Damage to the urinary tract secondary to irradiation

During the past two decades highly effective multimodality therapy with surgery, chemotherapy and irradiation has been developed through consecutive national and international study protocols for childhood genitourinary cancers, the model being Wilms' tumor. These studies represent a landmark achievement in the history of pediatric oncology and mark the success of multi-institutional efforts. Now that excellent survival rates have been established, current interest is now directed primarily at examination of survivors for long-term treatment complications and minimizing the side effects while preserving treatment efficacy. Treatment sequelae may not become evident until many years after the initial diagnosis of cancer and may have adverse influences on long-term survival and/or the quality of life of former patients. With radiotherapy being a mainstay on the stage adjusted therapy of primarily Wilms' tumor and rhabdomyosarcoma, morbidity may occur as either acute or chronic with the genitourinary tract as an important adversely affected vital organ system. The effects of radiotherapy in the treatment of genitourinary childhood cancers on the urinary tract are reviewed here.