Late effects of antineoplastic therapy in childhood on growth and endocrine function.

The major challenge for this generation of children's cancer specialists is to sustain the significant improvement in survival rates, while at the same time minimising treatment-induced late adverse effects. The available evidence suggests that, following first line treatment of acute lymphoblastic leukaemia (ALL), current treatment regimens used in the UK are unlikely to cause sterilisation in either gender. For men who are treated for Hodgkin's disease with 6 or more courses of antineoplastic therapy, azoospermia is the rule. Childhood studies have clearly indicated that the prepubertal testis is not protected from antineoplastic therapy that is potentially sterilising. The interpretation of tests of ovarian function in women treated for cancer in childhood is difficult, but there is increasing evidence of ovarian dysfunction in children treated for Hodgkin's disease. Reassuringly there is no evidence of an increased risk of miscarriage following antineoplastic therapy or an increased number of abnormalities in the offspring. The growth patterns and requirement for growth hormone replacement therapy in children treated for ALL are still unclear. There is good evidence that the intensity and duration of combination cytotoxic antineoplastic therapy received by children with ALL influences the pattern of growth, and that adjuvant antineoplastic therapy for children treated for a brain tumour is an important factor in final height achieved. A child who has been treated for cancer should not be discharged from follow-up. Late effects may have significant implications in later life, and an understanding of these effects is essential to enable balanced decisions to be made regarding the benefits and risks of currently available agents.