Conclusion

Late effects of treatment are common among neu-roblastoma survivors, mostly in high-risk patients. These complications are important and must be identified and treated early in order to minimize the impact on quality of life of the survivors. The new treatment paradigms for low- and intermediate-risk patients will probably result in a decrease in treatment-related morbidity. However, for high-risk pa-tients,the intensification of therapy for these patients treated at a very young age can have severe late effects; therefore, close follow-up of these patients after completion of the therapy is strongly recommended. More specifically, ovarian function of female patients should be followed closely. All high-risk patients treated with platinum compounds should be screened for hearing loss, and early audiological interventions, such as hearing aids and speech and language therapy, should be implemented as needed. In addition, neurocognitive development should be monitored with serial psychometric testing and patients should be screened for subsequent malignant neoplasms. Because long-term survivors of high-risk neuroblastoma can have complex medical problems with multi-organ dysfunction, these children are optimally cared for by physicians familiar with the late effects of intensive chemotherapy and radiation. New therapeutic strategies for high-risk neuroblastoma that will lead to higher rates of survival as well as enhanced quality of life are desperately needed.

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