Complications of cancer therapy in children: A radiologist's guide

As advances in cancer therapy improve the prognosis of patients with childh ood malignancies, awareness of the consequences of treatment methods assume s increasing importance. All cancer treatment modalities are associated wit h toxic effects, and the spectrum of therapy-induced complications involves all organ systems. Radiologists have a pivotal role in detecting these seq uelae, which can be categorized by the affected organ system and by whether they occur (a) at diagnosis or during initial therapy or (b) after the com pletion of treatment. The first group consists of oncologic emergencies, in fectious complications, and irritant effects. Oncologic emergencies can be further categorized as space-occupying lesions (eg, superior vena cava synd rome or spinal cord compression), vascular abnormalities (eg, hyperleukocyt osis, anemia, coagulopathy), and metabolic emergencies (eg, tumor lysis syn drome). Common complications developing after completion of treatment inclu de leukoencephalopathy and neurocognitive defects; cataract formation; card iomyopathy and congestive heart failure; hepatic dysfunction, fibrosis, and cirrhosis; radiation enteritis; renal dysfunction or failure; scoliosis an d short stature; hypothyroidism; gonadal dysfunction; graft-versus-host dis ease; and development of secondary malignancies. Physician awareness of the se complications will permit more effective patient surveillance, which may afford patients the opportunity for earlier intervention in these situatio ns and improved quality of life.