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Paediatric radiotherapy—the avoidance of late radiation damage to the growing hip

Department of Radiotherapy, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK

This excerpt was created in the absence of an abstract.

Epiphyseal plates of growing bones are sensitive to ionizing radiation and this poses problems for the paediatric radiotherapist.

The late abnormalities of spinal growth following radiotherapy are well documented in the literature (Rubin & Casarett, 1968; Probert et al, 1973; Probert & Parker, 1975). However, the proximal femoral and acetabular epiphyses are so close to many pelvic and inguinal/thigh portals and the consequences of abnormal hip development are so important, that this particular joint justifies closer scrutiny. Slipped capital femoral epiphysis following radiotherapy and chemotherapy (Dickerman et al 1979; Libshitz & Edeiken, 1981) and avascular necrosis of the femoral head (Timothy et al, 1978) have been described following high doses of radiotherapy to this region.

In this manuscript we describe a child in whom electron beam therapy to the groin delivered only low dose radiation to the proximal hip epiphyses—130 cGy fractionated over 5 weeks—but who suffered late maldevelopment.

We explore the success of various radiotherapy techniques in minimizing the dose to the hip epiphyses in four other children treated subsequently in this department. The appropriate positioning of the limb, the choice of treatment modality and, where possible, individual shielding blocks are considered and their effect on the dose to the hip estimated. Absorbed doses of radiation delivered to the midpoint of the proximal femoral epiphyses have been retrospectively determined.

In August 1983, an 8-month-old boy presented with short history of a lump in the left testis.

^* Current address: Radiotherapy Physics Department, Norfolk and Norwich Hospital, Norwich, Norfolk NR1 3SR, UK.

Received for publication June 11, 1992. Accepted for publication September 28, 1992.

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