Chemotherapy

• Skin and tendon contracture following infiltration of vesicant drugs (e.g., nitrogen mustard, anthracycline, vincristine, actinomycin D)

• Steroid-induced avascular necrosis and osteoporosis. The increased use of dex-amethasone in acute lymphocytic leukemia (ALL) therapy has resulted in an increased number of cases of avascular necrosis. Adolescents appear to be at higher risk. Recent Children's Oncology Group protocols have attempted to decrease this incidence by decreasing the number of continuous weeks of exposure to dexamethasone by the use of 1 week on and 1 week off when prolonged dexamethasone therapy is required after induction.

Investigators have found that bone mineral density is decreased in childhood cancer survivors and there is an increased incidence of osteopenia and osteoporosis. Use of bisphosphonates are being investigated in childhood cancer survivors to improve osteoporosis.

Table 27-5. Radiation Dose Toxicity Levels for Subacute and Late Visceral Effects

Whole organ irradiation Partial organ irradiation

Table 27-5. Radiation Dose Toxicity Levels for Subacute and Late Visceral Effects

Whole organ irradiation Partial organ irradiation

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