testicles can be a “sanctuary site” where leukemia may hide and then come back. The goal of maintenance is to keep the leukemia in remission. Maintenance is much less intensive than previous phases and consists of oral medicines given at home every day. Intermittent IV and IT (into the cerebral spinal fluid) medications are given in the clinic. Most children may return to school during this phase of treatment. Children begin to feel better and their hair starts to grow back. Radiation Therapy If your child has leukemia in the spinal fluid or testicles at diagnosis, or if your child has T-cell ALL, radiation therapy may be a part of his or her treatment. Radiation is typically administered during the middle of treatment. Radiation therapy uses a certain type of energy called ionizing radiation to kill leukemia cells by destroying the cells’ genetic material. Similar to chemotherapy, radiation therapy damages both cancer cells and normal cells. The goal of radiation therapy is to damage as many cancer cells as possible while limiting harm to healthy cells. A special team of doctors called radiation oncologists will determine the type of radiation your child will receive and how long treatment will continue. First, a process called simulation will be used to determine where to aim the radiation. During simulation, the child lies very still on an exam table while the radiation therapist uses a special X-ray machine to determine the exact place on the body where the radiation will be given. The areas to receive radiation are marked with a temporary or permanent marker, tiny dots, or a “tattoo.” Sometimes, a special mold is made of foam, plastic, or plaster to keep the child from moving during treatment. In some cases, the therapist also will make shields that cannot be penetrated by radiation to protect organs and tissues near the treatment field. Young children may be given medicines to sedate them during simulation and for each treatment session so that they lie very still. After simulation is complete, the radiation therapy team will meet to decide how much radiation is needed (the dose of radiation), how it should be delivered, and how many treatments the child should have. Your radiation oncologist will discuss the side effects of radiation that can occur during treatment and the side effects that may occur years later, called late effects. n WHAT ARE COMMON SIDE EFFECTS FROM TREATMENT? Chemotherapy drugs have an effect on rapidly dividing cells and, therefore, can unfortunately affect normal cells. When normal cells are damaged, side effects of treatment are seen. Side effects are usually temporary, and the severity of these effects can be decreased with medications. Each child may be affected differently, with some experiencing more side effects than others. There are many types of chemotherapy drugs, each with their own side effects. Common side effects of chemotherapy medicines include low blood counts, anemia, bleeding, bruising, nausea and vomiting, mucositis (sores in the mouth and throat), alopecia (loss or thinning of hair), darkening of the skin and nails, poor nutrition, diarrhea, or constipation. Hair thinning or loss usually begins around week 3 of treatment and may grow back very short and fall out again between treatments. Medicines such as Zofran (ondansetron) or Kytril (granisetron) are given to help prevent or lessen nausea and vomiting. Low blood counts may be treated with a transfusion of RBCs or platelets. When a child has low blood counts, he or she needs to be carefully monitored for fevers and other signs of illness or infection. Your healthcare team will teach you how to do this at home. Poor nutrition can occur because your child’s taste buds change during therapy and food may
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