Advances in the treatment of childhood cancer over the last decades have greatly improved the survival rates. Unfortunately, the improved prognosis has been accompanied by the occurrence of late, treatment-related complications. One of the adverse effects that can occur due to treatment of childhood cancer is damage to the liver. Hepatic adverse effects are common both during and soon after treatment. However, the evidence on adverse effects in the liver many years after treatment is still inconclusive. Liver injury as a result of childhood cancer treatment is most often subclinical (asymptomatic). If liver disease becomes symptomatic, a person's complaints may include fatigue, jaundice, nausea, weight loss and abdominal pain. The development of future treatment and follow-up policies should be based on high quality evidence on the risk of, and associated risk factors for, hepatic late adverse effects.
In this systematic review, 20 cohort studies examining hepatic late adverse effects after antineoplastic treatment for childhood cancer were included. The authors found that 8% to 53% of the childhood cancer survivors developed hepatic late adverse effects after their treatment. It is unclear which childhood cancer treatments increase the risk of hepatic late adverse effects. Childhood cancer survivors with chronic viral hepatitis seemed to have an increased risk of hepatic late adverse effects. The quality of the evidence was however limited. Therefore, more high quality research is needed.