Imaging of late complications of cancer therapy in children

Abstract

Long-term survival after childhood cancer has improved dramatically over recent decades but survivors face lifelong risks of adverse health effects. Many of these chronic conditions are a direct result of previous therapeutic exposures. Compared to their siblings, survivors face a greater than 8-fold increase in relative risk of severe or life-threatening medical conditions; the most significant of these include second malignancies and cardiovascular and pulmonary diseases. Imaging can play a key role in identifying and characterizing such complications, which can be reasonably predicted with knowledge of the child's treatment. This article highlights the varied radiologic presentations and features seen in late cancer-therapy-related conditions.

Massive non-incisional abdominal wall hernia caused by abdominal wall weakness resulting from childhood radiation therapy: a case report

“…Moreover, a CT scan had shown unilateral pelvic atrophy, scoliosis of the lumbar spine and atrophy of the erector spinae and rectus abdominis muscles, and subcutaneous tissue. Radiation therapy can cause impairment of bone growth [ 3 ] and soft-tissue hypoplasia. The characteristic response to radiation-induced injury varies according to tissue type, with atrophy predominating in epithelial tissue whereas fibrosis predominates in stromal tissue [ 4 ].…”

Imaging of pediatric neuroblastoma: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper

“…Perhaps the most devastating late effect is the development of secondary malignancy, which occurs in 3–12% of survivors of childhood cancers 36,37 . The risk of second malignancies in patients treated for NB increases with exposure to radiation therapy.…”

“…35 Perhaps the most devastating late effect is the development of secondary malignancy, which occurs in 3-12% of survivors of childhood cancers. 36,37 The risk of second malignancies in patients treated for NB increases with exposure to radiation therapy. In NB patients treated with 131 I-mIBG therapy, the incidence of secondary malignancy, typically acute myelogenous leukemia or myelodysplastic syndrome is as high as 3% by 3 years posttreatment.…”

Possible roles of genetic variations in chemotherapy related cardiotoxicity in pediatric acute lymphoblastic leukemia and osteosarcoma

“…One of the late toxic side effects of chemotherapy in childhood ALL is cardiotoxicity [ 5 , 7 , 11 , 12 ]. A 30-year-old survivor might face treatment-related cardiac damage usually characteristic for much older patients [ 13 – 15 ]. There is a need for preventing cardiac damage especially in children, because they can live for decades after treatment [ 16 ].…”