LONG-TERM EFFECTS OF RADIOTHERAPY ADMINISTERED IN CHILDHOOD FOR THE TREATMENT OF MALIGNANT DISEASES

Background: The use of radiotherapy for the treatment of childhood mal ignancy has improved long-term survival significantly, and many treate d children now survive well into adulthood. As a consequence, long-ter m effects of childhood irradiation are being seen with increasing freq uency. Methods: The medical records of 236 patients who had been treat ed for malignant disease with radiotherapy during childhood were exami ned to determine the long-term effect of the radiation on their growth and development. Results: Mean treatment dose was 35.5 Gy; mean age a t treatment was 7.2 years; and mean follow-up was 14.5 years. Adjuvant chemotherapy was given to 82%. Some degree of bone deformity (usually with overlying soft-tissue hypoplasia) was seen in 40%; 21% developed some type of endocrine deficiency; 30% developed atrophic skin change s; and 7% developed second malignancies. The incidence of bone deformi ty and hormonal deficiency increased with the radiation dose; the inci dence of second malignancy was independent of dose. Bone deformities w ere more common when radiation was administered before the age of 2 ye ars. Conclusions: The consequences of radiotherapy in childhood are si gnificant and must be considered when planning treatment. Even when tr eatment is essential, families should be informed of the possibility o f growth disturbance to prevent subsequent misunderstanding.