Abstract
Objectives: A significantly increased risk of slipped capital femoral epiphysis (SCFE) has recently been identified in survivors of childhood cancer treated with recombinant growth hormone (rhGH) after receiving total body irradiation (TBI) conditioning for hematopoietic stem cell transplantation (HSCT).
Methods: We identified 4 cases (1 female) of SCFE in our cohort of 104 children who received TBI conditioning prior to HSCT over the past 30 years, of which 3 were rhGH naïve at the time of presentation.
Results: The children presented 4.8-10.3 years after 12Gy TBI conditioning for autologous HSCT. Presentation was atypical compared to idiopathic SCFE: younger age (6.9-12.2 years), all prepubertal and only one overweight (BMI z-score -2.4 to 1.7). Two were bilateral at presentation, and three of the four patients presented with the uncommon valgus variant of SCFE. Overall time from symptom onset to radiological diagnosis was 5-27 months. The only child presenting with SCFE (unilateral) whilst on rhGH was a 12.2 year old female with unreplaced hypogonadism. She was diagnosed 11 months after commencing rhGH though had experienced x-ray ‘negative’ transient hip pain 7 months prior. Upon review of her original radiographs, by Yngve's criteria, there was subtle evidence of valgus slip.
Conclusions: We conclude that TBI alone is a significant risk factor for SCFE, with delays in diagnosis due to the atypical clinical and radiological presentation being common. Valgus slips are frequently subacute in presentation with standard radiology inadequate. Yngve's criteria are a more sensitive method of screening initial radiographs in children with hip symptoms. However, if standard radiological techniques are negative or equivocal, other modalities such as ultrasound and/or MRI must be considered and early orthopaedic referral mandatory. Furthermore, rhGH therapy is frequently considered in this population. The risk of developing SCFE must be carefully considered by clinicians and clearly discussed with families before embarking on rhGH therapy.
Methods: We identified 4 cases (1 female) of SCFE in our cohort of 104 children who received TBI conditioning prior to HSCT over the past 30 years, of which 3 were rhGH naïve at the time of presentation.
Results: The children presented 4.8-10.3 years after 12Gy TBI conditioning for autologous HSCT. Presentation was atypical compared to idiopathic SCFE: younger age (6.9-12.2 years), all prepubertal and only one overweight (BMI z-score -2.4 to 1.7). Two were bilateral at presentation, and three of the four patients presented with the uncommon valgus variant of SCFE. Overall time from symptom onset to radiological diagnosis was 5-27 months. The only child presenting with SCFE (unilateral) whilst on rhGH was a 12.2 year old female with unreplaced hypogonadism. She was diagnosed 11 months after commencing rhGH though had experienced x-ray ‘negative’ transient hip pain 7 months prior. Upon review of her original radiographs, by Yngve's criteria, there was subtle evidence of valgus slip.
Conclusions: We conclude that TBI alone is a significant risk factor for SCFE, with delays in diagnosis due to the atypical clinical and radiological presentation being common. Valgus slips are frequently subacute in presentation with standard radiology inadequate. Yngve's criteria are a more sensitive method of screening initial radiographs in children with hip symptoms. However, if standard radiological techniques are negative or equivocal, other modalities such as ultrasound and/or MRI must be considered and early orthopaedic referral mandatory. Furthermore, rhGH therapy is frequently considered in this population. The risk of developing SCFE must be carefully considered by clinicians and clearly discussed with families before embarking on rhGH therapy.
| Original language | English |
|---|---|
| Article number | EP-264 |
| Pages (from-to) | S313 |
| Number of pages | 1 |
| Journal | Pediatric Blood and Cancer |
| Volume | 61 |
| Issue number | Supplement 2 |
| Publication status | Published - Dec 2014 |
| Externally published | Yes |
| Event | 46th Congress of the International Society of Paediatric Oncology (SIOP) 2014 - Toronto, Canada Duration: 22 Oct 2014 → 25 Oct 2014 |