultades para avanzar en el conocimiento de los FR relacionados con el desarrollo de los TOM son&#58; <span class="elsevierStyleItalic">a&#41;</span> su origen multifactorial&#59; <span class="elsevierStyleItalic">b&#41;</span> la baja prevalencia poblacional&#59; <span class="elsevierStyleItalic">c&#41;</span> la inexistente formaci&#243;n en salud medioambiental pedi&#225;trica&#44; y <span class="elsevierStyleItalic">d&#41;</span> los escasos presupuestos econ&#243;micos p&#250;blicos o privados destinados a tal finalidad&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStyleSimplePara elsevierViewall">Cancer is the result of the interaction of two kinds of determinants&#58; genetic &#40;endogenous&#41; and environmental &#40;exogenous&#41;&#46; In the last few decades&#44; pediatric oncology as a whole has progressed&#44; including knowledge of malignant osseous tumors &#40;MOT&#41;&#46; Although advances have been made in diagnostic and therapeutic aspects&#44; little progress has taken place in our knowledge of the risk factors involved in their etiopathogenesis&#46;</p> <span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">This review has three objectives&#58; <span class="elsevierStyleItalic">a&#41;</span> to provide an update on MOT-related risk factors in the child and adult population&#59; <span class="elsevierStyleItalic">b&#41;</span> to disseminate knowledge of the main MOT-related risk factors among our colleagues in order to promote research into these factors&#44; diagnosis and future prevention&#44; and <span class="elsevierStyleItalic">c&#41;</span> to request help from our colleagues in the <span class="elsevierStyleItalic">Environment and Pediatric Cancer</span> research project&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p class="elsevierStyleSimplePara elsevierViewall">We performed a systematic review of the literature published in the last 30 years on risk factors implicated in the etiopathogenesis of MOT&#44; using Medline&#44; Cancerlit&#44; Science Citation Index and Embase&#46; The search profiles used were&#58; <span class="elsevierStyleItalic">pediatric&#47;childhood malignant bone tumors&#44; pediatric&#47; childhood bone cancer&#47;neoplasm&#44; osteosarcoma&#47;bone sarcoma&#47;Ewing&#39;s sarcoma and risk factors&#47;etiology&#47;epidemiology</span>&#46; The most interesting articles were selected and the most relevant references contained therein were retrieved&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">MOT represent 6-7&#37; of all pediatric neoplasms&#46; The most frequent types are osteosarcoma &#40;OS&#41; and Ewing&#39;s sarcoma &#40;ES&#41;&#44; representing 56 &#37; and 34 &#37; respectively&#46; OS-related risk factors are the following&#58; <span class="elsevierStyleItalic">a&#41;</span> previous osseous disease &#40;Paget&#39;s disease&#41;&#59; <span class="elsevierStyleItalic">b&#41;</span> familial-genetic factors &#40;hereditary retinoblastoma&#44; Li-Fraumeni syndrome&#44; Rothmund- Thompson syndrome&#44; Bloom syndrome&#44; familial OS&#44; Diamond-Blackfan anemia&#41;&#59; <span class="elsevierStyleItalic">c&#41;</span> chemical factors &#40;antineoplastic drugs&#41;&#59; <span class="elsevierStyleItalic">d&#41;</span> physical factors &#40;ionizing radiation&#41;&#59; <span class="elsevierStyleItalic">e&#41;</span> biologic factors&#59; <span class="elsevierStyleItalic">f&#41;</span> parental occupation&#44; and g&#41; other factors &#40;artificial osseous implants and traumatisms&#41;&#46; ES-related risk factors are the following&#58; <span class="elsevierStyleItalic">a&#41;</span> ethnic-cultural &#40;Caucasian race&#41;&#59; <span class="elsevierStyleItalic">b&#41;</span> genetic factors&#59; <span class="elsevierStyleItalic">c&#41;</span> parental occupation &#40;herbicide&#44; pesticide ad fertilizer exposure&#41;&#59; <span class="elsevierStyleItalic">d&#41;</span> maternal obstetric history&#44; and <span class="elsevierStyleItalic">e&#41;</span> other factors &#40;parental smoking and inguinal hernia&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Most causes of MOT are unknown&#46; Based on different levels of scientific evidence&#44; the main factors implicated in the etiopathogenesis of OS are&#58; Paget&#39;s disease&#44; hereditary retinoblastoma&#44; Li-Fraumeni syndrome&#44; antineoplastic drugs&#44; and ionizing radiation&#46; The main factors related to ES are&#58; Caucasian race&#44; parental occupation&#44; parental smoking&#44; and surgery for inguinal hernia&#46; The main obstacles to greater knowledge of MOT-related factors are&#58; <span class="elsevierStyleItalic">a&#41;</span> their multiple origin&#59; <span class="elsevierStyleItalic">b&#41;</span> the low prevalence in the population&#59; <span class="elsevierStyleItalic">c&#41;</span> lack of environmental health training in pediatrics&#44; and <span class="elsevierStyleItalic">d&#41;</span> the low public and private investment in this research field&#46;</p>"
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Vol. 63. Núm. 6.
Páginas 537-547 (diciembre 2005)
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Vol. 63. Núm. 6.
Páginas 537-547 (diciembre 2005)
Artículo especial
Acceso a texto completo
Factores de riesgo para los tumores óseos malignos pediátricos
Risk factors for pediatric malignant bone tumors
Visitas
13771
J. Ferrís i Tortajadaa,b,
Autor para correspondencia
ferris_jos@gva.es
http://www.pehsu.org

Correspondencia: Dr. J. Ferrís i Tortajada. Unidad de Salud Medioambiental. Sección de Oncología Pediátrica. Hospital Universitario Materno-Infantil La Fe. Avda. Campanar, 21. 46009 Valencia. España.
, O. Berbel Torneroa, J.A. Ortega Garcíaa, L. Claudio-Moralesd, J. García i Castelle, V. Martí Peralesf, L. Miranda Casasf
a Unidad de Salud Medioambiental Pediátrica. Hospital Universitario Virgen de la Arrixaca. Murcia. España
b Sección de Oncología Pediátrica. Hospital Materno-Infantil Universitario La Fe. Valencia. Unidad de Salud Medicoambiental Pediátrica. Hospital Universitario Virgen de la Arrixaca. Murcia. España
d Department of Community and Preventive Medicine. Mount Sinai School of Medicine. Nueva York. EE.UU. España
e Servicio de Anatomía Patológica. Hospital de Sagunto. Valencia. España
f Sección de Traumatología y Ortopedia Pediátrica. Hospital Materno-Infantil Universitario La Fe. Valencia. España
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Estadísticas
Introducción

El cáncer es el resultado final de la interacción multifactorial de dos clases de determinantes, el genético (endógeno) y el ambiental (exógeno). El progreso evidenciado por la oncología pediátrica, durante las últimas décadas, también se ha reflejado en los tumores óseos malignos (TOM). Estos avances se centran en los aspectos diagnósticos y terapéuticos, pero no en los factores de riesgo (FR) implicados en su etiopatogenia.

Objetivo

La presente revisión tiene tres objetivos: a) actualizar el conocimiento de los FR asociados con los TOM durante la época pediátrica y adulta; b) divulgar entre todos nuestros compañeros los principales FR relacionados a los TOM, para fomentar su investigación, diagnóstico y futura prevención, y c) solicitar la ayuda de nuestros colegas para el proyecto de investigación Medio ambiente y cáncer pediátrico.

Material y métodos

Revisión bibliográfica sistemática, de los últimos 30 años, de los FR implicados en la etiopatogenia de los TOM, obtenida del Medline, Cancerlit, Index Citation Science y Embase. Los perfiles de búsqueda utilizados han sido: pediatric/ childhood malignant bone tumors, pediatric/childhood bone cancer/neoplasm, osteosarcoma/bone sarcoma/ Ewing's sarcoma and risk factors/etiology/epidemiology. Se han seleccionado los artículos más interesantes y de sus referencias, las más relevantes.

Resultados

Los TOM constituyen el 6-7% de los cánceres pediátricos. Las dos variedades más frecuentes son el osteosarcoma (OTS) y el sarcoma de Ewing (SE), con el 56 y el 34% de los casos, respectivamente. Los FR asociados con el OTS son los siguientes: a) patologías óseas preexistentes (enfermedad de Paget); b) factores genético-familiares (retinoblastoma hereditario, síndrome de Li-Fraumeni, syndrome de Rothmund-Thompson, síndrome de Bloom, OTS familiar y anemia de Diamond-Blackfan); c) factores químicos (sustancias antineoplásicas); d) factores físicos (radiación ionizante); e) factores biológicos; f) ocupaciones parentales, y g) otros factores (implantes óseos artificiales y traumatismos). Los FR asociados con el SE son los siguientes: a) étnico-culturales (raza blanca); b) factores genéticos; c) ocupaciones parentales (exposiciones laborables a herbicidas, pesticidas y fertilizantes); d) antecedents obstétricos maternos, y e) otros factores (tabaquismo parental y hernias inguinales).

Conclusiones

La mayoría de las causas de los TOM son desconocidas. Los principales FR implicados, con mayor o menor evidencia científica, en la etiopatogenia del OTS son: enfermedad de Paget, retinoblastoma hereditario, síndrome de Li-Fraumeni, sustancias antineoplásicas y radiación ionizante. Los principales FR asociados al SE son: raza blanca, exposiciones ocupacionales parentales, tabaquismo parental y antecedente de hernia inguinal intervenida. Las principales dificultades para avanzar en el conocimiento de los FR relacionados con el desarrollo de los TOM son: a) su origen multifactorial; b) la baja prevalencia poblacional; c) la inexistente formación en salud medioambiental pediátrica, y d) los escasos presupuestos económicos públicos o privados destinados a tal finalidad.

Palabras clave:
Tumores óseos malignos pediátricos
Osteosarcoma
Sarcoma de Ewing
Factores de riesgo
Introduction

Cancer is the result of the interaction of two kinds of determinants: genetic (endogenous) and environmental (exogenous). In the last few decades, pediatric oncology as a whole has progressed, including knowledge of malignant osseous tumors (MOT). Although advances have been made in diagnostic and therapeutic aspects, little progress has taken place in our knowledge of the risk factors involved in their etiopathogenesis.

Objective

This review has three objectives: a) to provide an update on MOT-related risk factors in the child and adult population; b) to disseminate knowledge of the main MOT-related risk factors among our colleagues in order to promote research into these factors, diagnosis and future prevention, and c) to request help from our colleagues in the Environment and Pediatric Cancer research project.

Material and methods

We performed a systematic review of the literature published in the last 30 years on risk factors implicated in the etiopathogenesis of MOT, using Medline, Cancerlit, Science Citation Index and Embase. The search profiles used were: pediatric/childhood malignant bone tumors, pediatric/ childhood bone cancer/neoplasm, osteosarcoma/bone sarcoma/Ewing's sarcoma and risk factors/etiology/epidemiology. The most interesting articles were selected and the most relevant references contained therein were retrieved.

Results

MOT represent 6-7% of all pediatric neoplasms. The most frequent types are osteosarcoma (OS) and Ewing's sarcoma (ES), representing 56 % and 34 % respectively. OS-related risk factors are the following: a) previous osseous disease (Paget's disease); b) familial-genetic factors (hereditary retinoblastoma, Li-Fraumeni syndrome, Rothmund- Thompson syndrome, Bloom syndrome, familial OS, Diamond-Blackfan anemia); c) chemical factors (antineoplastic drugs); d) physical factors (ionizing radiation); e) biologic factors; f) parental occupation, and g) other factors (artificial osseous implants and traumatisms). ES-related risk factors are the following: a) ethnic-cultural (Caucasian race); b) genetic factors; c) parental occupation (herbicide, pesticide ad fertilizer exposure); d) maternal obstetric history, and e) other factors (parental smoking and inguinal hernia).

Conclusions

Most causes of MOT are unknown. Based on different levels of scientific evidence, the main factors implicated in the etiopathogenesis of OS are: Paget's disease, hereditary retinoblastoma, Li-Fraumeni syndrome, antineoplastic drugs, and ionizing radiation. The main factors related to ES are: Caucasian race, parental occupation, parental smoking, and surgery for inguinal hernia. The main obstacles to greater knowledge of MOT-related factors are: a) their multiple origin; b) the low prevalence in the population; c) lack of environmental health training in pediatrics, and d) the low public and private investment in this research field.

Key words:
Pediatric malignant bone tumour
Osteosarcoma
Ewing's sarcoma
Risk factor
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Trabajo financiado parcialmente por la Fundación Científica de la AECC (MAPACE-2004) y por el Programa de Capacitación en Salud Ambiental y Ocupacional del Mount Sinai Medical Center, con el apoyo del Fogarty International Center (NIH TW00640).

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