Late Effects in Survivors of Childhood Cancer

Abstract

1. Mandy M. Meck, MD* 2. Margaret Leary, MD* 3. Richard H. Sills, MD* 1. *Albany Medical College, Department of Pediatrics, Division of Pediatric Hematology/Oncology, Albany, NY After completing this article, readers should be able to: 1. Describe common late effects in children who are treated for cancer. 2. Know the common clinical presentations for the more serious late effects. 3. Explain how to monitor survivors of childhood cancer for late effects. 4. Recognize when to refer patients to a pediatric oncologist or other specialist. A 19-year-old male was treated for cerebellar medulloblastoma at 3 years of age. Therapy included total resection followed by craniospinal radiation in a dose of 3,600 cGy, with a boost to 5,040 cGy to the tumor bed, as well as chemotherapy with vincristine, cyclophosphamide, and cisplatin. School was a struggle, and he was held back in the 8th grade. One physician suggested methylphenidate therapy, but the boy’s mother refused. He has just graduated from high school but is having difficulty obtaining employment. Now he presents with his fiancee because they want to know if he can father children. He shows no evidence of recurrent disease or complications of his tumor. Physical examination documents a weight of 60 kg (16th percentile) and height of 158 cm (<3rd percentile). Abnormalities include a 3×4 cm area of alopecia over his occipital region and a posterior midline craniotomy scar. His only neurologic deficit is a mild impairment in upward gaze bilaterally. He has no lymphadenopathy or thyroid abnormalities. He is at Sexual Maturity Rating (SMR) 5. Results of complete blood count, chemistry profile, and thyroid function tests are normal; the insulin-like growth factor value is low. Semen analysis is normal. Audiogram demonstrates mild-to-moderate bilateral sensorineural hearing loss. The combined radiation and chemotherapy administered to the boy at a relatively young age would be expected to cause neurocognitive dysfunction. School problems are common for children treated with craniospinal irradiation (even older children), who should be evaluated and problems addressed promptly to …