Sue C Kaste1,2,3, Brian M DeFeo4, Michael D Neel5, Kenneth S Weiss5, Israel Fernandez-Pineda5, Kiri K Ness6. 1. Departments of Diagnostic Imaging. 2. Oncology. 3. Department of Radiology, University of Tennessee Health Science Center, Memphis, TN. 4. Rehabilitation Services. 5. Surgery, Division of Orthopedics. 6. Epidemiology and Cancer Control, St. Jude Children's Research Hospital.
Abstract
BACKGROUND: Osteonecrosis of the hips and knees is an often debilitating adverse event in children treated with glucocorticoids for leukemia and lymphoma but the impact of shoulder involvement has been understudied. Thus, we investigated the severity and functional impairment of shoulder osteonecrosis in a well-characterized population of pediatric patients treated for acute lymphoblastic leukemia or lymphoma. METHODS: We retrospectively reviewed orthopaedic clinic and physical therapy evaluations to determine range of motion (ROM), pain, and impact of magnetic resonance-defined osteonecrosis (ON) on activities of daily living. Adverse events were classified according to the National Cancer Institute's Common Terminology Criteria for Adverse Events version 4.03. RESULTS: We identified 35 patients (22 female), median age at cancer diagnosis 14.2 (range, 4.3 to 19) years; median age at ON diagnosis 16.7 (range, 5.5 to 28) years. Median time to last follow-up from diagnosis of primary malignancy was 6.4 (range, 0 to 12.7) years and from diagnosis of ON was 4.0 (range, 0 to 8.9) years. Twenty-two patients had magnetic resonance evidence of ON; 43 shoulders involved at least 30% of the articular surface of the capital humeral epiphyses.Common Terminology Criteria for Adverse Events mean scores for initial assessments of 55 shoulders (29 patients) showed moderate negative impact of ON on activity of daily living (1.94), decreased ROM limiting athletic activity (0.98), and mild to moderate levels of pain (1.38). Analysis of this group's most recent assessment showed improvement in pain and ON over time, with an average pain grade of 0.58 indicating no pain to mild pain, and 1.37 for ON grade, indicating asymptomatic to mildly symptomatic impact on activities of daily living. We also found minimal worsening average ROM grades (1.11). CONCLUSIONS: Shoulder ON is an underappreciated adverse late effect of therapy in children treated for leukemia/lymphoma which can limit quality of life and functionality. In most cases, pain and disability can be improved with treatment. LEVEL OF EVIDENCE: Level IV-case series.
BACKGROUND:Osteonecrosis of the hips and knees is an often debilitating adverse event in children treated with glucocorticoids for leukemia and lymphoma but the impact of shoulder involvement has been understudied. Thus, we investigated the severity and functional impairment of shoulder osteonecrosis in a well-characterized population of pediatric patients treated for acute lymphoblastic leukemia or lymphoma. METHODS: We retrospectively reviewed orthopaedic clinic and physical therapy evaluations to determine range of motion (ROM), pain, and impact of magnetic resonance-defined osteonecrosis (ON) on activities of daily living. Adverse events were classified according to the National Cancer Institute's Common Terminology Criteria for Adverse Events version 4.03. RESULTS: We identified 35 patients (22 female), median age at cancer diagnosis 14.2 (range, 4.3 to 19) years; median age at ON diagnosis 16.7 (range, 5.5 to 28) years. Median time to last follow-up from diagnosis of primary malignancy was 6.4 (range, 0 to 12.7) years and from diagnosis of ON was 4.0 (range, 0 to 8.9) years. Twenty-two patients had magnetic resonance evidence of ON; 43 shoulders involved at least 30% of the articular surface of the capital humeral epiphyses.Common Terminology Criteria for Adverse Events mean scores for initial assessments of 55 shoulders (29 patients) showed moderate negative impact of ON on activity of daily living (1.94), decreased ROM limiting athletic activity (0.98), and mild to moderate levels of pain (1.38). Analysis of this group's most recent assessment showed improvement in pain and ON over time, with an average pain grade of 0.58 indicating no pain to mild pain, and 1.37 for ON grade, indicating asymptomatic to mildly symptomatic impact on activities of daily living. We also found minimal worsening average ROM grades (1.11). CONCLUSIONS: Shoulder ON is an underappreciated adverse late effect of therapy in children treated for leukemia/lymphoma which can limit quality of life and functionality. In most cases, pain and disability can be improved with treatment. LEVEL OF EVIDENCE: Level IV-case series.
Authors: Ching-Hon Pui; John T Sandlund; Deqing Pei; Dario Campana; Gaston K Rivera; Raul C Ribeiro; Jeffrey E Rubnitz; Bassem I Razzouk; Scott C Howard; Melissa M Hudson; Cheng Cheng; Larry E Kun; Susana C Raimondi; Frederick G Behm; James R Downing; Mary V Relling; William E Evans Journal: Blood Date: 2004-07-13 Impact factor: 22.113
Authors: Paivi Maria Miettunen; Lucie Lafay-Cousin; Gregory M T Guilcher; Alberto Nettel-Aguirre; Vijay Moorjani Journal: Clin Orthop Relat Res Date: 2012-09-25 Impact factor: 4.176
Authors: Charles-Henri Flouzat-Lachaniette; François Roubineau; Clemence Heyberger; Charlie Bouthors; Philippe Hernigou Journal: Int Orthop Date: 2015-12-03 Impact factor: 3.075
Authors: Nobuko Hijiya; Clinton F Stewart; Yinmei Zhou; Dario Campana; Elaine Coustan-Smith; Gaston K Rivera; Mary V Relling; Ching-Hon Pui; Amar Gajjar Journal: Cancer Date: 2008-05-01 Impact factor: 6.860
Authors: C H Pui; D Pei; J T Sandlund; R C Ribeiro; J E Rubnitz; S C Raimondi; M Onciu; D Campana; L E Kun; S Jeha; C Cheng; S C Howard; M L Metzger; D Bhojwani; J R Downing; W E Evans; M V Relling Journal: Leukemia Date: 2009-12-10 Impact factor: 11.528
Authors: Hiroto Inaba; Olga Varechtchouk; Michael D Neel; Matthew J Ehrhardt; Monika L Metzger; Seth E Karol; Kirsten K Ness; Raul C Ribeiro; Ching-Hon Pui; Mary V Relling; John T Sandlund; Sue C Kaste Journal: Pediatr Blood Cancer Date: 2020-05-30 Impact factor: 3.167