Careful follow-up of treated patients is essential. The type of treatment administered may influence the later risk of secondary acute leukemia, as combined modality therapy with certain chemotherapeutic regimens and irradiation is associated with increased risk compared with either treatment alone. The risk of a secondary acute leukemia with irradiation alone is much less than with chemotherapy. Thus, all female patients should be informed of the breast cancer risk and breast self examination should be initiated at an early age. In sexually mature males who will undergo combination chemotherapy or pelvic irradiation, consideration should be given to storing sperm, since seminiferous tissue is often irreparably damaged by chemotherapy or scattered irradiation.
Sperm storage is complicated by the fact that many patients have low sperm counts at presentation.
In order to maintain fertility in males, etoposide has been substituted for procarbazine in combination chemotherapy regimens, since it causes less gonadal damage. Placement of titanium clips at the splenic hilum is strongly recommended to facilitate radiation therapy planning to shield the left kidney when the para-aortic nodes and splenic pedicle are to be irradiated. In addition, children will often show localized growth abnormalities after full-dose radiation. For example, the neck may have a smaller circumference or the upper chest may be poorly developed if these areas are irradiated. Gehan EA, Sullivan MP, Fuller LM, et al.