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Musculoskeletal QuickFact

Childhood cancer survivors can be at risk for developing the following musculoskeletal late effects:

 

   ·         Osteonecrosis

   ·         Decreased Bone Mineral Density (BMD)

   ·         Musculoskeletal Growth Problems

      o   Hypoplasia

      o   Fibrosis

      o   Reduced or uneven growth

      o   Shortened trunk height

      o   Limb length discrepancy

      o   Joint  Contractures

   ·         Craniofacial Abnormalities

      o   Osteoradionecrosis

      o   Temporomandibular joint dysfunction

   ·         Scoliosis/Kyphosis

   ·         Radiation Induced Fracture

   ·         Amputation or Limb-Sparing Related

      Complications

 

If your patient does not have a Survivor Health Plan (SHP), please refer him/her to the appropriate survivor clinic. 

 

Important factors in determining risk for musculoskeletal late effects:

 

    • Age at treatment
    • Corticosteroids
    • Type and total dose of radiation
    • Epiphysis in radiation treatment field
    • Sickle cell disease
    • Poor healing after surgery
    • Endocrine dysfunction
    • Ethnicity
    • Obesity
    • Diabetes
    • Smoking
    • Alcohol use
    • Carbonated beverages
    • Body Mass Index (BMI)
    • Inadequate intake of Calcium and Vitamin D

 


 


Chemotherapy
Table 1
 

Osteonecrosis
 

Decreased BMD

Musculoskeletal Growth Problems

Craniofacial abnormalities

Scoliosis
Kyphosis

Radiation Induced Fracture

Amputation or Limb Sparing Related Complications

Alkylating Agents
Carmustine
   BCNU
Busulfan
Lomustine
   CCNU
Chlorambucil Cyclophosphamide
   Cytoxan
Ifosphamide
Mechlorethamine
Melphalan
Procarbazine
Thiotepa
 
Dacarbazine
    DTIC
Temozolomide

 

 

 

 

 

 

 

Heavy Metals
Carboplatin
Cisplatin
 

 

 

 

 

 

 

 

Antimetabolites
Cytarabine
   Ara-C
Mercaptopurine
   6MP
Thioguanine
   6TG
Methotrexate
 

 

X
Methotrexate Only

 

 

 

 

 

Anthracycline antibiotics
Daunorubicin
Doxorubicin
   Adriamycin
Epirubicin
Idarubicin
Mitoxantrone
 

 

 

 

 

 

 

 

Chemotherapy
Table 2

Osteonecrosis
 

Decreased BMD

Musculoskeletal Growth Problems

Craniofacial abnormalities

Scoliosis
Kyphosis

Radiation Induced Fracture

Amputation or Limb Sparing Related Complications

Anti-tumor antibiotics
Bleomycin
Dactinomycin

 

 

 

 

 

 

 

Corticosteroids
Dexamethasone
   Decadron
Prednisone
 

X

X

 

 

 

 

 

Enzymes
Asparaginase
 

 

 

 

 

 

 

 

Plant alkaloids
Vincristine
Vinblastine
 

 

 

 

 

 

 

 

Epipodophyllotoxins
Etoposide
   VP16
Teniposide
   VM26
 
 

 

 

 

 

 

 

 

Radiation

Osteonecrosis
 

Decreased BMD

Musculoskeletal Growth Problems

Craniofacial abnormalities

Scoliosis
Kyphosis

Radiation Induced Fracture

Amputation or Limb Sparing Related Complications

All Radiation

 

 

 

 

 

 

 

TBI

 

 

X

 

 

 

 

Head/Brain

 

 

 

X
Cranio-facial abnormalities
 
>40 GY Osteoradionecrosis

 

 

 

Neck

 

 

X

 

 

>40 Gy
 
Include TBI in total dose calculation

 

Thorax

 

 

X

 

X

> 40 Gy
 
Include TBI in total dose calculation

 

Abdomen

 

 

X

 

X

> 40 Gy
 
Include TBI in total dose calculation

 

Pelvis

 

 

X

 

X

> 40 Gy
 
Include TBI in total dose calculation

 

Extremity
 

 

 

X

 

 

> 40 Gy
 
Include TBI in total dose calculation

 

Hematopoeitic Stem Cell Transplant

Osteonecrosis
 

Decreased BMD

Musculoskeletal Growth Problems

Craniofacial abnormalities

Scoliosis
Kyphosis

Radiation Induced Fracture

Amputation or Limb Sparing Related Complications

Hematopoeitic Stem Cell Transplant

X

X

 

 

 

 

 

Hematopoeitic Stem Cell Transplant with any History of Chronic GVHD

 

 

X

 

 

 

 

Surgery

Osteonecrosis
 

Decreased BMD

Musculoskeletal Growth Problems

Craniofacial abnormalities

Scoliosis
Kyphosis

Radiation Induced Fracture

Amputation or Limb Sparing Related Complications

Amputation 

 

 

 

 

 

 

X

Limb Sparing Procedure

 

 

 

 

 

 

X

Neurosurgery – Spine

 

 

 

 

X

 

 

Thoracic Surgery

 

 

 

 

X

 

 

 For recommendations on how to screen for all potential late effects, please refer to The Children’s Oncology Group Long-Term Follow-Up Guidelines.

Health Links- Teaching Handouts from The Children's Oncology Group  

Visit www.survivorshipguidelines.org  to find many of the Health Links translated into other languages.  

References:

Children’s Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers, and related Health Links  Version 4.0. October, 2013. www.survivorshipguidelines.org.

Source: Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta
Last Updated: 2/5/2015 5:41:25 PM
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