The majority of patients followed after therapy for pediatric astrocytomas will have received high dose RT to encompass only the site of the primary tumor - which might be supra or infratentorial. However some patients may have received craniospinal RT for metastatic disease. After treatment for astrocytomas there are many chronic health problems to be aware of and to screen for in long-term survivors of this disease:
| Investigation |
Important aspects to assess: |
| History |
General:
- Current health, energy level, appetite, any new symptoms
- Social/employment situation
- Life style: smoking, alcohol and recreational drug history, exercise
- Current medications
- List of physicians/HCPs following patient
|
After cranial RT, check for:
|
After spinal RT, also check for:
|
After chemotherapy, check for:
|
| Examination |
Always Check:
- Blood pressure (increased risk of elevation associated with metabolic syndrome)
- Weight and height (Body Mass Index: BMI)
- Examine neck to exclude thyroid nodules
- Alopecia and hair thinning within previous RT field
- Neurological examination to look for focal neurological signs such as ataxia secondary to cerebellar damage. These signs will depend very much on the location of the primary tumor
- Visual acuity, visual fields and fundoscopy
- General examination of respiratory, cardiovascular and GI systems
|
After spinal RT also check:
- Spine for scoliosis, kyphosis and short sitting height
|
| Neurocognitive testing |
- Neurocognitive problems are common in survivors of pediatric astrocytomas. It is likely to be important that a neuropsychologist documents problems with higher mental function in detail. This will make it possible to obtain vocational or recreational rehab and to be eligible for a disability pension
|
| Hearing Assessment |
- Hearing loss is common. Audiology referral and testing should be organized every 1 - 2 years
|
| Blood work |
|
| Radiology screening |
- MR of the head every 3 years or so in long term follow up to exclude radiation induced meningiomas
- Ultrasound scan of the thyroid every 3 years after cranial and craniospinal RT
|
Specialist
follow-up |
Patient should be assessed by specialists every 1 - 2 years:
- Endocrinology
- Ophthalmology or Neuro-ophthalmology assessment important if tumor was close to visual pathways or orbit
|
| Supportive care |
- Family counselling
- Psychology
- Psychiatry
- Vocational rehab
|
| Other screening |
After spinal RT there is an increased risk of secondary malignancy:
- Patient should have early screening for colon cancer
- COG recommends that colonoscopy should be performed beginning at age 35 years or 10 years following
RT (whichever occurs last)
|
Early screening for osteoporosis (bone density)
|
| Advice |
ACTH deficiency:
- Survivors of astrocytomas with hypopituitarism and ACTH deficiency need support with extra steroid medication during infections, surgery and illness
- Medic Alert bracelets are advised to warn about ACTH deficiency
|
Second malignant
neoplasms (SMNs):
The patient should be advised to seek immediate medical
help if:
- A new swelling (painless or painful) appears within the previous RT field as
this may be due to a SMN
- Severe, persistent headaches develop associated with possible nausea and
vomiting (may be associated with a new intracranial mass lesion)
|
Lifestyle:
- Advise about diet, exercise and lifestyle choices (such as smoking) which may further increase the risk of vascular disease.
- Diet should contain adequate number of dairy servings, Vitamin D and calcium to help prevent osteoporosis
- Previous spinal RT may be associated with spinal underdevelopment, scoliosis and increased risk of degenerative arthritis and osteoporosis - therefore survivors who had this therapy should avoid work which involves lifting heavy weights
|
Patient Information
COG Survivorship Guidelines |
|
