Organs at risk
There is a risk of short-term nerve toxicity causing dizziness, nausea, headache and long-term neuropsychiatric changes. Antiemetic treatment should be considered before starting treatment. Long-term neuropsychiatric changes may depend on multiple factors such as age and if chemotherapy is administered simultaneously (especially high-dose MTX). Those at the highest risk are patients over 60 years who receive whole brain radiation after high-dose MTX.
Lens of the eye
A dose over 4-6 Gy must often be accepted to obtain adequate coverage to structures near the lamina cribrosa. This may pose a risk for cataract development in some patients.
The dosages used are often lower than the tolerance dose for adults, however, endocrine function should be followed long after treatment in children.