Effect of spinal irradiation on growth.

Abstract

SUMMARY Standing height, sitting height, and leg length were measured in 79 patients (aged 16-30 years), who had been given craniospinal irradiation (n=37) or cranial irradiation (n=42) in childhood for a brain tumour and had completed their growth. Their measurements were compared with established standards for sitting height and leg length in British children (aged 16-18 years). To examine the effects of spinal irradiation on spinal growth independent of growth hormone deficiency we analysed the leg length (LL) minus sitting height (SH) standard deviation score (SDS) and used the cranial group as controls. There was an overall significant difference between the median craniospinal LL-SH SDS (1-98) and the median cranial LL-SH SDS (0-545). Within the craniospinal group there was a significant correlation with age at treatment, but there was no such correlation for the cranial group. After splitting age at treatment into three groups (0<5, 5<10, and 10-15 years) there was a significant difference between the LL-SH SDS of the craniospinal and cranial groups for each of the age ranges.In conclusion, spinal irradiation has a profound effect on spinal growth and the younger the child is when given irradiation the greater the subsequent skeletal disproportion. Our most conservative figures indicate that the eventual loss in height is 9 cm when irradiation is given at 1 year, 7 cm when given at 5 years, and 5-5 cm when given at 10 years.

Growth and Endocrine Disorders Secondary to Cranial Irradiation

“…The growth retardation due to spinal irradiation involving radiation doses above 2000 cGy has been well documented in children suffering from medulloblastoma. An effect on sitting height, independent of GH deficiency and resulting in very short trunk length, has been observed (65)(66)(67). Spinal irradiation accounted for most of the growth retardation observed in the 2 y after irradiation with a mean height loss of 1.3 SD as compared to only 0.3 SD in the cranial irradiated children (21).…”

Endocrine complications in long-term survivors of childhood cancers

“…The impact of non-endocrine factors falls beyond the scope of this review, and is mainly represented by the direct damage to the growth plate, mainly of the vertebrae, by highdose radiotherapy, as following total body irradiation (TBI). The result is a skeletal dysplasia where the sitting height is more affected than the standing height (Shalet et al 1987, Clayton & Shalet 1991a,b, Brauner et al 1993, Thomas et al 1993. A direct and lasting impact of high-dose chemotherapy on the growth plate has not been clearly established (Gleeson et al 2003, Gurney et al 2003b.…”

Renal size and function after cure of Wilms' tumour

“…This method is also obviously flawed because 40 children received radiation to the lumbar spine and four also had thoracic spine irradiation for pulmonary metastases. Shalet et al (1987) studied the effect of radiation on spinal growth of patients receiving craniospinal radiation and calculated a maximum loss of 9 cm. The value was dependent on age at time of radiation.…”