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Spinal changes after craniospinal irradiation in pediatric patients
Yoshiko Oshiro1,2, Masashi Mizumoto1,2, Haitao Pan3
1Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Pediatric Blood & Cancer
|October 3, 2020
Summary
Craniospinal irradiation (CSI) in pediatric patients can lead to significant long-term bone and soft tissue degenerative changes, including reduced vertebral growth and scoliosis. Growth hormone (GH) deficiency and higher radiation doses worsen these effects, necessitating careful spinal monitoring.
Area of Science:
- Pediatric Oncology
- Radiotherapy
- Orthopedics
Background:
- Craniospinal irradiation (CSI) is a common treatment for pediatric central nervous system tumors.
- Long-term effects of CSI on skeletal development and tissue integrity require thorough evaluation.
Purpose of the Study:
- To assess long-term degenerative changes in bone and soft tissue following CSI in pediatric patients.
- To identify factors influencing these degenerative changes.
Main Methods:
- Analysis of 892 vertebral bodies in 220 pediatric patients treated with CSI.
- Evaluation of vertebral body height, MRI signal changes, scoliosis, kyphosis, and degenerative changes in bones and discs.
- Investigation of factors influencing observed changes, including radiation dose and growth hormone (GH) status.
Main Results:
- Vertebral growth was significantly correlated with radiation dose and GH deficiency, with reduced growth rates observed at doses >39 Gy.
- Degenerative changes were frequent: 83% showed fatty marrow changes, 31% had disc degeneration, 13% had bone degeneration, 17% experienced wedging or height loss, and 27% developed scoliosis.
- Scoliosis risk remained high even with symmetrical irradiation.
Conclusions:
- High-dose CSI significantly impairs vertebral bone growth, underscoring the importance of adequate GH replacement therapy.
- CSI frequently leads to spinal demineralization and degenerative changes, with a high risk of scoliosis.
- Long-term spinal monitoring is crucial for pediatric patients treated with CSI as they transition into adulthood.
