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
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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:
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Age at treatment
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Corticosteroids
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Type and total dose of radiation
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Epiphysis in radiation treatment field
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Sickle cell disease
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Poor healing after surgery
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Endocrine dysfunction
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Ethnicity
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Obesity
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Diabetes
-
Smoking
-
Alcohol use
-
Carbonated beverages
-
Body Mass Index (BMI)
-
Inadequate intake of Calcium and Vitamin D
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For recommendations on how to screen for all potential late effects, please refer to The Children's Oncology Group Long-term Follow-up Guidelines.
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Chemotherapy
Table 1
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Osteonecrosis
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Decreased BMD
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Musculoskeletal Growth Problems
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Craniofacial abnormalities
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Scoliosis
Kyphosis
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Radiation Induced Fracture
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Amputation or Limb sparing Related Complications
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Alkylating Agents
Carmustine
BCNU
Busulfan
Lomustine
CCNU
Chlorambucil Cyclophosphamide
Cytoxan
Ifosphamide
Mechlorethamine
Melphalan
Procarbazine
Thiotepa
Dacarbazine
DTIC
Temozolomide
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Osteoradionecrosis
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Heavy Metals
Carboplatin
Cisplatin
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Antimetabolites
Cytarabine
Ara-C
Mercaptopurine
6MP
Thioguanine
6TG
Methotrexate
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X
Methotrexate Only
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Anthracycline antibiotics
Daunorubicin
Doxorubicin
Adriamycin
Epirubicin
Idarubicin
Mitoxantrone
Epipodophyllotoxins
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calculation
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Chemotherapy
Table 2
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Osteonecrosis
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Decreased BMD
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Musculoskeletal Growth Problems
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Craniofacial abnormalities
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Scoliosis
Kyphosis
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Radiation Induced Fracture
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Amputation or Limb sparing Related Complications
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Anti-tumor antibiotics
Bleomycin
Dactinomycin
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Methotrexate Only
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Osteoradionecrosis
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Corticosteroids
Dexamethasone
Decadron
Prednisone
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X
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X
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Enzymes
Asparaginase
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Plant alkaloids
Vincristine
Vinblastine
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Epipodophyllotoxins
Etoposide
VP16
Teniposide
VM26
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calculation
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Radiation
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Osteonecrosis
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Decreased BMD
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Musculoskeletal Growth Problems
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Craniofacial abnormalities
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Scoliosis
Kyphosis
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Radiation Induced Fracture
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Amputation or Limb sparing Related Complications
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All Radiation
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Methotrexate Only
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TBI
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X
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Head/Brain
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X
Cranio-facial abnormalities
>
40 GY
Osteoradionecrosis
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Neck
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X
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>
40 Gy
Include TBI in total dose calculation
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Thorax
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X
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X
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> 40 Gy
Include TBI in total dose calculation
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Abdomen
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X
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X
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> 40 Gy
Include TBI in total dose calculation
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Pelvis
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X
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X
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> 40 Gy
Include TBI in total dose calculation
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Extremity
Epipodophyllotoxins
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X
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> 40 Gy
Include TBI in total dose calculation
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Hematopoeitic Stem Cell Transplant
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Osteonecrosis
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Decreased BMD
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Musculoskeletal Growth Problems
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Craniofacial abnormalities
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Scoliosis
Kyphosis
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Radiation Induced Fracture
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Amputation or Limb sparing Related Complications
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Hematopoeitic Stem Cell Transplant
Epipodophyllotoxins
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X
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X
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Osteoradionecrosis
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Hematopoeitic Stem Cell Transplant with any History of Chronic GVHD
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Methotrexate Only
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X
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calculation
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Surgery
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Osteonecrosis
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Decreased BMD
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Musculoskeletal Growth Problems
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Craniofacial abnormalities
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Scoliosis
Kyphosis
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Radiation Induced Fracture
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Amputation or Limb sparing Related Complications
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Amputation
Epipodophyllotoxins
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Osteoradionecrosis
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calculation
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X
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Limb Sparing Procedure
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Methotrexate Only
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X
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