Late effects of treatments for rhabdomyosarcoma

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Recovering from rhabdomyosarcoma (RMS) 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 things. 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.

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 (pituitary gland) or reproductive organs can affect the ovaries and testicles. Some chemotherapy drugs used to treat RMS, such as cyclophosphamide (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. Sometimes children treated for RMS may be infertile when they are adults, meaning they will not be able to make children.

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

Heart problems

Certain chemotherapy drugs used to treat RMS, such as doxorubicin, can have late effects on the heart. These late effects include problems with the way the heart muscle works. Children who were treated with the chemotherapy drug doxorubicin will need regular echocardiograms.

Find out more about heart problems.

Second cancers

RMS survivors have a higher risk of developing a second cancer, especially if they received radiation therapy or have a genetic condition that makes them more likely to get RMS. But the benefit of treating a child's cancer 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, ifosfamide and etoposide (Vepesid), can increase the risk of developing acute myelogenous leukemia (AML) or a myelodysplastic syndrome (MDS).

Children treated for RMS 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

  • Paul Nathan, MD, MSc, FRCPC
  • Normand Laperriere, MD, FRCPC
  • American Society of Clinical Oncology (ASCO). Rhabdomyosarcoma - Childhood: Follow-Up Care. 2018:
  • American Cancer Society. After Treatment. 2018:
  • 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.
  • American Cancer Society. Treating Rhabdomyosarcoma. 2018:
  • Rhabdomyosarcoma. Provincial Health Services Authority. Musculoskeletal and Sarcoma. Vancouver, BC: Friday, March 20, 2020.
  • Cripe TP . Medscape Reference: Pediatric Rhabdomyosarcoma. WebMD LLC; 2018: