Radiotherapy (RT) Late Effects:
Late effects occur 90 days to many years after therapy. All cancer treatment is associated with adverse effects. RT treatment for neuroblastoma (NBL) is associated with long-term health risks and problems.
Late Effects associated abdominal RT (to adrenal bed):
|Organ at risk
Growth abnormalities and hypoplasia:
Increased risk of osteoporosis (especially involving the spine) and degenerative disease:
There is a small long term risk of veno-occlusive disease which consists of the clinical triad:
Patients may have undergone nephrectomy when their primary NBL tumor was resected and therefore have less renal reserve.
Large primary abdominal NBL tumors that cross the midline may extend very close to the contralateral kidney. RT to the tumor bed is likely to be associated with a significantly increased risk of chronic renal failure
If included in the RT treatment volume, stenosis of the contralateral renal artery may produce hypertension.
It is very important to check NBL survivor's blood pressure on a regular basis
Pelvic RT for a primary NBL arising in that region would be associated with a risk of gonadal failure
It would be anticipated that female patients who have abdominal RT for NBL - as with patients who received flank RT for Wilms are at increased risk for premature and low birth weight babies.
Late Effects associated with RT for paraspinal NBL:
Scoliosis and asymmetry of all musculoskeletal structures in the RT field are likely to occur due to:
There will be a decrease in sitting height and modest decrease in standing height after flank or abdominal RT depending on the age of the child at the time of therapy
If the child is very young, after RT to the thoracic spine there may be a mild restrictive problem due to reduced growth of the chest wall and ribs.
RT to the thoracic spine may be associated with:
Cervical spine RT is likely to be associated with a risk of hypothyroidism, thyroid nodules and papillary carcinoma of the thyroid.
Surgery Late Effects:
NBL patients often undergo a unilateral nephrectomy when their primary adrenal tumor is resected. Therefore they have many of the same long-term health concerns as patients who are Wilms tumor survivors. The remaining kidney generally adjusts its function and size: “compensatory hypertrophy of the kidney".
Proteinuria and hypertension may occur in the long term after a combination of nephrectomy, chemotherapy and significant radiotherapy.
In long term follow up, it is important to check:
- Blood pressure (a solitary kidney is associated with an increased risk of hypertension)
- Renal function using routine blood tests and urinalysis
It is also important to warn about the prompt treatment of urinary tract infections (there is no increased risk, but infection could potentially damage remaining renal tissue). Antibiotics associated with a risk of renal damage (such as aminoglycosides) should be avoided.
Patients who have had a nephrectomy may wish to avoid activities that might damage the remaining kidney and it would be reasonable to avoid contact sports.
COG Survivorship guidelines: Keeping your single kidney healthy
Chemotherapy Late Effects:
|Cisplatin & Carboplatin
COG survivorship guidelines: Kidney health after childhood cancer