Spinal deformity after intra-operative radiotherapy for paediatric patients.
The purpose of this study was to clarify the incidence and characteristics of late-onset complications of the spine in children who underwent intra-operative radiation therapy (IORT) for common paediatric malignant tumours. 12 children with more than 4 years of follow-up after IORT were included and, in 11 of these, thoracic and/or lumbar spines were irradiated. To compare doses of irradiation to the spine with the resulting deformities, dose simulations of IORT were carried out on two selected cases using a radiation treatment planning system with a pencil-beam algorithm. The mean follow-up period was 135 months (range, 53-234 months). Radiographic reviews found spinal deformity in six patients. Only one patient was symptomatic and the spinal deformity was severe (Grade 3), whereas spinal deformity was mild in the remaining five patients without clinical symptoms (Grade 1). In all of the six patients, anterior wedge-shaped deformity was dominant, and scoliosis was found in only two patients. In one particular case with nephrectomy, irradiation had penetrated much deeper than usual at the site of nephrectomy, and dose distribution was asymmetric, causing clinically significant spinal deformity with scoliosis. In conclusion, specific deformities of the spine observed after IORT can be explained on the basis of dose distribution of the electron beam to the spine.
Kunieda
E
E
Department of Radiology, Keio University, Tokyo, Japan. kunieda-mi@umin.ac.jp
Nishimura
G
G
Kaneko
T
T
Hirobe
S
S
Masaki
H
H
Kamagata
S
S
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D007223:Infant; D007432:Intraoperative Period; D007738:Kyphosis / Q000453:epidemiology* / Q000209:etiology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D011832:Radiation Injuries / Q000150:complications*; D011859:Radiography; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012600:Scoliosis / Q000453:epidemiology* / Q000209:etiology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging; D016896:Treatment Outcome
Eur Spine J. 2005 Oct;14(8):765-71
16012842
Ann Surg Oncol. 1995 Jul;2(4):343-50
7552625
Int J Radiat Oncol Biol Phys. 2006 Jan 1;64(1):235-41
16257132
Med Pediatr Oncol. 2003 Jun;40(6):360-6
12692803
Med Pediatr Oncol. 1997 Jun;28(6):424-8
9143387
J Bone Joint Surg Am. 1950 Apr;32A(2):401-4
15412182
Clin Orthop Relat Res. 1990 Feb;(251):235-40
2136823
J Bone Joint Surg Am. 1950 Apr;32A(2):396-401
15412181
Radiology. 1952 Nov;59(5):637-50
12994000
Int J Radiat Oncol Biol Phys. 2004 Sep 1;60(1):265-74
15337565
J Pediatr Surg. 2003 Dec;38(12):1735-8
14666455
Cancer. 1994 Jul 15;74(2):740-7
8033056
Jpn J Clin Oncol. 2008 Aug;38(8):562-6
18667476
J Neurooncol. 2008 Jul;88(3):321-30
18369529
Eur J Pediatr Surg. 2002 Aug;12(4):251-4
12369003
Clin Orthop Relat Res. 1998 Sep;(354):189-94
9755779
Bull Cancer Radiother. 1990;77(2):125-34
8703548
J Pediatr Surg. 1997 Nov;32(11):1616-9
9396539
Clin Orthop Relat Res. 1977 Oct;(128):101-6
202426
J Bone Joint Surg Am. 1981 Feb;63(2):183-93
7462275
J Bone Joint Surg Am. 1976 Jun;58(4):526-36
178664
Int J Radiat Oncol Biol Phys. 2007 Nov 1;69(3):858-64
17517478
Orthop Clin North Am. 1979 Oct;10(4):829-44
230440
Eur J Pediatr. 1993 Mar;152(3):197-200
8383053
Pediatr Surg Int. 2007 Dec;23(12):1203-7
17968560
Int J Radiat Oncol Biol Phys. 2000 Jul 1;47(4):985-92
10863069
J Urol. 1990 Jan;143(1):89-91
2294272
Cancer. 1991 Jun 1;67(11):2839-43
1851049