Late effects of treatments for rhabdomyosarcoma

Recovering from rhabdomyosarcoma and adjusting to life after treatment is different for each child. Recovery can depend on the stage of the disease, the type and dose of treatment, the child’s age at the time of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with late side effects.

The child’s healthcare team can suggest ways to help your child with the following.

Dental problems

Some chemotherapy drugs and radiation therapy to the head or neck can cause oral and dental problems. These problems may include a higher risk for cavities and white or discoloured patches on the teeth. These treatments can also affect the roots of teeth so they are shorter or thinner. Sometimes teeth or roots don’t grow at all. Oral and dental problems can develop many years after treatment is finished.

Find out more about dental problems.

Hearing problems

Radiation therapy to the head can cause hearing problems if the ear is in the treatment area. Hearing damage can also affect a child’s social, emotional and intellectual development.

Find out more about hearing problems.

Eye problems

Radiation to the eye or eye socket can cause eye problems such as cataracts (cloudy areas on or within the lens of the eye) and poor vision in that eye.

Find out more about eye problems.

Bone and muscle problems

Bones and soft tissues that receive radiation do not grow as well as they normally would. Radiation therapy to the spine can cause shorter overall height or curvature of the spine (called scoliosis). Radiation to a limb can lead to the limb being shorter than the other one or limited motion of a joint. Radiation therapy to the chest and neck area can cause narrow shoulders, a narrow neck and a poorly developed chest. Radiation to the face can cause poor development of the facial bones.

Find out more about bone and muscle problems.

Reproductive system problems

Radiation therapy to the head or reproductive organs can affect the ovaries and testicles. Some chemotherapy drugs used to treat rhabdomyosarcoma, such as cyclophosphamide (Cytoxan, Procytox) and ifosfamide (Ifex) can also affect the ovaries and testicles. These drugs can cause different reproductive system problems for children as they get older, including early or delayed puberty in both boys and girls. Sometimes children treated for rhabdomyosarcoma may be infertile when they are adults.

Find out more about male reproductive system problems and female reproductive system problems.

Lung problems

Pneumonitis is the most common lung problem caused by certain chemotherapy drugs, such as doxorubicin (Adriamycin) and dactinomycin (Cosmegen, actinomycin-D). Pneumonitis is inflammation of the lungs. It can progress to pulmonary fibrosis, which is the formation of scar tissue in the lungs.

Radiation therapy to the chest can also cause pneumonitis and pulmonary fibrosis.

Find out more about lung problems.

Heart problems

Certain chemotherapy drugs used to treat rhabdomyosarcoma, such as doxorubicin (Adriamycin), can have late effects on the heart. These late effects include problems with heart muscle function, such as left ventricular dysfunction or cardiomyopathy. Chemotherapy for rhabdomyosarcoma can also lead to abnormal heart rhythms, or arrhythmias.

Girls have a greater risk of developing heart problems after chemotherapy with doxorubicin. Other risk factors for heart problems after treatment with doxorubicin include:

  • larger total, or cumulative, dose of doxorubicin
  • radiation therapy to the chest
  • radiation to the left side of the abdomen

Find out more about heart problems.

Second cancers

Rhabdomyosarcoma survivors have a higher risk of developing a second cancer. The benefit of treating a child’s cancer usually far outweighs the risk of developing a second cancer from treatment. Every attempt is made to reduce the risk as much as possible. Treatment plans try to reduce the amount of radiation that is given or to delay it until the child is older and their healthy cells can better tolerate the effects of radiation. Limiting the dose or using other drugs (called chemoprotectants) can help prevent or lessen some of the toxic effects of chemotherapy.

The risk of a second cancer is different for each child, depending on their cancer diagnosis and treatment received.

Certain chemotherapy drugs, such as cyclophosphamide (Cytoxan, Procytox), ifosfamide (Ifex) and etoposide (Vepesid), can increase the risk of developing acute myelogenous leukemia (AML) or a myelodysplastic syndrome (MDS).

Children treated for rhabdomyosarcoma also have a higher risk of developing solid tumours, such as a bone or brain tumour. The risk varies depending on the treatments the child received, but it is mostly related to radiation. The risk may be further increased if chemotherapy was given with radiation therapy.

Find out more about second cancers.

Questions to ask about late effects and supportive care after treatment

To make the decisions that are right for your child, find out more about late effects of childhood cancer and ask the healthcare team questions about supportive care after treatment.

Expert review and references

  • American Society of Clinical Oncology. Rhabdomyosarcoma - childhood. 2014:
  • Cripe TP. Pediatric Rhabdomyosarcoma. WebMD LLC; 2014:
  • National Childhood Cancer Foundation & Children's Oncology Group. Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers. Bethesda, MD: 2013.
  • Rhabdomyosarcoma. St. Jude Children's Research Hospital. Cure4Kids. Memphis, TN: 2006.
  • Zinger Kotsubo C . Rhabdomyosarcoma. Baggott C, Fochtman D, Foley GV, Patterson K (eds.). Nursing Care of Children and Adolescents with Cancer and Blood Disorders. 4th ed. APHON; 2011: 31:1054-1070.