Title:A Systematic Review of Selected Musculoskeletal Late Effects in Survivors of Childhood Cancer
Volume: 10
Issue: 4
Author(s): Prasad L. Gawade, Melissa M. Hudson, Sue C. Kaste, Joseph P. Neglia, Karen Wasilewski- Masker, Louis S. Constine, Leslie L. Robison and Kirsten K. Ness
Affiliation:
Keywords:
Craniofacial abnormalities, musculoskeletal diseases, neoplasms, pediatrics, radiation, scoliosis, thoracic wall.
Abstract: Survivors of childhood cancer are at risk for treatment-related musculoskeletal late effects. Early detection
and orthopedic intervention can help ameliorate musculoskeletal late effects and prevent subsequent complications.
This systematic review summarizes the literature describing associations between cancer, its treatment, and musculoskeletal
late effects. We searched PubMed and Web of Science for English language articles published between January
1970 and December 2012. The search was limited to investigations with at least 15 participants and conducted at
least 2 years after completion of therapy for childhood, adolescent, or young adult cancer. Some late skeletal effects,
including low bone mineral density, osteonecrosis, slipped capital femoral epiphyses, oncogenic rickets, and hormonerelated
growth disturbances have been previously reviewed and were excluded, as were outcomes following amputation
and limb-salvage procedures. Of 2347 references identified, 30 met inclusion criteria and were retained. An additional
54 studies that met inclusion criteria were found in reference lists of retained studies. Of 84 studies, 60 focused
on associations between radiotherapy, six between chemotherapy, and 18 between surgery and musculoskeletal late effects.
We found that younger age, higher radiation dosage, and asymmetric or partial bone radiation volume influences
the effects of radiation on the musculoskeletal system. Methotrexate and vincristine are associated with long-term
muscular strength and flexibility deficits. Laminectomy and chest wall resection are associated with spinal malalignment,
and enucleation is associated with orbital deformities among survivors. Radiotherapy, chemotherapy, and
surgery are associated with musculoskeletal late effects independently and additively. Associations are additionally influenced
by host and treatment characteristics.
