Late Effects: Treatment-related Problems

Central Nervous System Cognitive

• Symptom: Learning disabilities
  Causative Associated Treatment: Cranial radiation, Methotrexate (high-dose and intrathecal)
• Symptom: Anatomic changes
  Causative Associated Treatment: Resection of tumor

Central Nervous System-Peripheral

• Symptom: Weakness, numbness, tingling, foot drop
  Causative Associated Treatment: Vincristine, Vinblastine, Etoposide, Cisplatin

Endocrine

• Symptom: Ovarian dysfunction
  Causative Associated Treatment: Procarbazine, Cytoxan, BCNU, CCNU, Nitrogen Mustard, Busulfan Cisplatin, Cranial radiation
• Symptom: Testicular dysfunction
  Causative Associated Treatment: Procarbazine, Cytoxan, BCNU, CCNU, Cisplatin, Cranial radiation
• Symptom: Thyroid dysfunction
  Causative Associated Treatment: Neck or cervical spine radiation, Total body irradiation, Thyroidectomy
• Symptom: Hypothalamic-pituitary axis Dysfunction
Causative Associated Treatment: Cranial radiation, Resection of tumor in HPA region

Cardiovascular

• Symptom: Cardiomyopathy Causative Associated Treatment: Anthracycline chemotherapy, High-dose Cytoxan, Mediastinal Radiation
• Symptom: Pericardial damage
  Causative Associated Treatment: Mediastinal radiation
• Symptom: Early coronary artery Atherosclerosis
  Causative Associated Treatment: Mediastinal radiation
• Symptom: Valvular damage
  Causative Associated Treatment: Mediastinal radiation
• Symptom: Ventricular arrhythmias
  Causative Associated Treatment: Anthracycline chemotherapy

Musculoskeletal

• Symptom: Scoliosis/Kyphosis
  Causative Associated Treatment: Thoracic radiation
• Symptom: Spinal shortening
  Causative Associated Treatment: Spinal radiation
• Symptom: Bone weakening/deformities
  Causative Associated Treatment: Radiation to bones, Corticosteroids, Vinca alkaloids
• Symptom: Facial asymmetry
  Causative Associated Treatment: Surgery, Radiation to head/neck
• Symptom:Dental problems
  Causative Associated Treatment: Radiation to jaw, Vincristine, Dactinomycin, Methotrexate, Mercaptopurine, Cytoxan, Procarbazine, Nitrogen Mustard

Vision

• Symptom: Cataracts
  Causative Associated Treatment: Corticosteroids, Radiation
• Symptom: Decreased tear production, Fibrosis of lacrimal duct, Ulcerations of eyelids, Decreased visual acuity, Conjunctive scarring/necrosis, Thinning of sclera, Corneal ulcers Causative Associated Treatment: Radiation

Hearing

• Symptom: Hearing loss, Tinnitus, Vertigo, Abnormal speech development
  Causative Associated Treatment: Cisplatin, Aminoglycosides, Radiation to the auditory area, Recurrent ear infections

Respiratory

• Symptom: Pulmonary fibrosis, pneumonitis
  Causative Associated Treatment: Radiation to chest/lung fields, Bleomycin, Chlorambucil, Mitomycin, Methotrexate, Cytarabine, BCNU, CCNU, Vinca alkaloids, Alkylating agents

Gastrointestinal

• Symptom: Fibrosis, strictures, obstruction, Enteritis, adhesions, ulcers, malabsorption Causative Associated Treatment: Abdominal radiation, Adriamycin, Dactinomycin, abdominal surgery

Liver

• Symptom: Liver fibrosis, cirrhosis, Hepatitis
  Causative Associated Treatment: Radiation, Dactinomycin, 6-Mercaptopurine and Methotrexate with Radiation

Kidney and Urinary Tract

• Symptom: Chronic nephritis, bladder deformities, Hemorrhagic cystitis, kidney damage/dysfunction
  Causative Associated Treatment: Radiation to kidney/pelvic area, Cisplatin, Ifosfamide, Cytoxan, Aminoglycosides, Cyclosporine
• Symptom: Unilateral kidney
  Causative Associated Treatment: Nephrectomy for Wilms Tumor

Hematologic

• Symptom: Hypoplastic/aplastic bone marrow, Frequent, recurrent infections, decreased Immunoglobulin levels
  Causative Associated Treatment: Radiation to marrow-containing bones, Total body irradiation, Splenectomy, High-dose chemotherapy for extended periods

Secondary Malignancies

• Symptom: Causative Associated Treatment: May occur in radiation field, High-dose chemotherapy, Etoposide