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Imaging of acute and subacute toxicities of cancer therapy in children

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Abstract

Effective cancer therapies have resulted in significant improvement in survival. However, treatment-related acute and subacute complications are a cause of significant morbidity and mortality. Effects of cancer therapy in children can be seen early in the survival period or later in life in almost all organ systems of the body. Many of these conditions are evaluated by imaging and some are diagnosed based on characteristic imaging features. This article aims to discuss acute and subacute toxicities of cancer therapy in children involving multiple organ systems, pulmonary, gastrointestinal, hepatobiliary, genitourinary and musculoskeletal systems with emphasis on those in which imaging plays a role in diagnosis or management. We also discuss the role of imaging and choice of imaging modalities in these conditions.

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References

  1. Reis LAG, Eisner MP, Kosary CL et al (2001) SEER cancer statistics review, 1973–1998. National Cancer Institute, Bethesda

    Google Scholar 

  2. Wang XX, Tang JY, Gu LJ et al (2010) Causes of deaths of children with malignant tumors during hospitalization in a single center. Zhonghua Er Ke Za Zhi 48:284–288

    PubMed  Google Scholar 

  3. Freycon F, Trombert-Paviot B, Casagranda L et al (2008) Trends in treatment-related deaths (TRDs) in childhood cancer and leukemia over time: a follow up of patients included in the Childhood Cancer Registry of Rhone-Alpes region in France (ARCERRA). Pediatr Blood Cancer 50:1213–1220

    Article  PubMed  Google Scholar 

  4. Hargrave DR, Hann IM (2001) Progressive reduction in treatment-related deaths in Medical Research Council childhood lymphoblastic leukemia trials from 1980 to 1997 (UKALL VIII, X and XI). Br J Haematol 112:293–299

    Article  PubMed  CAS  Google Scholar 

  5. Geenen MM, Cardous-Ubbink MC, Kremer LC et al (2007) Medical assessment of adverse health outcomes in long-term survivors of childhood cancer. JAMA 297:2705–2715

    Article  PubMed  CAS  Google Scholar 

  6. Lackner H, Benesch M, Schagerl S et al (2000) Prospective evaluation of late effects after childhood cancer therapy with a follow-up over 9 years. Eur J Pediatr 159:750–758

    Article  PubMed  CAS  Google Scholar 

  7. Hudson MM, Ness KK, Gurney JG et al (2013) Clinical ascertainment of health outcomes among adults treated for childhood cancer. JAMA 309:2371–2381

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Lind MJ (2008) Principles of cytotoxic chemotherapy. Medicine 36:19–23

    Article  Google Scholar 

  9. Warde P (2008) Radiotherapy: practical applications and clinical aspects. Medicine 36:15–18

    Article  Google Scholar 

  10. Maturen KM, Feng MU, Wasnik AP et al (2013) Imaging effects of radiation therapy in the abdomen and pelvis: evaluating ‘innocent bystander’ tissues. Radiographics 33:599–619

    Article  PubMed  Google Scholar 

  11. Fajarado LF (2005) The pathology of ionizing radiation as defined by morphologic patterns. Acta Oncol 44:13–22

    Article  Google Scholar 

  12. Hollingsworth CL, Frush DP, Kurtzburg J et al (2008) Pediatric hematopoietic stem cell transplantation and the role of imaging. Radiology 248:348–365

    Article  PubMed  Google Scholar 

  13. Pickhardt PJ, Siegel MJ, Hayashi RJ, Kelly M (2000) Posttransplantation lymphoproliferative disorder in children: clinical, histopathologic, and imaging features. Radiology 217:16–25

  14. Borhani AA, Hosseinzadeh K, Almusa O et al (2009) Imaging of posttransplantation lymphoproliferative disorder after solid organ transplantation. Radiographics 29:981–1002

    Article  PubMed  Google Scholar 

  15. Creutzig U, Zimmermann M, Reinhardt D et al (2004) Early deaths and treatment-related mortality in children undergoing therapy for acute myeloid leukemia: analysis of the multicenter clinical trials AML-BFM 93 and AML-BFM 98. J Clin Oncol 22:4384–4393

    Article  PubMed  Google Scholar 

  16. Molgaard-Hansen L, Mottonen M, Glosli H et al (2010) Early and treatment-related deaths in childhood acute myeloid leukemia in the Nordic countries: 1984–2003. Br J Haematol 151:447–459

    Article  PubMed  Google Scholar 

  17. Sung L, Buxton A, Gamis A et al (2012) Life-threatening and fatal infections in children with acute myeloid leukemia: a report from the Children’s Oncology Group. J Pediatr Hematol Oncol 34:e30–e35

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hartel C, Deuster M, Lehrnbecher T et al (2007) Current approaches for risk stratification of infectious complications in pediatric oncology. Pediatr Blood Cancer 49:767–773

    Article  PubMed  Google Scholar 

  19. Paulus S, Dobson S (2009) Febrile neutropenia in children with cancer. Adv Exp Med Biol 634:185–204

    Article  PubMed  Google Scholar 

  20. Ozsevik SN, Sensoy G, Karli A et al (2015) Invasive fungal infections in children with hematologic and malignant diseases. J Pediatr Hematol Oncol 37:e69–e72

    Article  PubMed  CAS  Google Scholar 

  21. Phillips RS, Sutton AJ, Riley RD et al (2012) Predicting infectious complications in neutropenic children and young people with cancer (IPD protocol). Syst Rev 1:8

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hakim H, Flynn PM, Knapp KM et al (2009) Etiology and clinical course of febrile neutropenia in children with cancer. J Pediatr Hematol Oncol 31:623–629

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lehrnbecher T, Phillips R, Alexander S et al (2012) Guidelines for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation. J Clin Oncol 30:4427–4438

    Article  PubMed  Google Scholar 

  24. Levine DS, Navarro OM, Chaudry G et al (2007) Imaging the complications of bone marrow transplantation in children. Radiographics 27:307–324

    Article  PubMed  Google Scholar 

  25. Roberts SD, Wells GM, Gandhi NM et al (2012) Diagnostic value of routine chest radiography in febrile, neutropenic children for early detection of pneumonia and mould infections. Support Care Cancer 20:2589–2594

    Article  PubMed  Google Scholar 

  26. Agrawal AK, Saini N, Gildengorin G et al (2011) Is routine computed tomographic scanning justified in the first week of persistent febrile neutropenia in children with malignancies? Pediatr Blood Cancer 57:620–624

    Article  PubMed  Google Scholar 

  27. Karthaus M, Huebner G, Elser C et al (1998) Early detection of chronic disseminated Candida infection in leukemia patients with febrile neutropenia: value of computer-assisted serial ultrasound documentation. Ann Hematol 77:41–45

    Article  PubMed  CAS  Google Scholar 

  28. Pagano L, Mele L, Fianchi L et al (2002) Chronic disseminated candidiasis in patients with hematologic malignancies. Clinical features and outcome of 29 episodes. Hematologica 87:535–541

    Google Scholar 

  29. Anttila VJ, Lamminen AE, Bondestam S et al (1996) Magnetic resonance imaging is superior to computed tomography and ultrasonography in imaging infectious liver foci in acute leukemia. Eur J Haematol 56:82–87

    Article  PubMed  CAS  Google Scholar 

  30. Donnelly LF, Morris CL (1996) Acute graft-versus-host disease in children: abdominal CT findings. Radiology 199:265–268

    Article  PubMed  CAS  Google Scholar 

  31. McCarville MB, Whittle SB, Goodin GS et al (2008) Clinical and CT features of benign pneumatosis intestinalis in pediatric hematopoietic stem cell transplant and oncology patients. Pediatr Radiol 38:1074–1083

    Article  PubMed  PubMed Central  Google Scholar 

  32. Merlini L, Borzani IMO, Anooshiravani M et al (2008) Correlation of lung abnormalities on high-resolution CT with clinical graft-versus-host disease after allogeneic versus autologous bone marrow transplantation in children. Pediatr Radiol 38:1201–1209

    Article  PubMed  Google Scholar 

  33. Duncan CN, Buonanno MR, Barry EV et al (2008) Bronchiolitis obliterans following pediatric allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 41:971–975

    Article  PubMed  CAS  Google Scholar 

  34. Helton KJ, Kuhn JP, Fletcher BD et al (1992) Bronchiolitis obliterans-organizing pneumonia (BOOP) in children with malignant disease. Pediatr Radiol 22:270–274

    Article  PubMed  CAS  Google Scholar 

  35. Ding X, Ji W, Li J et al (2011) Radiation recall pneumonitis induced by chemotherapy after thoracic radiotherapy for lung cancer. Radiat Oncol 6:24

    Article  PubMed  PubMed Central  Google Scholar 

  36. Ma LD, Taylor GA, Wharam MD et al (1993) “Recall” pneumonitis: adriamycin potentiation of radiation pneumonitis in two children. Radiology 187:465–467

    Article  PubMed  CAS  Google Scholar 

  37. Ghafoori P, Marks LB, Vujaskovic Z et al (2008) Radiation-induced lung injury. Assessment, management, and prevention. Oncology (Williston Park) 22:37–47

    Google Scholar 

  38. Woerner C, Cutz E, Yoo SJ et al (2014) Pulmonary venoocclusive disease in childhood. Chest 146:167–174

    Article  PubMed  Google Scholar 

  39. Miyata D, Fukushima T, Matsunaga M et al (2011) Fatal pulmonary veno-occlusive disease after chemotherapy for Burkitt’s lymphoma. Pediatr Int 53:403–405

    Article  PubMed  Google Scholar 

  40. MacNaughton WK (2000) Review article: new insights into the pathogenesis of radiation-induced intestinal dysfunction. Aliment Pharmacol Ther 14:523–528

    Article  PubMed  CAS  Google Scholar 

  41. Ransom JL, Novak RW, Kumar AP et al (1979) Delayed gastrointestinal complications after combined modality therapy of childhood rhabdomyosarcoma. Int J Radiat Oncol Biol Phys 5:1275–1279

    Article  PubMed  CAS  Google Scholar 

  42. Fike FB, Mortellaro V, Juang D et al (2011) Neutropenic colitis in children. J Surg Res 170:73–76

    Article  PubMed  Google Scholar 

  43. Kirkpatrick ID, Greenberg HM (2003) Gastrointestinal complications in the neutropenic patients: characterization and differentiation with abdominal CT. Radiology 226:668–674

    Article  PubMed  Google Scholar 

  44. McCarville MB, Adelman CS, Li C et al (2005) Typhlitis in childhood cancer. Cancer 104:380–387

    Article  PubMed  Google Scholar 

  45. Robinson PJA (2009) The effects of cancer chemotherapy on liver imaging. Eur Radiol 19:1752–1762

    Article  PubMed  Google Scholar 

  46. Grazia Scuderi M, Magro G, Cataldo AD et al (2013) Evaluation of noeadjuvant chemotherapy effects on liver parenchyma in resected pediatric malignancies. Pediatr Hematol Oncol 30:392–399

    Article  PubMed  Google Scholar 

  47. Barker CC, Butzner JD, Anderson RA et al (2003) Incidence, survival and risk factors for the development of veno-occlusive disease in pediatric hematopoietic stem cell transplant recipients. Bone Marrow Transplant 32:79–87

    Article  PubMed  CAS  Google Scholar 

  48. Cesaro S, Spiller M, Sartori MT et al (2011) Veno-occlusive disease in pediatric patients affected by Wilms tumor. Pediatr Blood Cancer 57:258–261

    Article  PubMed  Google Scholar 

  49. Czauderna P, Katski K, Kowalczyk J et al (2000) Venoocclusive liver disease (VOD) as a complication of Wilms’ tumor management in the series of consecutive 206 patients. Eur J Pediatr Surg 10:300–303

    Article  PubMed  CAS  Google Scholar 

  50. DeLeve LD, Shulman HM, McDonald GB (2002) Toxic injury to hepatic sinusoids: sinusoidal obstruction syndrome (veno-occlusive disease). Semin Liver Dis 22:27–41

    Article  PubMed  Google Scholar 

  51. Raja RA, Schmiegelow K, Frandsen TL (2012) Asparaginase-associated pancreatitis in children. Br J Haematol 159:18–27

    Article  PubMed  CAS  Google Scholar 

  52. Howard SC, Jones DP, Pui CH (2011) The tumor lysis syndrome. N Engl J Med 364:1844–1854

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  53. Shanbhogue AKP, Virmani V, Vikram R et al (2011) Spectrum of medication-induced complications in the abdomen: role of cross-sectional imaging. AJR Am J Roentgenol 197:W286–W294

    Article  PubMed  Google Scholar 

  54. Miano M, Faraci M, Dini G et al (2008) Early complications following haematopoietic SCT in children. Bone Marrow Transplant 41:S39–S42

    Article  PubMed  Google Scholar 

  55. McCarville MB, Hoffer FA, Gingrich JR et al (2000) Imaging findings of hemorrhagic cystitis in pediatric oncology patients. Pediatr Radiol 30:131–138

    Article  PubMed  CAS  Google Scholar 

  56. Riachy E, Krauel L, Rich BS et al (2014) Risk factors and predictors of severity score and complications of pediatric hemorrhagic cystitis. J Urol 191:186–192

    Article  PubMed  Google Scholar 

  57. Cartoni C, Arcese W, Awisati G et al (1993) Role of ultrasonography in the diagnosis and follow-up of hemorrhagic cystitis after bone marrow transplantation. Bone Marrow Transplant 12:463–467

    PubMed  CAS  Google Scholar 

  58. Schechter T, Liebman M, Gassas A et al (2010) BK virus-associated hemorrhagic cystitis presenting as mural nodules in the urinary bladder after hematopoietic stem cell transplantation. Pediatr Radiol 40:1430–1433

    Article  PubMed  Google Scholar 

  59. te Winkel ML, Pieters R, Hop WC et al (2011) Prospective study on incidence, risk factors, and long-term outcome of osteonecrosis in pediatric acute lymphoblastic leukemia. J Clin Oncol 29:4143–4150

    Article  Google Scholar 

  60. Leung W, Ahn H, Rose SR et al (2007) A prospective cohort study of late sequelae of pediatric allogeneic hematopoietic stem cell transplantation. Medicine (Baltimore) 86:215–224

    Article  Google Scholar 

  61. Karimova EJ, Rai SN, Ingle D et al (2006) MRI of knee osteonecrosis in children with leukemia and lymphoma: part 2, clinical and imaging patterns. AJR Am J Roentgenol 186:477–482

    Article  PubMed  Google Scholar 

  62. Sharma S, Leung WH, Deging P et al (2012) Osteonecrosis in children after allogeneic hematopoietic cell transplantation: study of prevalence, risk factors and longitudinal changes using MR imaging. Bone Marrow Transplant 47:1067–1074

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  63. Miettunen PM, Lafay-Cousin L, Guilcher GM et al (2012) Widespread osteonecrosis in children with leukemia revealed by whole-body MRI. Clin Orthop Relat Res 470:3587–3595

    Article  PubMed  PubMed Central  Google Scholar 

  64. Fletcher BD (1997) Effects of pediatric cancer therapy on the musculoskeletal system. Pediatr Radiol 27:623–636

    Article  PubMed  CAS  Google Scholar 

  65. Fletcher BD, Wall JE, Hanna SL (1993) Effects of hematopoietic growth factors on MR images of bone marrow in children undergoing chemotherapy. Radiology 189:745–751

    Article  PubMed  CAS  Google Scholar 

  66. Ulaner GA, Lyall A (2013) Identifying and distinguishing treatment effects and complications from malignancy at FDG PET/CT. Radiographics 33:1817–1834

    Article  PubMed  Google Scholar 

  67. Hattangadi J, Esty B, Winey B et al (2012) Radiation recall myositis in pediatric Ewing sarcoma. Pediatr Blood Cancer 59:570–572

    Article  PubMed  Google Scholar 

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Correspondence to Govind B. Chavhan.

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Chavhan, G.B., Babyn, P.S., Nathan, P.C. et al. Imaging of acute and subacute toxicities of cancer therapy in children. Pediatr Radiol 46, 9–20 (2016). https://doi.org/10.1007/s00247-015-3454-1

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