Nonmalignant late tissue and organ toxicity in adult cancer survivors.
| Organ . | Clinical manifestation . | Risk factors . | Monitoring . | Intervention . |
|---|---|---|---|---|
| Abbreviations: TBI, total body irradiation; GVHD, graft-versus-host disease; LVEF, left ventricular ejection fraction; ECG, electrocardiography; TSH, thyroid-stimulating hormone; FSH, follicle-stimulating hormone; LH, luteinizing hormone. | ||||
| Eye | Cataracts | Radiation Steroids | Split lamp examination | Fractionation of TBI Surgical repair |
| Keratoconjunctivitis | Radiation GVHD | Schirmer test | Treatment of GVHD Topical lubricants Topical steroids | |
| Heart | Restrictive or dilatative cardiopathy Arrhythmia Autonomous neuropathy | Anthracyclines Mediastinal radiotherapy | LVEF 24-hour ECG | Treatment of cardiac insufficiency Pace maker |
| Respiratory tract | Chronic obstructive lung disease Bronchiolitis obliterans | Infection GVHD Smoking | Pulmonary function testing Chest radiographic testing if clinically indicated | Treatment of infection Immune globulin substitution Treatment of GVHD |
| Restrictive lung disease | Radiation Chemotherapy Infection | Pulmonary function testing Chest radiographic testing if clinically indicated | Fractionation of radiation Lung shielding Treatment of infection Steroids | |
| Liver complications | Chronic hepatitis C | HVC infection Iron overload | Liver tests Hepatitis serologies Viral load if positive | Treatment of hepatitis C Treatment of iron overload (phlebotomy or chelation therapy) |
| Liver cirrhosis | HCV infection Iron overload | Ferritin | ||
| Chronic GVHD of the liver | Liver biopsy if indicated | Treatment of GVHD | ||
| Kidney | Nephropathy | TBI Chemotherapy (platinum) Cyclosporin | Renal function tests | Control of hypertension |
| Skeletal | Avascular necrosis of the bone | Steroids Radiation | Radiographic testing | Avoidance of long term treatment with steroids Symptomatic relief of pain Orthopedic measures Surgical repair |
| Osteoporosis | Steroids, cyclosporine, tacrolimus, hypogonadism, TBI, chemotherapy Immobilism | Dual photon densitometry | Sex hormone replacement Treatment of osteoporosis (biphosphonates, calcium, vitamin D) | |
| Oral | Chronic stomatitis | Chronic GVHD Radiation | Oral inspection | Oral hygiene Treatment of GVHD |
| Dental late effects | Radiation Chronic GVHD | Dental inspection | Prophylaxis, oral hygiene, instruction for dental care, brushing teeth, application of fluoride Treatment of caries | |
| Thyroid gland | Hypothyroidism | Radiation | TSH, T4 annually | Thyroid hormonal replacement |
| Gonadal function | Gonadal failure | Radiation Chemotherapy | FSH, LH, testosterone (males), oestradiol (females) | Hormonal replacement Sperm banking in males |
| Nervous system | Leukencephalopathy | Cranial radiation Intrathecal chemotherapy | Evaluation according to symptoms | |
| Peripheral neuropathy | Chemotherapy GVHD | |||
| Organ . | Clinical manifestation . | Risk factors . | Monitoring . | Intervention . |
|---|---|---|---|---|
| Abbreviations: TBI, total body irradiation; GVHD, graft-versus-host disease; LVEF, left ventricular ejection fraction; ECG, electrocardiography; TSH, thyroid-stimulating hormone; FSH, follicle-stimulating hormone; LH, luteinizing hormone. | ||||
| Eye | Cataracts | Radiation Steroids | Split lamp examination | Fractionation of TBI Surgical repair |
| Keratoconjunctivitis | Radiation GVHD | Schirmer test | Treatment of GVHD Topical lubricants Topical steroids | |
| Heart | Restrictive or dilatative cardiopathy Arrhythmia Autonomous neuropathy | Anthracyclines Mediastinal radiotherapy | LVEF 24-hour ECG | Treatment of cardiac insufficiency Pace maker |
| Respiratory tract | Chronic obstructive lung disease Bronchiolitis obliterans | Infection GVHD Smoking | Pulmonary function testing Chest radiographic testing if clinically indicated | Treatment of infection Immune globulin substitution Treatment of GVHD |
| Restrictive lung disease | Radiation Chemotherapy Infection | Pulmonary function testing Chest radiographic testing if clinically indicated | Fractionation of radiation Lung shielding Treatment of infection Steroids | |
| Liver complications | Chronic hepatitis C | HVC infection Iron overload | Liver tests Hepatitis serologies Viral load if positive | Treatment of hepatitis C Treatment of iron overload (phlebotomy or chelation therapy) |
| Liver cirrhosis | HCV infection Iron overload | Ferritin | ||
| Chronic GVHD of the liver | Liver biopsy if indicated | Treatment of GVHD | ||
| Kidney | Nephropathy | TBI Chemotherapy (platinum) Cyclosporin | Renal function tests | Control of hypertension |
| Skeletal | Avascular necrosis of the bone | Steroids Radiation | Radiographic testing | Avoidance of long term treatment with steroids Symptomatic relief of pain Orthopedic measures Surgical repair |
| Osteoporosis | Steroids, cyclosporine, tacrolimus, hypogonadism, TBI, chemotherapy Immobilism | Dual photon densitometry | Sex hormone replacement Treatment of osteoporosis (biphosphonates, calcium, vitamin D) | |
| Oral | Chronic stomatitis | Chronic GVHD Radiation | Oral inspection | Oral hygiene Treatment of GVHD |
| Dental late effects | Radiation Chronic GVHD | Dental inspection | Prophylaxis, oral hygiene, instruction for dental care, brushing teeth, application of fluoride Treatment of caries | |
| Thyroid gland | Hypothyroidism | Radiation | TSH, T4 annually | Thyroid hormonal replacement |
| Gonadal function | Gonadal failure | Radiation Chemotherapy | FSH, LH, testosterone (males), oestradiol (females) | Hormonal replacement Sperm banking in males |
| Nervous system | Leukencephalopathy | Cranial radiation Intrathecal chemotherapy | Evaluation according to symptoms | |
| Peripheral neuropathy | Chemotherapy GVHD | |||