Nearly all chemotherapeutic drugs have acute and long term side-effects. While many of the acute effects are short-livd or reversible, some of the long term effects are not. Factors that may influence chronic toxicity are cumulative dose of the drug, he nature of the tumor, combination with other drugs or radiation, and the presence of underlying disease prior to the cancer treatment. Methotrexate and actinomycin D may cause hepatic fibrosis or cirrhosis. Liver biopsy is sometimes indicated in patients who have received these dugs and develop abnormal liver function tests. Cardiotoxicity is the chief long-term side effect of doxorubicin, which is subject to cumulative dose and any underlying heart disease. Pulmonary fibrosis is the main consequence of bleomycin and peripheral neuorpathy of vincristine. long term follow-up is indicated for any cnacer survivor who has received chemotherapy.