A recent study published in the journal Pediatric Blood & Cancer has outlined the late effects radiation may have on pediatric cancer patients. Lengthened survival comes from total body irradiation (TBI), a necessary part of treatment during bone marrow transplant, which creates the ability to notice these long term effects of radiation, according to researchers from the University of Colorado Cancer Center.

TBI is a form of radiotherapy which is most commonly used as a preparative regimen for bone marrow transplantation. It requires irradiation of the whole body; and while in the setting of bone marrow transplantation, it destroys the patient’s immune system in order to prevent immunologic rejection of transplanted bone marrow from a donor or blood stem cells.

Jean Mulcahy-Levy, MD, researcher at the CU Cancer Center and leading author, said: “These kids basically lie on a table and truly do get radiation from head to toe. There is a little blocking of the lungs, but nothing of, for example, the brain or the kidneys.”

Many of the 15 patients who underwent TBI before the age of 3 developed metabolic and endocrine problems including testicular malfunction (78%), restrictive pulmonary disease caused by elevated levels of blood triglycerides (74%), and cataracts (78%).

Results showed abnormally low levels of the growth hormone in 90% of patients, while 71% were significantly under height.

Kidney, liver, skeletal, and cardiac malfunction were also late effects of TBI. A cognitive decline in IQ, which was tested before TBI, was seen in 3 of 4 patients.

Mulcahy-Levy said:

“Fifteen doesn’t seem like a large number, but because we have such a good pediatric bone marrow transplant program here at Children’s Hospital Colorado and radiation therapy program at the CU Cancer Center, we were able to get a large enough cohort of patients to see these overall effects.”

The recommendations of the Children’s Oncology Group for long term follow up care for kids undergoing TBI is supported by this research. Mulcahy-Levy wants doctors and patients to become more aware of likely effects of TBI in order to screen for, detect, and correct likely effects.

He concluded that it is important for the public to become aware of the problems of TBI in order to address them properly and proactively, because TBI is often a necessary part of treatment.

Written by Sarah Glynn