[Osteonecrosis after chemotherapy in children]

Area of Science:

• Oncology
• Orthopedics
• Pediatric Medicine

Background:

• Modern chemotherapy improves pediatric cancer survival but leads to long-term side effects.
• Avascular osteonecrosis (AVN) is a significant drug-related complication, affecting up to 40% of pediatric patients.
• AVN commonly impacts weight-bearing joints like the hip and knee, often appearing 12-18 months post-chemotherapy.

Purpose of the Study:

• To highlight the increasing prevalence and clinical significance of avascular osteonecrosis (AVN) in pediatric cancer survivors.
• To discuss the known risk factors, diagnostic methods, and current therapeutic challenges for chemotherapy-induced AVN.

Main Methods:

• Review of current literature on chemotherapy-induced avascular osteonecrosis in pediatric populations.
• Analysis of diagnostic modalities, particularly magnetic resonance imaging (MRI) for early detection.
• Examination of established and emerging treatment strategies, including operative and non-operative options.

Main Results:

• Avascular osteonecrosis (AVN) is a frequent complication, with onset typically 12-18 months after chemotherapy.
• Glucocorticoid use and patient age (≥10 years) are identified risk factors.
• Early-stage AVN may be asymptomatic but is detectable by MRI; standardized treatment guidelines are currently unavailable.

Conclusions:

• Avascular osteonecrosis (AVN) represents a growing concern in pediatric oncology due to improved survival rates.
• Early diagnosis using MRI is essential for managing chemotherapy-related bone complications.
• Further research is needed to establish evidence-based therapeutic concepts and orthopedic guidelines for pediatric AVN.