Dentofacial development in long-term survivors of acute lymphoblastic leukemia. A comparison of three treatment modalities.
Ninety-seven children who were diagnosed with acute lymphoblastic leukemia before 10 years of age and treated with chemotherapy alone, chemotherapy plus 1800-cGy cranial irradiation (RT), or chemotherapy plus 2400-cGy RT were evaluated for effects of therapy on dentofacial development. All patients were seen at least 5 years postdiagnosis. Dental abnormalities were determined from panoramic radiographs, and craniofacial evaluations were made from lateral cephalometric radiographs. Ninety-one (94%) of all patients and 41 (100%) of patients younger than 5 years of age at diagnosis had abnormal dental development. The severity of these abnormalities was greater in children who received treatment before 5 years of age and in those who received RT. Observed dental abnormalities included tooth agenesis, arrested root development, microdontia, and enamel dysplasias. Craniofacial abnormalities occurred in 18 of 20 (90%) of those patients who received chemotherapy plus 2400-cGy RT before 5 years of age. Mean cephalometric values of this group showed significant deficient mandibular development. The results of this study suggest that the severity of dentofacial-developmental abnormalities secondary to antileukemia therapy are related to the age of the patient at the initiation of treatment and the use of cranial RT.
Sonis
A L
AL
Children's Hospital, Boston, MA 02115.
Tarbell
N
N
Valachovic
R W
RW
Gelber
R
R
Schwenn
M
M
Sallan
S
S
D000293:Adolescent; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003744:Dental Enamel Hypoplasia / Q000139:chemically induced / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008445:Maxillofacial Development / Q000187:drug effects* / Q000528:radiation effects; D009805:Odontogenesis / Q000187:drug effects / Q000528:radiation effects; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000503:physiopathology / Q000532:radiotherapy / Q000628:therapy*; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D014076:Tooth Diseases / Q000139:chemically induced / Q000209:etiology*; D014092:Tooth Root / Q000187:drug effects / Q000528:radiation effects