Childhood cancer survivors can be at risk for developing the following neurological late effects:
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Peripheral Sensory/Motor Neuropathy
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Cerebrovascular Complications
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Clinical Leukoencephalopathy
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Motor and/or Sensory Deficits
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Seizures
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Hydrocephalus or Shunt Malfunction
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Neurogenic Bladder or Bowel
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Sexual Dysfunction (Male and Female)
See Cognitive/School Quick Fact for the neurocognitive late effects.
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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 neurological late effects:
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Time since treatment
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Age at treatment
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Tumor of the brain or spine
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CNS directed therapy
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Total dose of radiation
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Total dose of chemotherapy
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For recommendations on how to screen for all potential late effects, please refer to The Children’s Oncology Group Long-Term Follow-Up Guidelines.
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Chemotherapy
Table 1
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Peripheral Sensory/ Motor Neuropathy
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Cerebrovascular Complications
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Clinical Leuko-encephalopathy
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Motor and/or Sensory Deficits
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Seizures
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Hydrocephalus
Shunt Malfunction
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Neurogenic Bladder or Bowel
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Sexual Dysfunction
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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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Heavy Metals
Carboplatin
Cisplatin
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X
(Sensory only)
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Antimetabolites
Cytarabine
Ara-C
Mercaptopurine
6MP
Thioguanine
6TG
Methotrexate
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X
(High dose Methotrexate and Cytarabine; Intrathecal Methotrexate)
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Anthracycline antibiotics
Daunorubicin
Doxorubicin
Adriamycin
Epirubicin
Idarubicin
Mitoxantrone
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Chemotherapy
Table 2
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Peripheral Sensory/ Motor Neuropathy
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Cerebrovascular Complications
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Clinical Leuko-encephalopathy
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Motor and/or Sensory Deficits
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Seizures
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Hydrocephalus
Shunt Malfunction
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Neurogenic Bladder or Bowel
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Sexual Dysfunction
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Anti-tumor antibiotics
Bleomycin
Dactinomycin
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Corticosteroids
Dexamethasone
Decadron
Prednisone
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Enzymes
Asparaginase
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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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Radiation
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Peripheral Sensory/ Motor Neuropathy
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Cerebrovascular Complications
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Clinical Leuko-encephalopathy
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Motor and/or Sensory Deficits
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Seizures
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Hydrocephalus
Shunt Malfunction
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Neurogenic Bladder or Bowel
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Sexual Dysfunction
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All Radiation
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TBI
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X
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Head/Brain
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>
18 Gy
Include TBI in total dose calculation
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X
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Neck
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Thorax
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Abdomen
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Pelvis
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Extremity
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Surgery
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Peripheral Sensory/
Motor Neuropathy
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Cerebrovascular Complications
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Clinical Leuko-encephalopathy
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Motor and/or Sensory Deficits
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Seizures
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Hydrocephalus
Shunt Malfunction
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Neurogenic Bladder or Bowel
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Sexual Dysfunction
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Neurosurgery - Brain
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X
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X
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X
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Neurosurgery - Spine
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X
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X
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Pelvic surgery
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X
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X
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Cystectomy
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X
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X
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