Background: Impairment of bone health in survivors of childhood cancer occurs frequently. Retinoblastoma (RB) is a malignant eye tumour developing in very young children. Treatment can include chemotherapy as an adjuvant or eye sparing treatment attempt. We conducted a cross sectional study to assess bone health in a paediatric cohort of survivors of who had received treatment with chemotherapy at an especially young age (mean age 0.76+0.67 years).
Methods: The study (DRKS00003636) was approved by the local ethics committee. Thirty-eight survivors (14/38 female) were recruited at regular visits to the Childrens Hospital Essen. Of these, 14 patients had unilateral, 23 bilateral and one patient trilateral RB. Datasets of 33 patients, who underwent polychemotherapy combined with local therapies, were available for statistical evaluation. Patients were evaluated at a mean age of 4.4±3.9 (0.7 15.8) years. Polychemotherapy typically consisted of cyclophosphamide (4800 mg/m2), etoposide (1800 mg/m2), vincristine (9mg/m2) and carboplatin (1200mg/m2). Clinical and biochemical parameters of growth, pubertal development and bone health were obtained. The history of fractures and bone pain was assessed.
Results: The mean height SDS was -0.45±1.8 (-2.92 1.21) and mean BMI SDS was 0.46+0.81 (-1.4 2.3). A 25 OH-vitamin D deficiency (VD: < 20 ng/ml) was common and observed in 52% of the patients. Almost 15% had developed secondary hyperparathyroidism, and abnormal readings for bone formation or resorption markers. Bone pain was reported by 7% of the patients and 9% experienced fractures of long bones after primary diagnosis. We found no difference in bone health between children with bilateral and unilateral disease, or between irradiated vs. non irradiated children.
Conclusion: In addition to a vitamin D deficiency, around 20% of the survivors after early in life chemotherapy presented with bone pain and altered parameters of bone health. These are the children who might be at risk to develop serious bone health complications. Since identification of children at risk is difficult, we recommend long term monitoring and supplementation of vitamin D.
Disclosure: The authors declared no competing interests. Michael Schündeln and Corinna Grasemann were supported by an IFORES stipend from the University of Duisburg Essen.
Jens Bauer was supported by the Essen University Hospital Foundation Stiftung Universitätsmedizin.