Interiano Rodrigo B, Kaste Sue C, Li Chenghong, Srivastava Deo Kumar, Rao Bhaskar N, Warner William C, Green Daniel M, Krasin Matthew J, Robison Leslie L, Davidoff Andrew M, Hudson Melissa M, Fernandez-Pineda Israel, Ness Kirsten K
Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA.
University of Tennessee Health Science Center, 920 Court Avenue, Memphis, TN, 38163, USA.
J Cancer Surviv. 2017 Oct;11(5):553-561. doi: 10.1007/s11764-017-0624-1. Epub 2017 Jul 1.
Longer survival for children with sarcoma has led to the recognition of chronic health conditions related to prior therapy. We sought to study the association of sarcoma therapy with the development of scoliosis.
We reviewed patient demographics, treatment exposures, and functional outcomes for patients surviving >10 years after treatment for sarcoma between 1964 and 2002 at our institution. The diagnosis of scoliosis was determined by imaging. Functional performance and standardized questionnaires were completed in a long-term follow-up clinic.
We identified 367 patients, with median age at follow-up of 33.1 years. Scoliosis was identified in 100 (27.2%) patients. Chest radiation (relative risk (RR), 1.88 (95% confidence interval (CI), 1.21-2.92), p < 0.005) and rib resection (RR, 2.64 (CI, 1.79-3.89), p < 0.0001) were associated with an increased incidence of scoliosis; thoracotomy without rib resection was not. Of 21 patients who underwent rib resection, 16 (80.8%) had the apex of scoliosis towards the surgical side. Scoliosis was associated with worse pulmonary function (RR, 1.74 (CI, 1.14-2.66), p < 0.01) and self-reported health outcomes, including functional impairment (RR, 1.60 (CI, 1.07-2.38), p < 0.05) and cancer-related pain (RR, 1.55 (CI, 1.11-2.16), p < 0.01). Interestingly, pulmonary function was not associated with performance on the 6-min walk test in this young population.
Children with sarcoma are at risk of developing scoliosis when treatment regimens include chest radiation or rib resection. Identification of these risk factors may allow for early intervention designed to prevent adverse long-term outcomes.
Cancer survivors at risk of developing scoliosis may benefit from monitoring of pulmonary status and early physical therapy.
肉瘤患儿生存期的延长使得与既往治疗相关的慢性健康状况得到了认识。我们试图研究肉瘤治疗与脊柱侧弯发生之间的关联。
我们回顾了1964年至2002年间在我们机构接受肉瘤治疗后存活超过10年的患者的人口统计学资料、治疗暴露情况及功能结局。脊柱侧弯的诊断通过影像学确定。在长期随访门诊完成功能表现及标准化问卷。
我们确定了367例患者，随访时的中位年龄为33.1岁。100例（27.2%）患者被诊断为脊柱侧弯。胸部放疗（相对危险度（RR），1.88（95%置信区间（CI），1.21 - 2.92），p < 0.005）和肋骨切除（RR，2.64（CI，1.79 - 3.89），p < 0.0001）与脊柱侧弯发生率增加相关；未行肋骨切除的开胸手术则不然。在21例行肋骨切除的患者中，16例（80.8%）脊柱侧弯的顶点朝向手术侧。脊柱侧弯与较差的肺功能（RR，1.74（CI，1.14 - 2.66），p < 0.01）及自我报告的健康结局相关，包括功能损害（RR，1.60（CI，1.07 - 2.38），p < 0.05）和癌症相关疼痛（RR，1.55（CI，1.11 - 2.16），p < 0.01）。有趣的是，在这个年轻人群中，肺功能与6分钟步行试验的表现无关。
当治疗方案包括胸部放疗或肋骨切除时，肉瘤患儿有发生脊柱侧弯的风险。识别这些危险因素可能有助于进行旨在预防不良长期结局的早期干预。
有发生脊柱侧弯风险的癌症幸存者可能受益于肺功能监测和早期物理治疗。
