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Rao, Avani D. et al. International Journal of Radiation Oncology • Biology • Physics , Volume 103 , Issue 3 , 669 – 679

With the increasing use of advanced radiation techniques such as intensity modulated radiation therapy, stereotactic radiation therapy, and proton therapy, radiation oncologists now have the tools to mitigate radiation-associated toxicities. This is of utmost importance in the treatment of a pediatric patient. To best use these advanced techniques to mitigate radiation-induced growth abnormalities, the radiation oncologist should be equipped with a nuanced understanding of the anatomy of centers of growth. This article aims to enable the radiation oncologist to better understand, predict, and minimize radiation-mediated toxicities on growth. We review the process of bone development and radiation-induced growth abnormalities and provide an atlas for contouring important growth plates to guide radiation treatment planning. A more detailed recognition of important centers of growth may improve future treatment outcomes in children receiving radiation therapy.

1. Introduction
2. Complexities of a Standard Dose Constraint
3. Assessment of Skeletal Maturity and Completion of Growth
4. Anatomic Road Map of Important Growth Plates and Clinical Correlates of Radiation-Associated Growth Toxicity
   1. Whole-brain radiation therapy
   2. Craniofacial radiation therapy
      1. Facial hypoplasia
      2. Orbital defects
   3. Shoulder and arm radiation therapy
      1. Clavicular narrowing
      2. Slipped proximal humeral epiphysis
      3. Arm-length discrepancy
   4. Pelvic radiation therapy
      1. Slipped capital femoral epiphysis
      2. Osteonecrosis
      3. Leg-length discrepancy
   5. Spinal irradiation
      1. Reduced final height
      2. Scoliosis
5. Conclusion and Future Directions
6. Supplementary Data
7. References

Chloe J Bright, PhD Raoul C Reulen, PhD David L Winter, HNC Daniel P Stark, MD Martin G McCabe, PhD Angela B Edgar, MD et al.

“A previous large case-control study showed a dose-response relation between radiotherapy and risk of lung cancer in breast cancer survivors diagnosed at any age (not AYA-specific). Existing literature suggests that chest radiotherapy and smoking are both likely contributors to the substantial number of excess neoplasms accounted for by lung cancer.

The bladder and bowel would be directly exposed if external-beam radiotherapy was used to treat cervical cancer. A large case-control study showed a dose-response relation between radiotherapy and the risk of both bladder and rectal cancers in cervical cancer survivors. Existing literature suggests that pelvic irradiation and smoking are likely contributors to the number of excess neoplasms accounted for by lung, colorectal, and bladder cancer. Clinical follow-up of survivors of AYA cervical cancer, particularly where pelvic irradiation is used, should focus on lung, bowel, and bladder cancers.

Treatment for testicular cancer can involve irradiating the para-aortic lymph nodes, which might explain the excess of subsequent primary neoplasms seen in abdominal sites (prostate, bladder, and colorectal). The excess of subsequent primary neoplasms observed in the abdomen is consistent with international studies of testicular cancer survivors. The excess of lung subsequent primary neoplasms might be caused by radiotherapy to the lungs, since previous studies have reported an increased risk of lung cancer in survivors of testicular cancer who were given chest radiotherapy. Clinical follow-up of survivors of AYA testicular cancer should focus on prostate, bladder, colorectal, and lung cancers.

The lungs would be directly exposed if external-beam radiotherapy was used to treat Hodgkin lymphoma; previous studies of Hodgkin lymphoma survivors have provided evidence of a dose-dependent increase in lung cancer risk with radiotherapy with or without chemotherapy.”

https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(18)30903-3/fulltext

Christine E. Hill-Kayser, MD, Zelig Tochner, MD, Yimei Li∗, Goldie Kurtz, MD, Robert A. Lustig, MD, Paul James, Naomi Balamuth, MD, Richard Womer, MD, Peter Mattei, Stephen Grupp, MD PhD, Yael P. Mosse, MD, John M. Maris, MD, Rochelle Bagatell, MD

Conclusions : “excellent outcomes in patients treated with Proton Therapy for high-risk neuroblastoma from 2010-2015, with 82% of patients alive and 97% free of primary site recurrence. No patient has experienced long-term renal or liver toxicity. This treatment maximizes normal tissue preservation and is appropriate for this patient population.”

https://www.redjournal.org/article/S0360-3016(19)30190-7/pdf