Although short-term side effects appear and subside, long-term side effects may not become apparent for months or years after treatment ends. Specific late effects depend on the age of the child, the dose of radiation, the part of the body treated with radiation, and the vulnerability of each child. Children at greatest risk for cognitive problems are those treated with cranial radiation when younger than age five; those younger than age two are at highest risk. Chapter 20, School, discusses in detail the types of educational challenges some children face and ways to deal with them.

The effects of radiation on cognitive functioning, bone growth, soft tissue growth, teeth, sinuses, endocrine glands, puberty, and fertility range from no late effects to lifelong impacts. Second tumors in the radiation field are also a possible long-term side effect. Detailed information about possible late effects are described in Childhood Cancer Survivors: A Practical Guide to Your Future, 3rd edition by Nancy Keene, Wendy Hobbie, and Kathy Ruccione.

When radiation treatment is complete, you should be given a summary of your child’s care, including type of radiation, location, and dose. You also should be given a clear plan for any needed follow-up care. More information is available in Chapter 24, End of Treatment and Beyond.

My daughter had AML and had a bone marrow transplant when she was eight. She had total body irradiation and does have some late effects including ongoing endocrine problems, menstrual difficulties, and cataracts. She also has a reduced ejection fraction of the heart from the anthracyclines and had to deal with a second cancer in her thyroid gland. That said, you’d never pick her out of a crowd. She graduated from high school with a perfect 4.0 GPA and wants to specialize in biology with the intent to go into medicine (pediatric oncology) or molecular genetics with a focus on cancer genetics. There is hope.