title: Avascular osteonecrosis after hyperthermia in children and adolescents with pelvic malignancies: a retrospective analysis of potential risk factors.
abstract: OBJECTIVE
  In children with locally advanced or recurrent malignant tumours, prognosis can be improved by regional deep hyperthermia (RHT) in combination with platin-based chemotherapy. However, because of the increasing number of patients that achieve long-time remission with this therapy, it is necessary to evaluate long-term sequelae of thermochemotherapy. During the years 1993-2004 one has observed avascular osteonecrosis (AON) of the femoral head after RHT in seven children with pelvic germ cell tumours or rhabdomyosarcomas.
  
  
  METHODS
  Although AON may develop in patients with malignancies treated with chemo- or radiotherapy alone, RHT might nevertheless contribute to the occurrence of AON. In order to determine potential risk factors for AON after RHT, this study analysed the relationship of AON to the patient's age, medical history and treatment parameters such as thermal dose equivalent and power output.
  
  
  CONCLUSIONS
  In the present study AON was associated with young age as well as intensity of hyperthermia indicated by high power levels that exceed 20 W per kg body weight and/or application of eight or more heat sessions as well as additional radiotherapy. Based on this observation, it was assumed that an optimized three dimensional thermal field modelling may be helpful to avoid hazardous temperatures in the femoral heads during RHT treatment and to reduce AON of the femoral heads.
authors.affiliation: Clinic of Pediatric Oncology, Hematology and Immunology, Heinrich-Heine-University Düsseldorf, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Balzer
authors.forename: D T
authors.initials: DT
authors.lastname: Schneider
authors.forename: M B
authors.initials: MB
authors.lastname: Bernbeck
authors.forename: M
authors.initials: M
authors.lastname: Jäger
authors.forename: O
authors.initials: O
authors.lastname: Mils
authors.forename: J
authors.initials: J
authors.lastname: Schaper
authors.forename: R
authors.initials: R
authors.lastname: Willers
authors.forename: R
authors.initials: R
authors.lastname: Krauspe
authors.forename: U
authors.initials: U
authors.lastname: Göbel
authors.forename: R
authors.initials: R
authors.lastname: Wessalowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D007223:Infant; D008297:Male; D008875:Middle Aged; D009373:Neoplasms, Germ Cell and Embryonal / Q000188:drug therapy / Q000628:therapy; D010020:Osteonecrosis / Q000209:etiology*; D010386:Pelvic Neoplasms / Q000188:drug therapy / Q000628:therapy*; D012189:Retrospective Studies; D012208:Rhabdomyosarcoma / Q000188:drug therapy / Q000628:therapy; D012307:Risk Factors