Four Ways to Decrease Late Toxicity from Pelvic Radiotherapy in Children and Young Adults.

The use of curative-intent multimodality therapy with chemotherapy, surgery, and radiation results in late toxicities in almost two-thirds of pediatric cancer patients. When pelvic radiation is used for pediatric malignancies such as rhabdomyosarcoma, lymphoma, neuroblastoma, Ewing sarcoma, and Wilms tumor, the associated late toxicities can affect many normal tissues and may include growth asymmetries, cystitis, infertility, and sexual dysfunction. We describe four recommendations of how to prevent or minimize late toxicities from pelvic radiation and review the literature of these pediatric late toxicities.