University of Oulu

Jussila MP, Remes T, Anttonen J, Harila-Saari A, Niinimäki J, et al. (2018) Late vertebral side effects in long-term survivors of irradiated childhood brain tumor. PLOS ONE 13(12): e0209193.

Late vertebral side effects in long-term survivors of irradiated childhood brain tumor

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Author: Jussila, Miro-Pekka1,2; Remes, Tiina3,4,5; Anttonen, Julia3,4,5;
Organizations: 1Univ Oulu, Res Unit Med Imaging Phys & Technol, Fac Med, Oulu, Finland.
2Univ Oulu, Med Res Ctr, Oulu, Finland.
3Oulu Univ Hosp, Dept Pediat & Adolescence, Oulu, Finland.
4Oulu Univ Hosp, PEDEGO Res Unit, Oulu, Finland.
5Univ Oulu, Oulu, Finland.
6Uppsala Univ, Dept Womens & Childrens Hlth, Uppsala, Sweden.
7Oulu Univ Hosp, Dept Diagnost Radiol, Oulu, Finland.
8Kuopio Univ Hosp, Dept Clin Radiol, Kuopio, Finland.
9Univ Helsinki, Dept Pediat Radiol, HUS Med Imaging Ctr, Radiol, Helsinki, Finland.
10Helsinki Univ Hosp, Helsinki, Finland.
11Kuopio Univ Hosp, Dept Pediat & Adolescence, Kuopio, Finland.
12Univ Eastern Finland, Kuopio, Finland.
13Tampere Univ Hosp, Dept Pediat, Tampere, Finland.
14Univ Tampere, Fac Med & Life Sci, Tampere, Finland.
15Turku Univ Hosp, Dept Pediat & Adolescent Med, Turku, Finland.
16Turku Univ, Turku, Finland.
17Helsinki Univ Hosp, Dept Pediat & Adolescence, Helsinki, Finland.
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1 MB)
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Language: English
Published: Public Library of Science, 2018
Publish Date: 2021-07-09


Purpose: Long-term side effects of the treatments are common in survivors of irradiated pediatric brain tumors. Ionizing radiation in combination with surgery and chemotherapy during childhood may reduce vertebral height and bone mineral density (BMD), and cause growth failure. The aim of this study was to evaluate the late consequences of tumor treatments on vertebrae in survivors of childhood brain tumors.

Methods: 72 adult survivors (mean age 27.8 years, standard deviation 6.7) of irradiated childhood brain tumor were studied by spinal magnetic resonance imaging (MRI) for vertebral abnormalities from the national cohort of Finland. Patients were treated in five university hospitals in Finland between the years 1970 and 2008. Subject height and weight were measured and body mass index (BMI) was calculated. The morphology and height/ depth ratio of the vertebrae in the middle of the kyphotic thoracic curvature (Th8) and lumbar lordosis (L3) were examined. Vertebrae were analyzed by Genant’s semiquantative (SQ) method and spinal deformity index (SDI) was calculated. BMD was measured by using dual X-ray absorptiometry.

Results: 4.2% (3/72) of the patients had undiagnosed asymptomatic vertebral fracture and 5.6% (4/72) of patients had radiation- induced decreased vertebral body height. Male patients had flatter vertebrae compared with females. Patient age at the time of irradiation, BMI and irradiation area correlated to vertebral morphology differentially in males and females. BMD had no association with the vertebral shape. Patients who had received craniospinal irradiation were shorter than the general population.

Conclusion: Childhood brain tumor survivors had a high number of vertebral abnormalities in young adulthood. Irradiation was associated with abnormal vertebral morphology and compromised final height. Male gender may predispose vertebrae to the side effects of irradiation.

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Series: PLoS one
ISSN: 1932-6203
ISSN-E: 1932-6203
ISSN-L: 1932-6203
Volume: 13
Issue: 12
Article number: e0209193
DOI: 10.1371/journal.pone.0209193
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
3123 Gynaecology and paediatrics
Funding: This work was supported by Special State Grants for Health Research in the Department of Pediatrics and Adolescence, Oulu University Hospital, Finland ( (TR); Vare Foundation for Pediatric Cancer Research, Finland ( (M-PJ TR); the Paivikki and Sakari Sohlberg Foundation, Finland Foundation, Finland ( (TR); the Foundation for Pediatric Research, Finland ( HR); the Thelma Makikyro Foundation, Finland (TR); the Cancer Foundation of Northern Finland ( (TR); the Alma and K. A. Snellman Foundation, Finland Donner Foundation, Finland (TR). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright information: © 2018 Jussila et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.