Tissue effects of chemotherapeutic agents in children with solid tumors

The cases of 21 children and young adults with solid neoplasms, who died and were autopsied at the University of Wisconsin Hospital between 1967 and 1980, have been reviewed in order to ascertain adverse effects of chemotherapy and/or radiotherapy. The main purposes of this review were to relate toxicity to specific chemotherapy in childhood neoplasms and to correlate possible toxic synergisms between radiotherapy and chemotherapy in children who received both forms of therapy. Results show that tissue toxicity correlates with the dosage (per m2) for most chemotherapeutic agents. The data suggest that the amount of drug administration per dosage as well as total amount of chemotherapeutic agents given closely correlate with tissue toxicity. Some patients showed no clinically apparent signs of toxicity prior to autopsy, although histopathological evidence of tissue toxicity was observed. Irreversible toxic tissue changes should be recognized as a long-term effect in the chemotherapeutic treatment of childhood malignancy. This is especially important in patients who experience long-term survival following diagnosis.