Late Toxicity After 3-Dimensional External Beam Radiotherapy Among Children With Cancer: A Systematic Review

Josien G M Beijer, Jop C Teepen, Nina Streefkerk, Richard M Heijnen, Geert O Janssens, Leontien C M Kremer, Elvira C van Dalen, Cécile M Ronckers

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Radiotherapy has evolved from 2-dimensional conventional radiotherapy (2D-RT) to 3-dimensional planned radiotherapy (3D-RT). Because 3D-RT improves conformity, an altered late health outcomes risk profile is anticipated. Here, we systematically reviewed the current literature on late toxicity after 3D-RT in children treated for cancer. PubMed was searched for studies describing late toxicity after 3D-RT for childhood cancer (below 21 y). Late toxicity was defined as somatic health outcomes occurring ≥90 days after treatment. We identified 13 eligible studies, describing most frequently head/neck area tumors. Included studies reported on crude frequencies of late toxicities including subsequent tumors and conditions of organ systems. Three studies offered a global assessment of the full spectrum of late toxicity; one study compared toxicities after 2D-RT and 3D-RT. Incidence rates were typically not provided. Heterogeneity in study characteristics, small study sizes and short follow-up times precluded multivariable modeling and pooling of data. In conclusion, among the first pediatric cohorts treated with 3D-RT, a broad variety of late toxicity is reported; precise estimates of incidence, and contributions of risk factors are unclear. Continued systematic evaluation of well-defined health outcomes in survivors treated with 3D-RT, including proton therapy, is needed to optimize evidence-based care for children with cancer and survivors.

Original languageEnglish
Pages (from-to)117-134
Number of pages18
JournalJournal of pediatric hematology/oncology
Issue number4
Publication statusPublished - 1 May 2022


  • Child
  • Head and Neck Neoplasms
  • Humans
  • Proton Therapy/adverse effects
  • Radiotherapy Dosage
  • Radiotherapy, Intensity-Modulated


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