Late effects after therapy of childhood cancer

Since two thirds pediatric cancer patients can be cured of their disease, the recognition and treatment of late effects of therapy have become increasingly important. Most of these patients will pass the different stages of normal development having survived cancer in childhood. Knowledge of the normal child-adolescent development is one of the requirements for the long-term care of survivors of childhood cancer. In this manuscript we depict the known main risk factors for the late toxicity of different organs. The identification of risk factors was based on a survey of the literature. A main cause for late effects is radiation therapy. In addition there is an increased risk of sequelae for solid tumors versus hematologic malignancies. According to the definition of risk factors, indications for a specific diagnostic program are determined. We recommend an individualized schedule for follow-up depending upon the presence of these risk factors. With this diagnostic program presented it should be possible to diagnose known relevant late effects, thus preventing excessive medical attention for the patients and limiting the diagnostic efforts and costs for the physicians taking care of each patient.