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Long-term effects of local radiotherapy on growth and vertebral features in children with high-risk neuroblastoma
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  • Kyungmi Yang,
  • Joong Hyun Ahn,
  • Sook-Young Woo,
  • Sang Hoon Jung,
  • Ki Woong Sung,
  • Ji Won Lee,
  • Do Hoon Lim
Kyungmi Yang
Samsung Medical Center Department of Radiation Oncology
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Joong Hyun Ahn
Seoul Medical Center Research Institute
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Sook-Young Woo
Seoul Medical Center Research Institute
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Sang Hoon Jung
Samsung Medical Center Department of Radiation Oncology
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Ki Woong Sung
Samsung Medical Center
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Ji Won Lee
Samsung Medical Center
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Do Hoon Lim
Samsung Medical Center Department of Radiation Oncology

Corresponding Author:[email protected]

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Abstract

Objectives: To evaluate the effects of local radiotherapy (RT) on growth, we evaluated the chronological growth profiles and vertebral features of children with high-risk neuroblastoma. Materials and Methods: Thirty-eight children who received local photon or proton beam therapy to the abdomen or retroperitoneum between January 2014 and September 2019 were included. Simple radiography of the thoracolumbar spine was performed before and every year after RT. The height and vertical length of the irradiated vertebral bodies (VBs) compared with the unirradiated VBs (vertebral body ratio, VBR) were analyzed using the linear mixed model. Shape feature analysis was performed to compare the irradiated and unirradiated vertebrae. Results: The follow-up was a median of 53.5 months (range, 21-81­ months) after RT. A decline in height z-scores was mainly found in the early phase after treatment. In the linear mixed model with height, the initial height (fixed, p < .001), sex (time interaction, p = .008), endocrine dysfunction (time interaction, 0.019), and age at diagnosis (fixed and time interaction, both p = .002) were significant. Unlike the trend in height, the change in VBR (ΔVBR) decreased gradually ( p < .001). The ΔVBR in the group that received more than 30 Gy decreased more than in the group that received smaller doses. In the shape feature analysis, the irradiated VBs changed to a more irregular surface that were neither round nor rectangular. Conclusion: The irradiated VBs in children were gradually restricted compared to the unirradiated VBs in long-term follow-up, and higher RT doses were significantly affected. Radiation-induced irregular features of VBs were observed.