Skeletal Changes Following Irradiation of Childhood Tumors

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Abstract
Skeletal aberrations may develop in patients who survive childhood tumors treated with radiotherapy. In our series of fifty-one children with Wilms' tumor and forty-six with neuroblastoma, nineteen and thirteen, respectively, survived after surgical and radiation therapy. Of these, twenty-eight patients were available for critical follow-up study three to twenty-four years after treatment. In addition, three other patients treated for retinoblastoma, a hemangiolymphangioma of the lower extremity, and a hemangioma of the wrist, respectively, are included in this study because of interesting skeletal changes following irradiation. The skeletal sequelae observed were changes in the vertebral bodies, scoliosis, hypoplasia of the ilium and rib cage, osteocartilaginous exostoses, epiphyseal destruction with limb-length discrepancy and deformity, and postirradiation sarcoma. These complications of radiotherapy were related to the age of the patient, the nature of the primary disease, and the amount and quality of the radiation administered. Because of such changes, it is our belief that all children treated with radiation should be followed carefully during their skeletal growth. Finally, it must be re-emphasized that these injurious effects should not obscure the significant role that radiotherapy played in the survival of these patients.

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