Table 1.

Host and Treatment Factors Increasing Risk of Selected Medical Complications ≥ 5 Years After Diagnosis of Childhood Cancer

Medical Late Effect	Host Factor	Treatment Factor
Hypothyroidism8	Female; older age at diagnosis (> 15 years)	Radiation to thyroid, any dose, increasing risk with increasing dose
Hyperthyroidism8	Time since diagnosis < 3 years	Radiation to thyroid ≥ 35 Gy
Thyroid nodules8	Female; time since diagnosis > 10 years	Radiation to thyroid ≥ 25 Gy
Short stature (analysis limited to ALL survivors)13	Female; diagnosis before puberty	Cranial radiation > 20 Gy; radiation to spine
Short stature (analysis limited to brain tumor survivors)12	Younger age at diagnosis (< 4 years)	Radiation to hypothalamic pituitary axis, any dose, increasing risk with increasing dose
Overweight/obese15	Female; younger age at diagnosis	Cranial radiation
Acute ovarian failure6	Diagnosis ≥ 12 years	Ovarian radiation > 10 Gy; procarbazine and cyclophosphamide
Premature menopause7	Older attained age	Ovarian radiation; alkylating agents
Pulmonary fibrosis25		Chest radiation; cyclophosphamide, bleomycin, busulfan, CCNU, and BCNU
Stroke31,32	Smoking (Hodgkin's disease)	Mantle radiation > 40 Gy for Hodgkin's disease; cranial radiation > 30 Gy for brain tumor and leukemia
Motor problems34		Radiation > 50 Gy to frontal regions
Hearing loss34		Radiation > 50 Gy to posterior fossa
Seizure disorder 34		Radiation dose > 30 Gy to any cortical segment of brain

Abbreviations: ALL, acute lymphoblastic leukemia; CCNU, lomustine; BCNU, carmustine.