Long-Term Follow-Up Roadmaps by Disease and Treatment


Chemotherapy

Dose

Late effect

Baseline screening

Anthracycline

≥300 mg/m2 or

Cardiomyopathy valvular, pericardial damage, coronary artery disease

EKG, ECHO

(Doxorubicin

>200 mg/m2 +

Daunorubicin

Chest XRT ≥30 Gy

Epirubicin

HD CTX (120–200 mg/kg)

Mitoxantrone

Idarubicin)

Acute myeloid leukemia

CBC

Cyclophosphamide (Cytoxan)

>7.5 gm/m2

Gonadal failure

FSH, LH, estradiol/testosterone

Cardiomyopathy

EKG, ECHO

Second cancersa

CBC, UA

Nephropathy/bladder irritation

Serum electrolytes, UA

Ifosfamide

≥60 gm/m2

Nephropathy

Serum electrolytes, UA

Second cancersa

CBC, UA

Gonadal failure

FSH, LH, estradiol/testosterone

Etoposide

>3.5 gm/m2

Leukemia

CBC

HD MTX b with IT chemo

>1 gm/m2

Neurocognitive

Neurocognitive testing

Deficits,
 
Leukoencephalopathy
 
Hepatic fibrosis (MTX)

LFTs, bilirubin

Bleomycin

>400 U

Pulmonary toxicity

PFT, CXR

Cisplatin

≥360 mg/m2 or

Ototoxicity

Audiogram

<360 mg/m2 +CXRT
 
Glomerular, tubular Dysfunction, Low Mg

UA, electrolytes

Dyslipidemia

Fasting Lipid panel


aLeukemia, bladder CA

b HD MTX high dose methotrexate




Table 4.2
Cumulative dose ranges of common chemotherapy agents based on current COG protocols for each diagnosis






















































Chemotherapy
ALL
AML
STS
EWS
Osteosarcoma

Anthracycline

75–300 mg/m2

450 mg/m2

375–450 mg/m2

375 mg/m2

375–450 mg/m2

Doxorubicin

Daunorubicin

Idarubicin

Mitoxantrone

Cyclophosphamide

1–4 gm/m2
 
4.8–16.8 gm/m2

8.4 gm/m2
 

Ifosfamide

9 gm/m2 a
   
63 gm/m2

48–51 gm/m2

Etoposide

1 gm/m2 a

1.5 gm/m2

0–2.5 gm/m2

3.5 gm/m2

1.5 gm/m2


aCOG Very High Risk Protocol only [6]. Treatment protocols continue to evolve, hence, the above table serves only as a guideline



Table 4.3
Isotoxic dose conversion of anthracyclines based on current Children’s Oncology Guidelines

























Anthracycline
Conversion

Doxorubicin
Multiply by 1

Daunorubicin
Multiply by 0.833

Epirubicin
Multiply by 0.67

Mitoxantrone
Multiply by 4

Idarubicin
Multiply by 5


This table is a guide to determine the total anthracycline dose received based on equivalent dosing with doxorubicin. For example, if a survivor received 48 mg/m2 of Mitoxantrone, multiply this by 4, to give a total anthracycline dose of 192 mg/m2



Table 4.4
Leukemia follow-up


































































































































































































































Evaluation
Baseline off therapy
LTFU 2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years

Date
                        

History, physical and exam
X
X
X
X
X
X
X
X
X
X
X
X

CBC, BUN, Crt, LFTs, UA, TSH, FT4, ferritin (baseline only)
X
X
X
X
X
X
X
X
X
X
X
X

Fasting glucose and lipid profile every 3–5 years and at entry to LTFU
X
X
        
X
        
X

Girls: FSH, LH, estradiol
                        

Boys: LH, FSH, testosterone

Baseline at age >13 and for delayed puberty, s/sx of estrogen/testosterone deficiency

EKG, ECHO
X
X
        
X
        
X

Total anthracycline ≥300 mg/m 2 (yearly) or <300 mg/m 2 (every 3–5 years and at entry to LTFU)

DEXA scan
                        

Baseline at age 18 years, consider earlier if clinically indicated

Neuropsychological evaluation
X
                      

Baseline and then PRN

Ophthalmology
X
X
X
X
X
X
X
X
X
X
X
X

Dentist every 6 months
X
X
X
X
X
X
X
X
X
X
X
X

If patient has sx of Osteonecrosis,
                        

MRI/orthopedic referral

Monitor for obesity, second cancers
                        

Craniospinal XRT: monitor growth curve, IGF-1, IGFBP3, scoliosis
                        



Table 4.5
Hodgkin lymphoma follow-up









































































































































































































Evaluation
Baseline off therapy
LTFU 2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
13 Years

Date
                          

History, physical and exam
X
X
X
X
X
X
X
X
X
X
X
X
X

Chest XRT—include clinical breast exam

CBC, BUN, Crt, LFTs, TSH, FT4, ferritin (baseline only)
X
X
X
X
X
X
X
X
X
X
X
X
X

Fasting glucose and lipid profile every 3–5 years and at entry to LTFU
X
X
        
X
        
X
  

Girls: FSH, LH, estradiol
                          

Boys: LH, FSH, testosterone, semen analysis PRN

Baseline at age >13 and for delayed puberty, s/sx of estrogen/testosterone deficiency

CXR (every 3–5 years to rule out fibrosis)
    
X
                    

EKG, ECHO
X
X
        
X
        
X
  

Total anthracycline ≥300 mg/m 2 (yearly) or <300 mg/m 2 (every 3–5 years and at entry to LTFU)

Pulmonary function test (every 3–5 years or more frequently if clinically indicated)
X
      
X
        
X
      

DEXA scan
                          

Baseline at age 18 years, consider earlier if clinically indicated

Neuropsychological evaluation
X
                        

Baseline and then PRN

Ophthalmology
X
X
X

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Dec 10, 2016 | Posted by in ONCOLOGY | Comments Off on Long-Term Follow-Up Roadmaps by Disease and Treatment

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