Late Effect	Causative Treatment	Signs and Symptoms	Screening and Diagnostic Tests	Management and Intervention
aAdapted from Schwartz et al.[37]
Neurocognitive deficit	Chemotherapy: High-dose IV methotrexate, IT methotrexate	Difficulty with: reading, language, verbal and nonverbal memory, arithmetic, receptive and expressive language, decreased mental processing speed, attention deficit, decreased IQ, behavior problems, poor school attendance, poor hand-eye coordination	Neurocognitive testing: psycho-educational, neuropsychologic	Psychoeducation assistance
	Radiation: >18 Gy
	Surgery: Resection of CNS tumor and postop complications including infection and hydrocephalus
Leuko-encephalopathy	Chemotherapy: Methotrexate: IT or IV, IT cytarabine	Seizures, neurologic impairment, compare with premorbid status	Computed tomography (CT)/magnetic resonance imaging (MRI) scan baseline and symptoms	Symptom management: muscle relaxants, anticonvulsants, physical therapy, occupational therapy
	Radiation: >18 Gy (with methotrexate)
Focal necrosis	Chemotherapy: Methotrexate: IT or high-dose IV carmustine (BCNU), cisplatin	Headaches, nausea, seizures, papilledema, hemiparesis/other focal findings, speech, learning, and memory deficits	CT/MRI scan baseline, as needed for symptoms, positron emission tomography or single photon emission CT scan	Steroid therapy, debulking of necrotic tissue
	Radiation: >50 Gy (especially with >2 Gy daily fraction)
	Surgery: Resection of tumor
Large-vessel stroke	Radiation: >60 Gy	Headache, seizures, hemiparesis, aphasia, focal neurologic findings	CT/MRI, arteriogram	Determined by specific neurologic impairment
Vision loss	Chemotherapy: Intra-arterial BCNU, cisplatin	Progressive visual loss	Ophthalmic evaluation, visual-evoked response	Visual aids
	Radiation: >50 Gy (optic nerve chiasm, occipital lobe)
	Surgery: Resection of tumor
Ototoxicity	Chemotherapy: Cisplatin, carboplatin	Abnormal speech development, hearing	Audiogram baseline, as needed for symptoms	Speech therapy, hearing aid
	Radiation: >35 Gy (middle/inner ear)
	Surgery: Surgery, cerebrospinal fluid (CSF) shunting
Myelitis	Radiation: >45–50 Gy	Paresis, spasticity, altered sensation, loss of sphincter control	MRI	Steroids, physical therapy, occupational therapy
	Surgery: Spinal cord surgery

References

37. Schwartz C L, Hobbie WL, Constine LS, et al., eds.: Survivors of Childhood Cancer: Assessment and Management. St. Louis, Mo: Mosby, 1994.