Childhood Urologic Cancer Therapy Related Sequelae and Their Impact on Management

Multidisciplinary treatment for childhood urologic cancer has resulted in improved survival. However, the sucessful results may be marred by the appearance of therapy-related sequelae. Thus, radiation therapy has produced spine deformities (kyphosis and scoliosis), ovarian failure, renal disease and abnormalities in the skin, subcutaneous tissue, and muscle. Successful treatment of pulmonary metastases has been associated with abnormalities in pulmonary physiology and chest wall deformities. Chemotherapy-related complications include hemorrhagic cystitis and possible gonadal failure. If exenteration for bladder or prostate cancer is required, the sequelae are immediately apparent and include ureterosigmoidostomy, colostomy, or iliostomy. Oncogenic sequelae comprise benign and malignant neoplasms, and many of them appear to be radiation induced. Recognition of these sequelae has lead to changes in therapy to reduce or prevent their occurrence. However, despite innovative changes, long-term survivors still appear to be a risk for the development of late complications. The importance of continued surveillance is stressed.