Late Effects of Neuroblastoma Treatment

Late effects are health issues that neuroblastoma patients can develop after treatments have ended. Common late effects of neuroblastoma include learning issues, vision problems, growth and developmental delays, developmental problems, seizures, headaches as well as loss of function in certain organs. The risk of developing late effects depends on various factors, such as the specific drugs used during treatment, the dose of those drugs and the child's age during treatment. It is important to discuss possible late effects with your child’s doctor at every stage of neuroblastoma treatment.

While this is not meant to be an exhaustive list, the following provides a high level overview of the most common late effects associated with neuroblastoma:

Neuroblastoma Learning Challenges

Learning late effects* – also classified as cognitive impairments -- most often manifest as:
  • lower academic achievement test scores
  • problems in memory and attention
  • poor hand-eye coordination
  • slowed development over time
  • behavior problems
  • IQ drops 10 to 20 points
*More apparent in children diagnosed under the age of 5

Neuroblastoma Vision Problems

Common late effects on vision include:
  • dry eye
  • eye irritation (feels like something is in the eye)
  • discolored sclera (white part of the eye may be a different color, often yellow)
  • damage to the optic nerve and retina
  • poor vision
  • light sensitivity
  • poor night vision
  • tumors on the eyelid
  • drooping eyelid

Neuroblastoma Growth and Development Issues

Decreased growth rates during neuroblastoma treatment are a common occurrence. Many children will experience catch-up growth after treatment, but in some children, short stature (height) is permanent. Chemotherapy may contribute to a slow-down in growth. But when chemotherapy is given alone, without radiation, the change in growth rate is most often short-term. Over time, many patients catch up to a normal growth pattern after treatment. However, certain chemotherapy drugs, when given in high doses, can have lasting effects on a child’s growth rate and many of the long-term effects of intensive chemotherapy remain unclear.

Many of the late effects on growth and development are linked to radiation. Radiation has a direct effect on the growth of bones located in the area that is being treated. Radiation to the head also contributes to slower growth.

Neuroblastoma Muscle and Bone Complications

Radiation treatment can have serious effects on the proper growth of bone and muscle in infants and children. Bones, soft tissue, muscle, and blood vessels are very sensitive to radiation during times of rapid growth. This means children under the age of 6, and those going through a growth spurt at puberty are at greatest risk for late effects issues.

Along with stunted bone growth, other late effects related to bone and muscle include:
  • unequal growth of body parts (the treated side doesn't grow the same way as the untreated side)
  • bone pain
  • joint stiffness
  • gait changes (changes in the way the child walks)
  • weak bones that can break easily (osteoporosis)
  • decreased calcium in the bones