Late side effects of pediatric radiotherapy.

Abstract

During the last two decades the place of radiotherapy in the combination treatment of pediatric malignancies has changed considerably, mainly because of the high chemosensitivity of most pediatric tumors. The essential role of radiotherapy for local tumor control has been widely clarified for Hodgkin’s disease, central nervous system (CNS) leukemia, soft tissue sarcoma, Ewing’s sarcoma, retinoblastoma, and nephroblastoma (stage II N+, III) and is being clarified for the majority of CNS malignancies. Local radiotherapy is no longer commonly used within multimodal treatment of standard risk acute lymphoblastic leukemia (ALL), non-Hodgkin’s lymphoma (NHL), prognostic favorable and operable nephroblastoma, operable osteosarcoma, extracranial germ cell tumors, histiocytosis X, and localized, chemoresponsive neuroblastoma. Late side effects of multimodal treatment will be observed with increasing frequencies due to the high cure rates — more than two thirds of all children with cancer survive (Table 1) — and the resulting long follow-up periods.