The treatment of childhood cancer and the disease itself can cause many different musculoskeletal late effects:
Radiation therapy (RT) is associated with:
- Reduced growth and skeletal deformity leading to problems like scoliosis (curved spine) and limb length discrepancy.
- Bone density is also affected and there is an increased risk in the long term of fracture.
- At higher doses there may be problems with "bone death" or osteoradionecrosis.
- After any RT there is always the risk of secondary tumors:
- Benign - osteochondromas
- Malignant - secondary bone and soft tissue sarcomas.
Chemotherapy and steroids can lead to:
- Avascular necrosis and serious long term joint problems.
- Osteoporosis (early onset and more severe) is well documented after high dose chemotherapy and bone marrow transplant. Related to therapy and factors such as ovarian failure in survivors.
Surgery can lead to significant deformity and joint dysfunction:
- Laminectomy for neuroblastoma can be associated with subsequent spinal deformity (scoliosis and kyphosis)
- Risk is especially severe if there is also:
- Epidural tumor spread
- Spinal damage and paraplegia
- Additional therapy with RT
- Extensive chest wall resection for Ewing sarcoma can be associated with significant subsequent thoracic deformity.
Often many tumor and treatment factors all play a role in determining the severity of long term musculoskeletal side effects - though it has to be said that RT can be especially damaging.