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Complications of Therapy

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Imaging in Pediatric Oncology

Part of the book series: Pediatric Oncology ((PEDIATRICO))

Abstract

Pediatric oncologic patients are treated according to a variety of treatment regimens, depending on the type of malignancy. The complications associated with treatment can be divided into those related to change in immune status/infection-related complications and complications directly related to the toxicity of the treatment. Acute toxicities include myelosuppression, alopecia, nausea and emesis, mucositis, liver function disturbances, and allergic reactions. Infections are related to immunosuppressive therapy and to the disruption of the mucocutaneous integrity by local tumor invasion, insertion of foreign bodies such as vascular catheters, surgery, radiotherapy, and cytotoxic chemotherapy. In this chapter the complications for which imaging can play a role will be discussed in general and separately per anatomic system or location.

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References

  1. Chavhan GB, Babyn PS, Nathan PC, Kaste SC. Imaging of acute and subacute toxicities of cancer therapy in children. Pediatr Radiol. 2016;46(1):9–20. quiz 6–8.

    Article  PubMed  Google Scholar 

  2. Mor M, Gilad G, Kornreich L, Fisher S, Yaniv I, Levy I. Invasive fungal infections in pediatric oncology. Pediatr Blood Cancer. 2011;56(7):1092–7.

    Article  PubMed  Google Scholar 

  3. MCG S, Caron HN, Biondi A. Cancer in children. Clinical management. 6th ed. New York, NY: Oxford University Press; 2012.

    Google Scholar 

  4. Roberts SD, Wells GM, Gandhi NM, York NR, Maron G, Razzouk B, et al. Diagnostic value of routine chest radiography in febrile, neutropenic children for early detection of pneumonia and mould infections. Support Care Cancer. 2012;20(10):2589–94.

    Article  PubMed  Google Scholar 

  5. Cox JA, DeMasi J, McCollom S, Jackson G, Scothorn D, Aquino VM. The diagnostic utility of routine chest radiography in the evaluation of the initial fever in patients undergoing hematopoietic stem cell. Pediatr Blood Cancer. 2011;57(4):666–8.

    Article  PubMed  Google Scholar 

  6. Phillips RS, Lehrnbecher T, Alexander S, Sung L. Updated systematic review and meta-analysis of the performance of risk prediction rules in children and young people with febrile neutropenia. PLoS One. 2012;7(5):e38300.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Lehrnbecher T, Robinson P, Fisher B, Alexander S, Ammann RA, Beauchemin M, et al. Guideline for the management of fever and neutropenia in children with cancer and hematopoietic stem-cell transplantation recipients: 2017 update. J Clin Oncol. 2017;35(18):2082–94.

    Article  CAS  PubMed  Google Scholar 

  8. Vazquez E, Delgado I, Sanchez-Montanez A, Barber I, Sanchez-Toledo J, Enriquez G. Side effects of oncologic therapies in the pediatric central nervous system: update on neuroimaging findings. Radiographics. 2011;31(4):1123–39.

    Article  PubMed  Google Scholar 

  9. Zerizer I, Humphries PD. Imaging ‘the lost tribe’: a review of adolescent cancer imaging. Part 2: imaging of complications of cancer treatment. Cancer Imaging. 2009;9:82–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Chu WC, Lee V, Howard RG, Roebuck DJ, Chik KW, Li CK. Imaging findings of paediatric oncology patients presenting with acute neurological symptoms. Clin Radiol. 2003;58(8):589–603.

    Article  CAS  PubMed  Google Scholar 

  11. Nickerson JP, Richner B, Santy K, Lequin MH, Poretti A, Filippi CG, et al. Neuroimaging of pediatric intracranial infection--Part 2: TORCH, viral, fungal, and parasitic infections. J Neuroimaging. 2012;22(2):e52–63.

    Article  PubMed  Google Scholar 

  12. Orlowski HLP, McWilliams S, Mellnick VM, Bhalla S, Lubner MG, Pickhardt PJ, et al. Imaging spectrum of invasive fungal and fungal-like infections. Radiographics. 2017;37(4):1119–34.

    Article  PubMed  Google Scholar 

  13. Khan RB, Sadighi ZS, Zabrowski J, Gajjar A, Jeha S. Imaging patterns and outcome of posterior reversible encephalopathy syndrome during childhood cancer treatment. Pediatr Blood Cancer. 2016;63(3):523–6.

    Article  CAS  PubMed  Google Scholar 

  14. Baytan B, Evim MS, Guler S, Gunes AM, Okan M. Acute central nervous system complications in pediatric acute lymphoblastic leukemia. Pediatr Neurol. 2015;53(4):312–8.

    Article  PubMed  Google Scholar 

  15. Averill LW, Acikgoz G, Miller RE, Kandula VV, Epelman M. Update on pediatric leukemia and lymphoma imaging. Semin Ultrasound CT MR. 2013;34(6):578–99.

    Article  PubMed  Google Scholar 

  16. Tavares M, Arantes M, Chacim S, Junior AC, Pinto A, Mariz JM, et al. Posterior reversible encephalopathy syndrome in children with hematologic malignancies. J Child Neurol. 2015;30(12):1669–75.

    Article  PubMed  Google Scholar 

  17. Rossi Espagnet MC, Pasquini L, Napolitano A, Cacchione A, Mastronuzzi A, Caruso R, et al. Magnetic resonance imaging patterns of treatment-related toxicity in the pediatric brain: an update and review of the literature. Pediatr Radiol. 2017;47(6):633–48.

    Article  PubMed  Google Scholar 

  18. Lo Nigro L, Di Cataldo A, Schiliro G. Acute neurotoxicity in children with B-lineage acute lymphoblastic leukemia (B-ALL) treated with intermediate risk protocols. Med Pediatr Oncol. 2000;35(5):449–55.

    Article  CAS  PubMed  Google Scholar 

  19. Toma P, Bertaina A, Castagnola E, Colafati GS, D’Andrea ML, Finocchi A, et al. Fungal infections of the lung in children. Pediatr Radiol. 2016;46(13):1856–65.

    Article  PubMed  Google Scholar 

  20. Muller FM, Trusen A, Weig M. Clinical manifestations and diagnosis of invasive aspergillosis in immunocompromised children. Eur J Pediatr. 2002;161(11):563–74.

    Article  PubMed  Google Scholar 

  21. Patsios D, Maimon N, Chung T, Roberts H, Disperati P, Minden M, et al. Chest low-dose computed tomography in neutropenic acute myeloid leukaemia patients. Respir Med. 2010;104(4):600–5.

    Article  PubMed  Google Scholar 

  22. Thomas KE, Owens CM, Veys PA, Novelli V, Costoli V. The radiological spectrum of invasive aspergillosis in children: a 10-year review. Pediatr Radiol. 2003;33(7):453–60.

    Article  PubMed  Google Scholar 

  23. Attenberger UI, Morelli JN, Henzler T, Buchheidt D, Fink C, Schoenberg SO, et al. 3 Tesla proton MRI for the diagnosis of pneumonia/lung infiltrates in neutropenic patients with acute myeloid leukemia: initial results in comparison to HRCT. Eur J Radiol. 2014;83(1):e61–6.

    Article  CAS  PubMed  Google Scholar 

  24. Yan C, Tan X, Wei Q, Feng R, Li C, Wu Y, et al. Lung MRI of invasive fungal infection at 3 Tesla: evaluation of five different pulse sequences and comparison with multidetector computed tomography (MDCT). Eur Radiol. 2015;25(2):550–7.

    Article  PubMed  Google Scholar 

  25. Nagel SN, Wyschkon S, Schwartz S, Hamm B, Elgeti T. Can magnetic resonance imaging be an alternative to computed tomography in immunocompromised patients with suspected fungal infections? Feasibility of a speed optimized examination protocol at 3 Tesla. Eur J Radiol. 2016;85(4):857–63.

    Article  PubMed  Google Scholar 

  26. Rieger C, Herzog P, Eibel R, Fiegl M, Ostermann H. Pulmonary MRI--a new approach for the evaluation of febrile neutropenic patients with malignancies. Support Care Cancer. 2008;16(6):599–606.

    Article  CAS  PubMed  Google Scholar 

  27. Peltola V, Ruuskanen O, Svedstrom E. Magnetic resonance imaging of lung infections in children. Pediatr Radiol. 2008;38(11):1225–31.

    Article  PubMed  Google Scholar 

  28. Sodhi KS, Bhatia A, Khandelwal N. Rapid lung magnetic resonance imaging in children with pulmonary infection. Pediatr Radiol. 2017;47(6):764–5.

    Article  PubMed  Google Scholar 

  29. Interiano RB, McCarville MB, Wu J, Davidoff AM, Sandoval J, Navid F. Pneumothorax as a complication of combination antiangiogenic therapy in children and young adults with refractory/recurrent solid tumors. J Pediatr Surg. 2015;50(9):1484–9.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Khoury NJ, Kanj V, Abboud M, Muwakkit S, Birjawi GA, Haddad MC. Abdominal complications of chemotherapy in pediatric malignancies: imaging findings. Clin Imaging. 2009;33(4):253–60.

    Article  PubMed  Google Scholar 

  31. Flores-Calderon J, Exiga-Gonzalez E, Moran-Villota S, Martin-Trejo J, Yamamoto-Nagano A. Acute pancreatitis in children with acute lymphoblastic leukemia treated with L-asparaginase. J Pediatr Hematol Oncol. 2009;31(10):790–3.

    Article  PubMed  Google Scholar 

  32. Cesaro S, Pillon M, Talenti E, Toffolutti T, Calore E, Tridello G, et al. A prospective survey on incidence, risk factors and therapy of hepatic veno-occlusive disease in children after hematopoietic stem cell transplantation. Haematologica. 2005;90(10):1396–404.

    PubMed  Google Scholar 

  33. Choi A, Kang YK, Lim S, Kim DH, Lim JS, Lee JA. Severe hepatic sinusoidal obstruction syndrome in a child receiving vincristine, actinomycin-D, and cyclophosphamide for rhabdomyosarcoma: successful treatment with defibrotide. Cancer Res Treat. 2016;48(4):1443–7.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Mohty M, Malard F, Abecassis M, Aerts E, Alaskar AS, Aljurf M, et al. Sinusoidal obstruction syndrome/veno-occlusive disease: current situation and perspectives-a position statement from the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant. 2015;50(6):781–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Cesaro S, Spiller M, Sartori MT, Alaggio R, Peruzzo M, Saggiorato G, et al. Veno-occlusive disease in pediatric patients affected by Wilms tumor. Pediatr Blood Cancer. 2011;57(2):258–61.

    Article  PubMed  Google Scholar 

  36. McCarville MB, Hoffer FA, Howard SC, Goloubeva O, Kauffman WM. Hepatic veno-occlusive disease in children undergoing bone-marrow transplantation: usefulness of sonographic findings. Pediatr Radiol. 2001;31(2):102–5.

    Article  CAS  PubMed  Google Scholar 

  37. Kaya N, Erbey F, Atay D, Akcay A, Bozkurt C, Ozturk G. The diagnostic value of hepatic arterial velocity in venoocclusive disease after pediatric hematopoietic stem cell transplantation. J Pediatr Hematol Oncol. 2017;39:249.

    Article  PubMed  Google Scholar 

  38. Colecchia A, Marasco G, Ravaioli F, Kleinschmidt K, Masetti R, Prete A, et al. Usefulness of liver stiffness measurement in predicting hepatic veno-occlusive disease development in patients who undergo HSCT. Bone Marrow Transplant. 2017;52(3):494–7.

    Article  CAS  PubMed  Google Scholar 

  39. Brisse H, Orbach D, Lassau N, Servois V, Doz F, Debray D, et al. Portal vein thrombosis during antineoplastic chemotherapy in children: report of five cases and review of the literature. Eur J Cancer. 2004;40(18):2659–66.

    Article  CAS  PubMed  Google Scholar 

  40. Dosik GM, Luna M, Valdivieso M, McCredie KB, Gehan EA, Gil-Extremera B, et al. Necrotizing colitis in patients with cancer. Am J Med. 1979;67(4):646–56.

    Article  CAS  PubMed  Google Scholar 

  41. Mullassery D, Bader A, Battersby AJ, Mohammad Z, Jones EL, Parmar C, et al. Diagnosis, incidence, and outcomes of suspected typhlitis in oncology patients--experience in a tertiary pediatric surgical center in the United Kingdom. J Pediatr Surg. 2009;44(2):381–5.

    Article  PubMed  Google Scholar 

  42. Shafey A, Ethier MC, Traubici J, Naqvi A, Sung L. Incidence, risk factors, and outcomes of enteritis, typhlitis, and colitis in children with acute leukemia. J Pediatr Hematol Oncol. 2013;35(7):514–7.

    Article  CAS  PubMed  Google Scholar 

  43. Rizzatti M, Brandalise SR, de Azevedo AC, Pinheiro VR, Aguiar Sdos S. Neutropenic enterocolitis in children and young adults with cancer: prognostic value of clinical and image findings. Pediatr Hematol Oncol. 2010;27(6):462–70.

    Article  PubMed  Google Scholar 

  44. Urbach DR, Rotstein OD. Typhlitis. Can J Surg. 1999;42(6):415–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Gray TL, Ooi CY, Tran D, Traubici J, Gerstle JT, Sung L. Gastrointestinal complications in children with acute myeloid leukemia. Leuk Lymphoma. 2010;51(5):768–77.

    Article  PubMed  Google Scholar 

  46. El-Matary W, Soleimani M, Spady D, Belletrutti M. Typhlitis in children with malignancy: a single center experience. J Pediatr Hematol Oncol. 2011;33(3):e98–100.

    Article  PubMed  Google Scholar 

  47. Reyna-Figueroa J, Garcia-Beristain JC, Galindo-Delgado P, Limon-Rojas AE, Madrid-Marina V. Antibiotic use before chemotherapy: a risk factor for developing neutropenic colitis in children with leukemia. J Pediatr Hematol Oncol. 2015;37(2):121–7.

    Article  CAS  PubMed  Google Scholar 

  48. Capria S, Vitolo D, Cartoni C, Dessanti L, Micozzi A, Mandelli F, et al. Neutropenic enterocolitis in acute leukemia: diagnostic and therapeutic dilemma. Ann Hematol. 2004;83(3):195–7.

    Article  CAS  PubMed  Google Scholar 

  49. McCarville MB, Adelman CS, Li C, Xiong X, Furman WL, Razzouk BI, et al. Typhlitis in childhood cancer. Cancer. 2005;104(2):380–7.

    Article  PubMed  Google Scholar 

  50. Parisi MT, Fahmy JL, Kaminsky CK, Malogolowkin MH. Complications of cancer therapy in children: a radiologist’s guide. Radiographics. 1999;19(2):283–97.

    Article  CAS  PubMed  Google Scholar 

  51. Cardona Zorrilla AF, Reveiz Herault L, Casasbuenas A, Aponte DM, Ramos PL. Systematic review of case reports concerning adults suffering from neutropenic enterocolitis. Clin Transl Oncol. 2006;8(1):31–8.

    Article  PubMed  Google Scholar 

  52. de Lijster MS, Smets AM, van den Berg H, Reekers JA. Embolisation for caecal bleeding in a child with typhlitis. Pediatr Radiol. 2015;45(2):283–5.

    Article  PubMed  Google Scholar 

  53. Fenton LZ, Buonomo C. Benign pneumatosis in children. Pediatr Radiol. 2000;30(11):786–93.

    Article  CAS  PubMed  Google Scholar 

  54. McCarville MB, Whittle SB, Goodin GS, Li CS, Smeltzer MP, Hale GA, et al. Clinical and CT features of benign pneumatosis intestinalis in pediatric hematopoietic stem cell transplant and oncology patients. Pediatr Radiol. 2008;38(10):1074–83.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Olson DE, Kim YW, Ying J, Donnelly LF. CT predictors for differentiating benign and clinically worrisome pneumatosis intestinalis in children beyond the neonatal period. Radiology. 2009;253(2):513–9.

    Article  PubMed  Google Scholar 

  56. Johnston D, Schurtz E, Tourville E, Jones T, Boemer A, Giel D. Risk factors associated with severity and outcomes in pediatric patients with hemorrhagic cystitis. J Urol. 2016;195(4 Pt 2):1312–7.

    Article  PubMed  Google Scholar 

  57. McCarville MB, Hoffer FA, Gingrich JR, Jenkins JJ III. Imaging findings of hemorrhagic cystitis in pediatric oncology patients. Pediatr Radiol. 2000;30(3):131–8.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands

    Eline E. Deurloo & Anne M. J. B. Smets

Authors
  1. Eline E. Deurloo
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  2. Anne M. J. B. Smets
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Correspondence to Eline E. Deurloo .

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Editors and Affiliations

  1. Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Stephan D. Voss

  2. Department of Radiology, Great Ormond Street Hospital for Children, London, UK

    Kieran McHugh

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Deurloo, E.E., Smets, A.M.J.B. (2019). Complications of Therapy. In: Voss, S., McHugh, K. (eds) Imaging in Pediatric Oncology. Pediatric Oncology. Springer, Cham. https://doi.org/10.1007/978-3-030-03777-2_11

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  • DOI: https://doi.org/10.1007/978-3-030-03777-2_11

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