Childhood cancer survivors can be at risk for developing the following vascular late effects:
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Cerebrovascular Complications
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Carotid Artery Disease
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Subclavian Artery Disease
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Vasospastic Attacks (Raynaud’s Phenomenon)
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Thrombosis/Vascular Insufficiency
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Veno-occlusive Disease (VOD)
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Osteonecrosis (Avascular Necrosis)
See Cardiac Quick Fact for the following late effects:
- Cardiac
- Pericardial
- Valvular
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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:
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Time since treatment
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Age at treatment
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Total dose of radiation
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Total dose of chemotherapy
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Smoking
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Down Syndrome
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Sickle Cell Disease
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Chemotherapy
Table 1
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Cerebrovascular Complications
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Carotid Artery Disease
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Subclavian Artery Disease
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Vasospastic Attacks (Raynaud’s Phenomenon)
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Thrombosis/ Vascular Insufficiency
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Osteonecrosis
(Avascular Necrosis)
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VOD
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Alkylating Agents
Carmustine
BCNU
Busulfan
Lomustine
CCNU
Chlorambucil Cyclophosphamide
Cytoxan
Ifosphamide
Mechlorethamine
Melphalan
Procarbazine
Thiotepa
Dacarbazine
DTIC
Temozolomide
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= 18 Gy
Include TBI in total dose calculation
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= 40 Gy
Include TBI in total dose calculation
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= 40 Gy
Include TBI in total dose calculation
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|
|
|
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Heavy Metals
Carboplatin
Cisplatin
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|
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|
|
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Antimetabolites
Cytarabine
Ara-C
Mercaptopurine
6MP
Thioguanine
6TG
Methotrexate
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|
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|
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X
(mercaptopurine and thioguinine only)
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Anthracycline antibiotics
Daunorubicin
Doxorubicin
Adriamycin
Epirubicin
Idarubicin
Mitoxantrone
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|
|
|
|
|
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Chemotherapy
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Cerebrovascular Complications
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Carotid Artery Disease
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Subclavian Artery Disease
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Vasospastic Attacks (Raynaud’s Phenomenon)
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Thrombosis/ Vascular Insufficiency
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Osteonecrosis
(Avascular Necrosis)
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VOD
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Anti-tumor antibiotics
Bleomycin
Dactinomycin
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= 18 Gy
Include TBI in total dose calculation
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= 40 Gy
Include TBI in total dose calculation
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= 40 Gy
Include TBI in total dose calculation
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|
|
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X
(mercaptopurine and thioguinine only)
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Corticosteroids
Dexamethasone
Decadron
Prednisone
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|
|
|
|
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X
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Enzymes
Asparaginase
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|
|
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Plant alkaloids
Vincristine
Vinblastine
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X
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Epipodophyllotoxins
Etoposide
VP16
Teniposide
VM26
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|
|
|
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|
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Radiation
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Cerebrovascular Complications
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Carotid Artery Disease
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Subclavian Artery Disease
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Vasospastic Attacks (Raynaud’s Phenomenon)
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Thrombosis/ Vascular Insufficiency
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Osteonecrosis
(Avascular Necrosis)
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VOD
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All Radiation
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TBI
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Head/Brain
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>
18 Gy
Include TBI in total dose calculation
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>
40 Gy
Include TBI in total dose calculation
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|
|
|
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X
(mercaptopurine and thioguinine only)
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Neck
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>
40 Gy
Include TBI in total dose calculation
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>
40 Gy
Include TBI in total dose calculation
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Thorax
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>
40 Gy
Include TBI in total dose calculation
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>
40 Gy
Include TBI in total dose calculation
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|
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Abdomen
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Pelvis
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Extremity
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Hematopoeitic Stem
Cell Transplant
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Cerebrovascular Complications
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Carotid Artery Disease
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Subclavian Artery Disease
|
Vasospastic Attacks (Raynaud’s Phenomenon)
|
Thrombosis/ Vascular Insufficiency
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Osteonecrosis
(Avascular Necrosis)
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VOD
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Hematopoeitic Stem Cell Transplant
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calculation
|
calculation
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|
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X
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X
(mercaptopurine
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Surgery
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Cerebrovascular Complications
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Carotid Artery Disease
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Subclavian Artery Disease
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Vasospastic Attacks (Raynaud’s Phenomenon)
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Thrombosis/ Vascular Insufficiency
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Osteonecrosis
(Avascular Necrosis)
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VOD
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Central Venous Catheter
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calculation
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calculation
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X
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X
(mercaptopurine
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