Disease Management and Treatment Modalities
Treatment modalities and agent-specific toxicity
Pediatric cancer treatment is multimodal and protocol-driven. Candidates must understand the purpose of induction, consolidation or intensification, maintenance, and central nervous system prophylaxis in leukemia; surgery, radiation, chemotherapy, targeted agents, immunotherapy, and hematopoietic stem cell transplant in solid tumors and lymphomas. Know that chemotherapy kills dividing cells and therefore affects marrow, mucosa, hair, and gonads, and that nadir timing varies by regimen. Intrathecal chemotherapy requires specific positioning and post-procedure monitoring. Radiation has acute and late effects that depend on site and dose. CAR-T therapy carries cytokine release syndrome and neurotoxicity; transplant carries graft-versus-host disease and infection risk.
Traps include memorizing regimens without linking drugs to unique toxicities, assuming all chemotherapy causes the same nadir, or missing that targeted and immune therapies have distinctive adverse effects. Distinguish induction (remission) from consolidation (eliminating residual disease) and maintenance (prolonged lower-intensity therapy). Do not confuse radiation recall with infection. Monitor for anthracycline cardiotoxicity, vincristine neuropathy and constipation, asparaginase pancreatitis and thrombosis, cyclophosphamide hemorrhagic cystitis, cisplatin nephrotoxicity and ototoxicity, and bleomycin pulmonary toxicity.
Worked example: a child receiving high-dose methotrexate needs alkaline hydration, urine pH and methotrexate level monitoring, and leucovorin rescue. Leucovorin is not a generic antidote for all chemotherapy; it rescues normal cells from methotrexate toxicity. If urine output falls or the level is high, escalate per protocol.
Rule of thumb: for every chemotherapy agent, know one defining toxicity and the monitoring or supportive measure that goes with it.