Complications
These problems are mainly due to cumulative anthracycline treatment.[55] Current protocols minimise the risk.
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Children and older adults are at greatest risk. Other risk factors include radiotherapy to the mediastinum and comorbid conditions. Vascular endothelial growth factor (VEGF)-directed therapy (sunitinib, sorafenib, and pazopanib) has also been rarely associated with cardiac failure.[59][94]
Evaluation of cardiac function, by gated blood pool scan or echocardiogram, in patients treated with anthracyclines, including doxorubicin, is required.
Ifosfamide has been associated with reports of confusion, seizures, coma, and death.
There are limited data available. The probability of infertility in males is low, unless the gonads have been subject to irradiation. Sperm banking is relatively easily implemented.
In females, the risk of primary amenorrhoea is directly proportional to the age at which treatment is applied. However, it is likely that depletion of ova may accelerate time to menopause. A limited range of safe and effective options is available for women, including oophoropexy if the ovaries can be moved out of line of a radiation field.[93] Unproven options include gonadotrophin-releasing hormone agonists, ovarian wedge resection, and cryopreservation.
The risk of second malignancies is related to chemotherapy, radiotherapy, and genetic predisposition. The estimated second malignancy rate in survivors of sarcomas may reach 20%.[95] Cancers include breast cancer with mediastinal irradiation, leukaemia, thyroid cancer, and secondary sarcomas.
Related to the use of ifosfamide.
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