Associations between treatment, scoliosis, pulmonary function, and physical performance in long-term survivors of sarcoma

Abstract

Purpose

Longer survival for children with sarcoma has led to the recognition of chronic health conditions related to prior therapy. We sought to study the association of sarcoma therapy with the development of scoliosis.

Methods

We reviewed patient demographics, treatment exposures, and functional outcomes for patients surviving >10 years after treatment for sarcoma between 1964 and 2002 at our institution. The diagnosis of scoliosis was determined by imaging. Functional performance and standardized questionnaires were completed in a long-term follow-up clinic.

Results

We identified 367 patients, with median age at follow-up of 33.1 years. Scoliosis was identified in 100 (27.2%) patients. Chest radiation (relative risk (RR), 1.88 (95% confidence interval (CI), 1.21–2.92), p < 0.005) and rib resection (RR, 2.64 (CI, 1.79–3.89), p < 0.0001) were associated with an increased incidence of scoliosis; thoracotomy without rib resection was not. Of 21 patients who underwent rib resection, 16 (80.8%) had the apex of scoliosis towards the surgical side. Scoliosis was associated with worse pulmonary function (RR, 1.74 (CI, 1.14–2.66), p < 0.01) and self-reported health outcomes, including functional impairment (RR, 1.60 (CI, 1.07–2.38), p < 0.05) and cancer-related pain (RR, 1.55 (CI, 1.11–2.16), p < 0.01). Interestingly, pulmonary function was not associated with performance on the 6-min walk test in this young population.

Conclusions

Children with sarcoma are at risk of developing scoliosis when treatment regimens include chest radiation or rib resection. Identification of these risk factors may allow for early intervention designed to prevent adverse long-term outcomes.

Implications for cancer survivors

Cancer survivors at risk of developing scoliosis may benefit from monitoring of pulmonary status and early physical therapy.

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