Table 2.

Examples of Delayed Treatment-associated Organ Effects

Organ	Toxicity	Associated agents
Cardiac	Congestive heart failure	Anthracyclines (e.g., doxorubicin)
		Rates increase further out from treatment
		(reported up to 25 years)
		Irreversible systolic and diastolic dysfunction
		Risk increases with
		increasing dose
		younger age at treatment
		Trastuzumab
		Reversible, not dose dependent
		Long-term studies lacking
		Radiation* –largely diastolic dysfunction
	Conduction problems	Radiation*
	(AV block, BBB)
	Pericardial disease	Radiation*
		Presents months to years later
		May progress to chronic constrictive pericarditis
	Valvular	Radiation* (AI most commonly seen)
	Atherosclerosis	Cisplatin-
		Endothelial damage
		May also increase risk of traditional heart disease
		risk factors (e.g., lipid problems and obesity)
		Radiation* (RCA more commonly involved)
Pulmonary	Pneumonitis	Radiation*
	(1–3 months after therapy)	Risk highest for external beam radiation for lung cancer
		Bleomycin-
		Usually acute but there are reports as late as 2 years after therapy
		Risk increases with concurrent use of radiation
	Pulmonary fibrosis	Radiation*
Nervous system	Neuropathy	Taxanes (e.g., docetaxel, paclitaxel)
Other	Leukemia	Alkylating agents
	Premature	Alkylating agents
	Menopause
	Lymphedema	Especially with both axillary node dissection and radiation

atrioventricular, bundle branch block, aortic insufficiency, right coronary artery

*Radiation toxicity significantly reduced after 1985.