Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Gilg, M.
Height prediction in children treated with polychemotherapy for osteosarcoma and Ewing´s sarcoma ¿ a retrospective analysis
[ Diplomarbeit ] Medical University of Graz; 2013. pp.
- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Leithner Andreas
- Wibmer Christine Linda
- Altmetrics:
- Abstract:
- The majority of osteosarcoma and Ewing¿s sarcoma patients is diagnosed in childhood and adolescence. Tumourorthopaedic surgeons have to decide whether to implant expandable prostheses for limb reconstruction. Therefore a reliable height prediction is necessary. Paley´s Multiplier Method is currently accepted for height prediction. Recent studies suggest a direct effect of polychemotherapy on the growth plate. The aim of this study was to find out whether adult height is impaired and whether Paley¿s formula is applicable to children who have received polychemotherapy. We retrospectively analysed the height records of 33 children in two centres, from initial diagnosis until maturity (18 years). All patients have received polychemotherapy for OS or ES. Growth impairment was evaluated for 23 children by calculation of z-scores (WHO child growth standards) at initial diagnosis (Z-start), the end of chemotherapy (Z-end) and maturity (18 years= Z-off). Paley¿s formula was tested by comparison of actual adult height (Ha) with the height predicted (Hp) at the date of initial diagnosis. The height difference (Hdiff) Ha minus Hp was also calculated. Z-end (0.24) compared to Z-start (0.55) was significantly decreased (p= 0.004) in OS patients indicating that OS patients have a decrease in growth velocity during chemotherapy. After skeletal maturity this retardation was compensated, Z-start was not significantly (p= 0.546) different from Z-off (0.46). As in OS, ES patients didn¿t grow at the expected rate during chemotherapy, since Z-end (0.24) compared to Z-start (0.64) was significantly decreased (p= 0.008). Z-off (0.34) remained significantly decreased compared to Z-start (p= 0.043). With Paley¿s formula the estimated adult height was too high in 25 and too low in 8 children. Within one standard deviation 10 children had a correct and 23 children had a false prognosis of Ha. The median absolute error of prediction was 5.0 cm. Median Hdiff was -5.0 cm (range -17 to -0.6 cm) in children whose height was overestimated and 5.4 cm (range 0.5 to 8 cm) in those whose height was underestimated. Overall the Hp was 2.3 cm higher than the Ha (p= .013). Our results confirm the observation that polychemotherapy impairs growth. Due to the high amount of false predictions a reliable prognosis of adult height could not be made with Paley¿s method in our collective. The median of the absolute error of prediction was 5 cm. Consequently, Paley¿s formula may have to be adjusted for patients undergoing polychemotherapy for osteosarcoma and Ewing¿s sarcoma.