Heikens J, Somers R, Behrendt H, Oldenburger F, Langeveld N E, Bakker P J
Afd. Medische Oncologie, Academisch Medisch Centrum, Amsterdam.
Ned Tijdschr Geneeskd. 1998 Oct 3;142(40):2191-5.
The risk of late effects of cancer treatment in children is higher than that after treatment during adulthood. The late effects of chemotherapy are proportional to the dosage and those of irradiation to the size of the radiation field, fractionation and dose. Irradiation may lead to impaired growth of bone and soft tissues, cranial irradiation to pituitary deficiencies, alopecia and impaired cognitive function, irradiation of the neck to altered thyroid function, thoracic irradiation to diminished pulmonary function and cardiovascular morbidity, radiation therapy of the abdomen to infertility in females, impaired renal function and chronic enteritis. Chemotherapy-induced damage is more organ-specific. Well-known cardiotoxic agents are the anthracycline derivatives. Restricted pulmonary function is seen after treatment with bleomycin and nitrourea derivatives. Several antineoplastic agents are gonadotoxic in men. Nephrotoxic agents are cisplatin and ifosfamide. The cumulative relative risk of developing a second primary neoplasm is 3,8-6,9 after a follow-up period of 25 years. Alkylating agents and the topoisomerase inhibitors are known to increase the risk of haematologic malignancy, while radiation therapy is associated with bone, soft tissue, thyroid, breast, brain and gastrointestinal malignancies.
儿童癌症治疗的远期效应风险高于成人治疗后的风险。化疗的远期效应与剂量成正比，而放疗的远期效应与辐射野大小、分次照射及剂量相关。放疗可能导致骨骼和软组织生长受损、头部放疗导致垂体功能减退、脱发及认知功能受损、颈部放疗导致甲状腺功能改变、胸部放疗导致肺功能减退及心血管疾病、腹部放疗导致女性不孕、肾功能受损及慢性肠炎。化疗所致损伤更具器官特异性。著名的心脏毒性药物是蒽环类衍生物。使用博来霉素和亚硝基脲衍生物治疗后可见肺功能受限。几种抗肿瘤药物对男性有性腺毒性。肾毒性药物是顺铂和异环磷酰胺。随访25年后发生第二种原发性肿瘤的累积相对风险为3.8 - 6.9。已知烷化剂和拓扑异构酶抑制剂会增加血液系统恶性肿瘤的风险，而放疗与骨、软组织、甲状腺、乳腺、脑及胃肠道恶性肿瘤相关。
