Complications
Anthracyclines (e.g., doxorubicin) have been associated with arrhythmias, cardiomyopathy, and congestive heart failure.[117] Pericarditis and myocarditis have also been reported.
Risk of developing these effects is dose-dependent.
Patients treated with these agents should be monitored (i.e., ECG and echocardiogram) during and after completion of treatment.
Patients are at risk of developing renal impairment from chemotherapy, mainly platinum compounds or cyclophosphamide.
Renal impairment is typically mild and patients do not generally progress to chronic renal failure.[118]
Serum creatinine/BUN should be monitored during treatment. If elevated, a dose modification may be required for some drugs.
Rarely, patients with a high disease burden may develop tumor lysis syndrome after starting chemotherapy.
Serum electrolytes should be monitored.
Platinum chemotherapy-related ototoxicity (e.g., tinnitus, hearing loss/deafness) can occur in up to 70% of patients with high-risk disease. The use of platinum compounds in both induction and myeloablative (consolidation) therapy significantly increases this risk.[118][119][120][121][122]
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Hearing loss can be unilateral or bilateral, can occur during or after treatment (and is dose dependent), is more pronounced in children, and is irreversible.
All patients should have audiometric testing at baseline and before each dose. An audiogram is also recommended 1 year after completion of therapy to assess for treatment-related ototoxicity.
Given the high doses of chemotherapy required to treat high-risk disease, patients are at an increased risk of infertility in the future.[123]
Children with solid tumors are at an increased risk of developing premature osteoporosis due to treatment-related adverse effects.[125]
Benign tumor of the liver, which is usually asymptomatic and rarely grows.
Possible long-term finding in infants with metastatic neuroblastoma, which can either be a result of the condition or its treatment.[122]
CT or MRI scan of the liver is diagnostic, and treatment is usually conservative.
More than 40% of patients with neuroblastoma who present with spinal cord compression have residual symptoms at a median of 8 years after treatment.[126]
Paraneoplastic syndrome associated with neuroblastoma.
Approximately 2% of neuroblastoma patients will develop OMA.[32] The majority of patients will not have complete resolution of their symptoms despite the disease being cured.[32]
Rapid, dancing eye movements, rhythmic jerking of limbs/trunk, and ataxia are pathognomonic.[8]
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