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Vascular QuickFact

Childhood cancer survivors can be at risk for developing the following vascular late effects:

  • Cerebrovascular Complications
    • Stroke
    • Moyamoya
    • Occlusive Cerebral Vasculopathy
    • Cavernomas
  • Carotid Artery Disease
  • Subclavian Artery Disease
  • Vasospastic Attacks (Raynaud’s Phenomenon)
  • Thrombosis/Vascular Insufficiency
  • Veno-occlusive Disease (VOD)
  • Osteonecrosis (Avascular Necrosis)

See Cardiac Quick Fact for the following late effects:

  • Cardiac
  • Pericardial
  • Valvular

 

If your patient does not have a Survivor Health Plan (SHP), please refer him/her to the appropriate survivor clinic. 

 

Important factors in determining risk for vascular late effects:

 

    • Time since treatment
    • Age at treatment
    • Total dose of radiation
    • Total dose of chemotherapy
    • Smoking
    • Down Syndrome
    • Sickle Cell Disease

 

 

Chemotherapy             

Table 1

 

Cerebrovascular Complications

Carotid Artery Disease

Subclavian Artery Disease

Vasospastic Attacks (Raynaud’s Phenomenon)

Thrombosis/ Vascular Insufficiency

Osteonecrosis

(Avascular Necrosis)

VOD

 

Alkylating Agents

Carmustine

   BCNU

Busulfan

Lomustine

   CCNU

Chlorambucil Cyclophosphamide

   Cytoxan

Ifosphamide

Mechlorethamine

Melphalan

Procarbazine

Thiotepa

 

Dacarbazine

    DTIC

Temozolomide

= 18 Gy

 

Include TBI in total dose calculation

= 40 Gy

 

Include TBI in total dose calculation

= 40 Gy

 

Include TBI in total dose calculation

 

 

 

 

Heavy Metals

Carboplatin

Cisplatin

 

 

 

 

 

 

 

 

Antimetabolites

Cytarabine

   Ara-C

Mercaptopurine

   6MP

Thioguanine

   6TG

Methotrexate

 

 

 

 

 

 

 

X

(mercaptopurine and thioguinine only)

Anthracycline antibiotics

Daunorubicin

Doxorubicin

   Adriamycin

Epirubicin

Idarubicin

Mitoxantrone

 

 

 

 

 

 

 

 

Chemotherapy             

Cerebrovascular Complications

Carotid Artery Disease

Subclavian Artery Disease

Vasospastic Attacks (Raynaud’s Phenomenon)

Thrombosis/ Vascular Insufficiency

Osteonecrosis

(Avascular Necrosis)

VOD

 

Anti-tumor antibiotics

Bleomycin

Dactinomycin

= 18 Gy

 

Include TBI in total dose calculation

= 40 Gy

 

Include TBI in total dose calculation

= 40 Gy

 

Include TBI in total dose calculation

 

 

 

X

(mercaptopurine and thioguinine only)

Corticosteroids

Dexamethasone

   Decadron

Prednisone

 

 

 

 

 

 

X

 

Enzymes

Asparaginase

 

 

 

 

 

 

 

 

Plant alkaloids

Vincristine

Vinblastine

 

 

 

 

X

 

 

 

Epipodophyllotoxins

Etoposide

   VP16

Teniposide

   VM26

 

 

 

 

 

 

 

 

 

Radiation

Cerebrovascular Complications

Carotid Artery Disease

Subclavian Artery Disease

Vasospastic Attacks (Raynaud’s Phenomenon)

Thrombosis/ Vascular Insufficiency

Osteonecrosis

(Avascular Necrosis)

VOD

 

All Radiation                   

 

 

 

 

 

 

 

TBI

 

 

 

 

 

 

 

Head/Brain

>  18 Gy

 

Include TBI in total dose calculation

>  40 Gy

 

Include TBI in total dose calculation

 

 

 

 

 

X

(mercaptopurine and thioguinine only)

Neck

 

>  40 Gy

 

Include TBI in total dose calculation

>  40 Gy

 

Include TBI in total dose calculation

 

 

 

 

Thorax

 

>  40 Gy

 

Include TBI in total dose calculation

>  40 Gy

 

Include TBI in total dose calculation

 

 

 

 

Abdomen

 

 

 

 

 

 

 

Pelvis

 

 

 

 

 

 

 

Extremity

 

 

 

 

 

 

 

 

Hematopoeitic Stem

Cell Transplant

Cerebrovascular Complications

Carotid Artery Disease

Subclavian Artery Disease

Vasospastic Attacks (Raynaud’s Phenomenon)

Thrombosis/ Vascular Insufficiency

Osteonecrosis

(Avascular Necrosis)

VOD

 

Hematopoeitic Stem Cell Transplant             

 

calculation

calculation

 

 

X

X

(mercaptopurine

Surgery

Cerebrovascular Complications

Carotid Artery Disease

Subclavian Artery Disease

Vasospastic Attacks (Raynaud’s Phenomenon)

Thrombosis/ Vascular Insufficiency

Osteonecrosis

(Avascular Necrosis)

VOD

 

Central Venous Catheter                        

  

calculation

calculation

 

X

 

X

(mercaptopurine

For recommendations on how to screen for all potential late effects, please refer to The Children’s Oncology Group Long-Term Follow-Up Guidelines.

Health Links-Teaching Handouts from The Children's Oncology Group        

Visit http://www.survivorshipguidelines.org/ to find many of the Health Links translated into other languages.

Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers, and related Health Links Version 4.0. October, 2013. www.survivorshipguidelines.org.

Source: Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta
Last Updated: 2/10/2015 9:01:06 PM
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