title: Valgus and varus deformity after wide-local excision, brachytherapy and external beam irradiation in two children with lower extremity synovial cell sarcoma: case report.
abstract: BACKGROUND
  Limb-salvage is a primary objective in the management of extremity soft-tissue sarcoma in adults and children. Wide-local excision combined with radiation therapy is effective in achieving local tumor control with acceptable morbidity and good functional outcomes for most patients.
  
  
  METHODS
  Two cases of deformity after wide-local excision, brachytherapy and external beam irradiation for lower-extremity synovial cell sarcoma are presented and discussed to highlight contributing factors, time course of radiation effects and orthopedic management. In an effort to spare normal tissues from the long-term effects of radiation therapy, more focal irradiation techniques have been applied to patients with musculoskeletal tumors including brachytherapy and conformal radiation therapy. As illustrated in this report, the use of these techniques results in the asymmetric irradiation of growth plates and contributes to the development of valgus or varus deformity and leg-length discrepancies.
  
  
  CONCLUSIONS
  Despite good functional outcomes, progressive deformity in both patients required epiphysiodesis more than 3 years after initial management. There is a dearth of information related to the effects of radiation therapy on the musculoskeletal system in children. Because limb-sparing approaches are to be highlighted in the next generation of cooperative group protocols for children with musculoskeletal tumors, documentation of the effects of surgery and radiation therapy will lead to improved decision making in the selection of the best treatment approach and in the follow-up of these patients.
authors.affiliation: Division of Radiation Oncology, Department of Radiological Sciences, St. Jude Children's Research Hospital, 332 N. Lauderdale Street, Memphis, Tennessee, USA. dfletch2@utmem.edu
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Fletcher
authors.forename: William C
authors.initials: WC
authors.lastname: Warner
authors.forename: Michael D
authors.initials: MD
authors.lastname: Neel
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Merchant
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001706:Biopsy; D001918:Brachytherapy / Q000009:adverse effects*; D017024:Chemotherapy, Adjuvant; D002648:Child; D003937:Diagnosis, Differential; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D016916:Joint Deformities, Acquired / Q000209:etiology* / Q000534:rehabilitation; D007717:Knee; D007719:Knee Joint / Q000002:abnormalities*; D008297:Male; D018365:Neoplasm, Residual; D026761:Physical Therapy Specialty; D011151:Popliteal Cyst / Q000175:diagnosis; D012086:Reoperation; D013584:Sarcoma, Synovial / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery*; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D007069:Ifosfamide