Avascular osteonecrosis AFTER  hyprthrmia in childrn & adolscnts



Avascular osteonecrosis after hyperthermia in children and adolescents with pelvic malignancies: A retrospective analysis of potential risk factors

S. Balzer A1, D. T. Schneider A1, M. B. Bernbeck A1, M. Jäger A2, O. Mils A1, J. Schaper A3, R. Willers A4, R. Krauspe A2, U. Göbel A1, R. Wessalowski A1

A1 Clinic of Pediatric Oncology, Hematology and Immunology, Heinrich-Heine-University Düsseldorf, Germany A2 Clinic of Orthopedics, Heinrich-Heine-University Düsseldorf, Germany A3 Institute of Diagnostic Radiology, Heinrich-Heine-University Düsseldorf, Germany A4 Institute of Computer Science, Heinrich-Heine-University Düsseldorf, Germany

Abstract:

Purpose: In children with locally advanced or recurrent malignant tumours, prognosis can be improved by regional deep hyperthermia (RHT) in combination with platin-based chemotherapy.

However, because of the increasing number of patients that achieve long-time remission with this therapy, it is necessary to evaluate long-term sequelae of thermochemotherapy. During the years 1993–2004 one has observed avascular osteonecrosis (AON) of the femoral head after RHT in seven children with pelvic germ cell tumours or rhabdomyosarcomas.

Methods: Although AON may develop in patients with malignancies treated with chemo- or radiotherapy alone, RHT might nevertheless contribute to the occurrence of AON.

In order to determine potential risk factors for AON after RHT, this study analysed the relationship of AON to the patient's age, medical history and treatment parameters such as thermal dose equivalent and power output.

Results and conclusions: In the present study AON was associated with young age as well as intensity of hyperthermia indicated by high power levels that exceed 20 W per kg body weight and/or application of eight or more heat sessions as well as additional radiotherapy.

Based on this observation, it was assumed that an optimized three dimensional thermal field modelling may be helpful to avoid hazardous temperatures in the femoral heads during RHT treatment and to reduce AON of the femoral heads.

International Journal of Hyperthermia Volume 22, Number 6 / September 2006 Pages: 451 - 461

DOI: 10.1080/02656730600893619

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