Radiation induced height impairment in pediatric Hodgkin's disease.

Abstract

To quantitate the impairment in skeletal growth from radiation treatment, we reviewed height measurements among children with Hodgkin's disease irradiated at Stanford University Medical Center between 1965 and 1986. One hundred and twenty-four children with Hodgkin's disease, in whom long-term follow-up data were available, became the subjects for this analysis. They all had baseline height measurements within 1 year of radiation treatment, a final height measurement beyond age 15 for boys and 13 for girls, and a minimum time interval between baseline and final measurement of 2 years. A baseline and final percent height, as compared to a reference standard, was calculated for each patient. The difference between these two figures was used to assess height impairment. The study group was divided into age and treatment groups and a comparative analysis between these groups was performed. Height impairment was most severe among children who were given high dose radiation to the entire spine when pre-pubertal in age. These patients demonstrated a 7.7% (p < 0.0001) average height impairment, which equates to a height loss of 13 cm or two standard deviations of the U.S. population mean. Pubertal and post-pubertal patients given similar heavy treatment as well as pre-pubertal patients given light treatment also demonstrated some impairment of skeletal growth, however, the loss was not deemed clinically significant. Comparison of standing versus sitting height impairment did not show evidence of disproportionate final growth impairment. Treatment regimens that use low doses of radiation for pediatric Hodgkin's disease are thus not associated with clinically significant impairment of skeletal growth, as measured by standing and sitting heights.