Surveillance of patients treated with TBI
| System or organ involved . | Complications and screening method . |
|---|---|
| Growth | Failure to thrive: weight and height measurements compared against previous values and values of children of the same age using growth charts (yearly), pediatric endocrinology referral as clinically indicated |
| Puberty, fertility | Pubertal delay: Tanner stages including testicular volume evaluation in boys (yearly until sexually mature); ovarian/testicular hormone deficiency: FSH, LH, estradiol/testosterone levels at adolescence |
| Brain | Meningiomas and other CNS tumors: brain MRI (or CT) as clinically indicated; neurodevelopmental defects: referral for neurodevelopmental evaluation as clinically indicated |
| Skin | Skin cancer (basal cell carcinomas, melanomas): dermatological examination (yearly) |
| Breast | Breast cancer: education to breast autopalpation, mammogram and breast MRI (yearly after age 25 y) |
| Heart | Anthracycline-related cardiomyopathy: echocardiography with global longitudinal strain (every 2 y) |
| Thyroid | Thyroid cancer: neck palpation (yearly) and thyroid US (every 2 y), oncological referral in case of thyroid nodule; thyroid function: TSH, FT4 (yearly) |
| Lungs | Pulmonary function defects: pulmonary function tests including DLCO and spirometry (at entry into long-term follow-up, repeat as clinically indicated); lung cancer: pulmonary examination, consider lung spiral CT in high-risk patients (other risk factors such as smoking) |
| Metabolic and cardiovascular risk | Metabolic syndrome: blood pressure, waist circumference, body mass index, fasting triglyceride, total, LDL- and HDL-cholesterol, glucose, and insulin levels, HbA1c level (yearly from adulthood) |
| Eyes | Cataracts: ophthalmology referral for slit-lamp examination (every 2 y) |
| Oral health | Dental defects: dental care (yearly) |
| Liver | Liver toxicity: physical examination, AST, ALT, GGT, bilirubin (at entry into long-term follow-up, repeat as clinically indicated) |
| Kidney | Renal toxicity: creatinine, electrolytes including Ca, P, and Mg, urinary tests (at entry into long-term follow-up, repeat as clinically indicated) |
| System or organ involved . | Complications and screening method . |
|---|---|
| Growth | Failure to thrive: weight and height measurements compared against previous values and values of children of the same age using growth charts (yearly), pediatric endocrinology referral as clinically indicated |
| Puberty, fertility | Pubertal delay: Tanner stages including testicular volume evaluation in boys (yearly until sexually mature); ovarian/testicular hormone deficiency: FSH, LH, estradiol/testosterone levels at adolescence |
| Brain | Meningiomas and other CNS tumors: brain MRI (or CT) as clinically indicated; neurodevelopmental defects: referral for neurodevelopmental evaluation as clinically indicated |
| Skin | Skin cancer (basal cell carcinomas, melanomas): dermatological examination (yearly) |
| Breast | Breast cancer: education to breast autopalpation, mammogram and breast MRI (yearly after age 25 y) |
| Heart | Anthracycline-related cardiomyopathy: echocardiography with global longitudinal strain (every 2 y) |
| Thyroid | Thyroid cancer: neck palpation (yearly) and thyroid US (every 2 y), oncological referral in case of thyroid nodule; thyroid function: TSH, FT4 (yearly) |
| Lungs | Pulmonary function defects: pulmonary function tests including DLCO and spirometry (at entry into long-term follow-up, repeat as clinically indicated); lung cancer: pulmonary examination, consider lung spiral CT in high-risk patients (other risk factors such as smoking) |
| Metabolic and cardiovascular risk | Metabolic syndrome: blood pressure, waist circumference, body mass index, fasting triglyceride, total, LDL- and HDL-cholesterol, glucose, and insulin levels, HbA1c level (yearly from adulthood) |
| Eyes | Cataracts: ophthalmology referral for slit-lamp examination (every 2 y) |
| Oral health | Dental defects: dental care (yearly) |
| Liver | Liver toxicity: physical examination, AST, ALT, GGT, bilirubin (at entry into long-term follow-up, repeat as clinically indicated) |
| Kidney | Renal toxicity: creatinine, electrolytes including Ca, P, and Mg, urinary tests (at entry into long-term follow-up, repeat as clinically indicated) |
AMH, anti-Mullerian hormone; ALT, alanine aminotransferase; AST, aspartate aminotransferase; CT, computed tomography; DLCO, carbon monoxide diffusing capacity; FSH, follicle-stimulating hormone; FT4, thyroxin; GGT, gamma-glutamyl transferase; Hb, hemoglobin; HDL, high-density lipoprotein; LH, luteinizing hormone; TSH, thyroid-stimulating hormone; US, ultrasound.