Table 1.
Potential Late Effects of Selected Therapeutic Interventions for Childhood, Adolescent and Young Adult Cancer by Organ
| Organ | Therapeutic Exposures | Potential Late Effect | ||
|---|---|---|---|---|
| Chemotherapy | Radiation Therapy Field(s) | Surgery | ||
| Any organ/tissue | All fields | Subsequent neoplasms (skin, breast, thyroid, brain, colon, bone, soft tissues, etc) | ||
| Bones | Corticosteroids Methotrexate |
-- | -- | Osteopenia/osteoporosis Osteonecrosis |
| Bones/soft tissues | -- | All fields | -- | Reduced/uneven growth Reduced function/mobility Hypoplasia, fibrosis Radiation-induced fracture Scoliosis/kyphosis (trunk fields only) |
| Bones/soft tissues | -- | -- | Amputation Limb sparing |
Reduced/uneven growth Reduced function/mobility Chronic pain |
| Bowel | -- | Abdomen1 Pelvis Spine (lumbar, sacral, whole) |
Laparotomy Pelvic/spinal surgery |
Chronic enterocolitis GI tract strictures Adhesions/obstruction Fecal incontinence |
| Bladder | Cyclophosphamide Ifosfamide |
Pelvic Spine (sacral, whole) |
Spinal surgery Cystectomy |
Hemorrhagic cystitis Bladder fibrosis Dysfunctional voiding Neurogenic bladder |
| Brain (cognitive function) | Methotrexate (intrathecal administration or IV doses ≥1000 mg/m2) Cytarabine (IV doses ≥1000 mg/m2) |
Head/Brain Total body |
Neurosurgery | Neurocognitive deficits (executive function, attention, memory, processing speed, visual motor integration) Learning deficits Diminished intelligence quotient |
| Brain (motor and sensory function) | Methotrexate, cytarabine (intrathecal administration or IV doses ≥1000 mg/m2) | Head/Brain | Neurosurgery | Cranial nerve dysfunction Motor and sensory deficits including paralysis Cerebellar dysfunction Seizures |
| Brain (hypothalamic-pituitary axis) | -- | Head/Brain Total body |
Neurosurgery | Growth hormone deficiency Precocious puberty (altered gonadotropin secretion) Gonadotropin insufficiency Central adrenal insufficiency (XRT ≥30 Gy) |
| Brain (vascular) | -- | Head/Brain | Neurosurgery | Cerebrovascular complications (stroke, moya moya, occlusive cerebral vasculopathy) |
| Breast | -- | Chest Axilla Total body |
-- | Breast tissue hypoplasia Breast cancer |
| Ear | Cisplatin Carboplatin (in myeloablative doses only) |
Head/Brain | -- | Sensorineural hearing loss (XRT doses ≥30 Gy) Conductive hearing loss (XRT only) Eustachian tube dysfunction (XRT only) |
| Esophagus | Neck Chest Abdomen Spine (cervical, thoracic, whole) |
Esophageal stricture | ||
| Eye | Busulfan Corticosteroids |
Head/Brain Total body |
Neurosurgery | Cataracts Retinopathy (XRT only) Ocular nerve palsy (neurosurgery only) |
| Heart | Anthracycline agents (eg, doxorubicin, daunorubicin) | Chest Abdomen Spine (thoracic, whole) Total body |
-- | Cardiomyopathy Congestive heart failure Arrhythmia Subclinical left ventricular dysfunction XRT only:
|
| Kidney | Cisplatin Carboplatin Ifosfamide Methotrexate |
Abdomen Total body |
Nephrectomy | Glomerular toxicity Tubular dysfunction Renal insufficiency Hypertension |
| Liver/biliary tract | Antimetabolites (mercaptopurine, thioguanine, methotrexate) | Abdomen | -- | Hepatic dysfunction Veno-occlusive disease Hepatic fibrosis, cirrhosis Cholelithiasis |
| Lungs | Bleomycin Busulfan Carmustine Lomustine |
Chest Axilla Total body |
Pulmonary resection Lobectomy |
Pulmonary fibrosis Interstitial pneumonitis Restrictive/obstructive lung disease Pulmonary dysfunction |
| Nerves (peripheral) | Plant alkaloids (vincristine, vinblastine) Cisplatin, carboplatin |
-- | Spinal surgery | Peripheral sensory or motor neuropathy |
| Ovary | Alkylating agents (eg, busulfan, carmustine, lomustine, cyclophosphamide, mechlorethamine, melphalan, procarbazine) | Pelvis Spine (sacral, whole) Total body |
Oophorectomy | Ovarian hormone insufficiency Delayed/arrested puberty Premature menopause Diminished ovarian reserve Infertility Uterine vascular insufficiency (XRT only) Vaginal fibrosis/stenosis (XRT only) |
| Skin | -- | All fields | -- | Permanent alopecia Altered skin pigmentation Telangiectasias Fibrosis Dysplastic nevi |
| Spleen | Abdomen (doses ≥40 Gy) | Splenectomy | Life-threatening infection related to functional or anatomic aspleniaa | |
| Teeth | Any chemotherapy before development of secondary dentition | Head/Brain Neck Spine (cervical, whole) Total body |
-- | Dental maldevelopment (tooth/root agenesis, microdontia, enamel dysplasia) Periodontal disease Dental caries Osteoradionecrosis (XRT doses ≥40 Gy) |
| Testes | Alkylating agents (eg, busulfan, carmustine, lomustine, cyclophosphamide, mechlorethamine, melphalan, procarbazine) | Testes Total body |
Pelvic/spinal surgery Orchiectomy |
Testosterone insufficiency Delayed/arrested puberty Impaired spermatogenesis Infertility Erectile/ejaculatory dysfunction |
| Thyroid | Head/Brain Neck Spine (cervical, whole) Total body |
Thyroidectomy | Hypothyroidism Hyperthyroidism Thyroid nodules (XRT only) |
|
Gy indicates Gray; IV, intravenous; XRT, radiation therapy.
Note: This table briefly summarizes potential late effects for selected therapeutic exposures only; the complete set of Long-Term Follow-Up Guidelines from the Children’s Oncology Group, including screening recommendations, is available at www.survivorshipguidelines.org. In addition to organ/tissue-specific late effects, any cancer experience may increase the risk of adverse psychosocial and quality-of-life outcomes summarized at www.survivorshipguidelines.org (sections 1-6).
a
Functional asplenia can also occur as a consequence of active chronic graft-versus-host disease following hematopoietic stem cell transplant