Survivorship

Question 1

neurocognitive late effects RF

Answer 1

RT
antimetabolite: MTX, cytarabine

Question 2

ocular late effects and RF

Answer 2

cataracts
xeropthalmia
glaucoma
retinopathy

RT > 15Gy
CS
Busulfan

Question 3

ototox RF

Answer 3

Cisplatin (SNHL, cochlear hair destruction)
myeloablative carbo
RT >30 Gy
CN VIII surgery

Question 4

RT thresholds by tissue

Ocular
Oto
Thyroid
Heart
Renal
Hepatic
brain necrosis
Neuropsych
GH deficiency

Answer 4

Ocular: >15Gy (54Gy max)
Oto: >30Gy
Thyroid: >35Gy
Heart: >30Gy (15Gy w anthracycline)
Renal: >20Gy
Hepatic: >20Gy
brain necrosis >60Gy
Neuropsych: >12-18Gy
GH deficiency: >18-25Gy

Question 5

anterior pituitary dysfunction RF and epi

Answer 5

RT
50% develop at least one deficiency, 11% with multiple

Question 6

decreased linear growth RF

Answer 6

RT, cranial or spinal
CS
retinoids
TKI

Question 7

Thyroid late effect RF and epi

Answer 7

RT >35Gy
MIBG
I-131

20y incidence 30%

Question 8

pulmonary late effects RF

Answer 8

RT
Bleo
Busulfan
BCNU, CCNU
thoracic surgery

Question 9

cardiomyopathy epi, RF

Answer 9

leading cause of non-onc death

anthracycline >250 mg/m2 doxo equivalents
Chest RT >30Gy (or 15Gy with anthracycline)

Question 10

Anthracycline cardiotoxic dose and conversion

Answer 10

> 250mg/m2 doxo equivalents

1 doxo
0.5 dauno
4-10 mitoxantrone

Question 11

renal tox RF

Answer 11

cisplat
carbo
ifos
RT >20Gy
nephrectomy

Question 12

hepatic tox RF

Answer 12

thioguanine
MP
MTX
RT >20Gy

Question 13

osteopenia RF

Answer 13

steroid
MTX

Question 14

AVN RF

Answer 14

steroid (dex > pred)

Question 15

breast cancer SMN RF and screening

Answer 15

RT

annual exam until 25yo then q6mo
mammogram and breast MR starting 25yo or 8y post RT

Question 16

cyclophosphamide fertility dose threshold and equivalents

Answer 16

cyclo 1 mg/m2
ifos 0.24
busulfan 8.8
melphalan 40
thio 50