[Vertebral changes after irradiation for Wilms' tumor in early childhood. A retrospective interdisciplinary long-term...

82 children with nephroblastomas, who had therapy between 1960 and 1983, underwent continuous follow-up examinations until 1988. 79 children who survived had been treated with nephrectomy followed by radiation therapy (n = 72) and chemotherapy (n = 72). 64 of these patients had a combination of both post-surgical treatments. Radiotherapy was performed with cobalt-60 until 1977, followed by high-energy photon and electron beam therapy since 1978. In the beginning the dose applied in each patient within five to seven weeks was 46.5 Gy. Since 1972 it was reduced to 42.8 Gy and after 1978 to 32.3 Gy. The overall survival rate between 1960 and 1988 was 65% and rising to 91% since 1980. 47 children had spinal X-ray examinations at regular intervals for more than two years and 28 of these patients could be followed up to 20 years after radiotherapy. 39 children who had been irradiated before the age of 2 1/2 years developed a more pronounced degree of scoliosis and lumbar kyphosis with a higher incidence. 1500 spinal radiograms were evaluated. Measurements of the second lumbar vertebra, which was constantly situated within the target volume, were compared with those of the eight thoracic vertebral body outside the radiation field, and the curvature of the spine was analysed. Late radiation injuries of the spine could be reduced by involving the whole vertebral diameter into the radiation beam, by the use of high-energy radiation techniques and by excluding children under the age of one year from radiotherapy. However, disturbances of spinal growth cannot always be prevented.