Onkológia 1/2009

Osteonecrosis – complication at oncological treatment in childhood

Osteonecrosis is one of serious complications at oncological treatment of children. The etiopathogenesis has not been completely elucidated, mostly it has a multifactorial character. The incidence is in 1,5 – 9,3 % range. ON affects predominantly the weight bearing joints. It affects mostly the patients with acute lymphoblastic leukemia and those at adolescent age. The course of disease is unpredictable. The changes at early stages can be reversible, but at some patients the disease progresses and can lead to a disability. At Children oncology clinic of Children teaching hospital in Bratislava during the years 1992 – 2008 we identified 12 patients affected by ON out of 146 children with ALL (8,2 %), 1 out of 42 with NHL (2,4 %) and 1 out of 42 with HL (2,4 %). The age at diagnosis of malignity: 4y7m – 17y, the age at diagnosis ON: 10y5m – 19y. Further course: regression – 2 patients, stabilised state – 6 patients, progression – 3 patients. 3 pacients were lost from our follow up. The treatment was conservative, with the exception of one patient, who had to undergo surgery due to the progression of disease. To avoid the risk of inducing ON during the treatment of oncological patient in childhood it is important to optimalize the therapeutical protocols and to diagnose this complication early.

Keywords: osteonecrosis in children, anticancer treatment, etiopathogenesis, prognosis, therapy