Spinal growth after irradiation for Wilm's tumour

Abstract

Between 1960 and 1983, 82 children were treated for Wilm's tumour at our hospital. The secondary effects and changes in the skeleton have been assessed. Radiotherapy was found to cause growth disturbances and osteochondrosis of variable degree, but not osteonecrosis. Since irradiation produces late damage, it should be applied symmetrically to the spine and the dose limited as far as is possible. A long follow up is necessary since skeletal damage can only be assessed after the end of growth.

Implementation of contemporary radiation therapy planning concepts for pediatric Hodgkin lymphoma: Guidelines from the International Lymphoma Radiation Oncology Group

“…Epiphyseal chondroblasts are highly radiosensitive at young ages with clinical growth effects potentially occurring in a dosedependent fashion increasing from N 8 Gy. Conventional teaching is that asymmetric radiation of the growing spine can result in kyphosis or scoliosis and RT plans should not include substantial dose gradients (ie, N 10-15 Gy) across vertebrae, 35 although this convention is based in part on Wilms tumor survivors treated with doses N 25 Gy or orthovoltage radiation 36,37 who have other soft tissue deficits that can contribute to scoliosis. The avoidance of dose gradients across the spine should be viewed as one consideration among many when sparing other organs at risk.…”