Prospective evaluation of late effects after childhood cancer therapy witha follow-up over 9 years

Intensive multimodality treatment has led to a remarkable improvement of pr ognosis in paediatric cancer patients, however, a great number of long-term survivors suffer from considerable tumour- or treatment-related late effec ts. Between January 1990 and December 1998, 223 consecutive survivors of ch ildhood malignancies entered a prospective follow-up study designed to eval uate the frequency and severity of tumour and/or therapy-related long-term sequelae. After cessation of therapy and subsequently once a year, all pati ents underwent a detailed examination programme including physical examinat ion, laboratory tests, abdominal sonography, echocardiography, electrocardi ography, electroencephalography, spirometry, audiometry, ophthalmological e xamination and endocrine stimulation tests. Median follow-up was 5 years (r ange 0.4 to 9.6 years). A total of 167 patients (75%) had at least one chro nic medical problem of whom 80 needed permanent medical support. The organ systems most frequently affected were the nervous system in 39%, the endocr ine system in 32%, the ears/eyes in 22%, the kidneys in 17%, and the liver in 12% of the patients. Some late effects (endocrine deficits, hearing loss , tubulopathy) were primarily diagnosed only several years after the end of oncological therapy. Conclusion The results of this study indicate that a considerable number of former paediatric cancer patients suffer from remarkable long-term side-ef fects. Since life quality is an important parameter of cancer survival, car eful follow-up of long-term survivors is mandatory with the aim to reduce o r even abrogate possible side-effects at the earliest time.