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Disproportionate short stature after cranial irradiation and combination chemotherapy for leukaemia
H A Davies1, E Didcock, M Didi
1University Department of Paediatrics, Children's Hospital, Sheffield.
Insights
Childhood acute lymphoblastic leukemia (ALL) survivors treated with cranial irradiation experienced reduced final height, primarily due to shorter sitting height, impacting body proportions.
Area of Science:
- Pediatric Oncology
- Endocrinology
- Growth and Development
Background:
- Childhood acute lymphoblastic leukemia (ALL) is a common pediatric cancer.
- Treatment often involves combination chemotherapy and cranial irradiation.
- Long-term effects on growth and body proportions require further investigation.
Purpose of the Study:
- To assess the impact of cranial irradiation doses on final height and body proportions in ALL survivors.
- To determine the contribution of sitting height versus leg length to observed height deficits.
- To explore potential causes for observed growth abnormalities.
Main Methods:
- Retrospective analysis of 142 children treated for ALL.
- Comparison of final height and body proportions between groups receiving 18 Gy and 24 Gy cranial irradiation.
- Mathematical correction for sitting height loss to evaluate standing height.
- Analysis of sitting height to leg length ratios.
Main Results:
- All groups showed a significant reduction in standing height SD score from diagnosis to final height.
- A majority of children (81%) exhibited disproportionately shorter backs than legs, with 23% showing marked disproportion.
- After adjusting for sitting height loss, standing height deficits were no longer significant, except in girls who received 24 Gy cranial irradiation.
Conclusions:
- Disproportionate growth (shorter trunk relative to legs) is common in ALL survivors treated with cranial irradiation.
- Reduced sitting height significantly contributes to the overall height loss observed.
- Disturbances in puberty and/or chemotherapy effects on spinal growth may explain these findings.
Abstract:
The effect of combination chemotherapy and cranial irradiation on final height and body proportions was retrospectively examined in a cohort of 142 children treated for acute lymphoblastic leukaemia (ALL). Eighty four children (48 girls, 36 boys) received 24 Gy cranial irradiation and 58 (35 girls, 23 boys) 18 Gy. None had received testicular or spinal irradiation. A significant reduction in standing height SD score from diagnosis to final height was seen in all groups. Of the 109 children in whom sitting height measurements were available, 88 (81%) had relatively shorter backs than legs and in 25 (23%) this disproportion was of a marked degree. After mathematical correction for sitting height loss there was no longer a significant reduction in standing height SD score at final height in all except the 24 Gy group of girls. These data suggest that disproportion is a common finding after treatment for ALL and that, at least in some children, much if not all of the height loss seen is due to a reduction in sitting height. Possible explanations for this disproportion include a disturbance of puberty or an effect of chemotherapy on spinal growth, or both.