Table 4 Literature summary of systematic review on chest wall abnormalities in childhood cancer survivors

 Kasteler 2017, CH [12]

1997–2005

Childhood cancer Survived 5 years from diagnosis ≥16 years old at survey

Postal questionnaire

1894

Median: 9 IQR: 4–14

Median: 18

IQR: 13–23

Chest wall abnormalities

- Ever in life

42

2.2%

- After cancer diagnosis

38

2.0%

 Mertens 2001, USA [11]

1970–1986

Childhood cancer Survived 5 years from diagnosis

Postal questionnaire

12,390

Range: 0–21

n.m.

Chest wall abnormalities overall

158

1.3%

- Before diagnosis

22

0.2%

- Diagnosis to end of treatment

39

0.3%

- During first 5 years after end of treatment

21

0.2%

- > 5 years after end of treatments

36

0.3%

 Lucas 2017, USA [1]

10/06/ 2003–11/06/2011

Chest wall sarcoma survivors

CT or chest x-ray

23

Median: 12.5 Range: 3.6–20.6

Median: 9.25

Bone abnormalities

- ctCAE Grade IV (rib fracture with non-union resulting in pseudoarthrosis)

1

4%

 Utriainen2017, FI [9]

1980–2000

High risk neuroblastoma survivors

Treated with HSCT

Questionnaire, interview, hospital records, Physical examination

21

Median: 1.7

Range: 0.2–3.9

Median: 20

Range: 13–28

Skeletal complications

- Sternal asymmetry

1

5%

 Huang2013, USA [10]

1970–1986

CNS tumor survived 5 years from diagnosis

Postal questionnaire

1653

Median: 7.6

Range: 0–21

Median: 18.5

Range: 3.3–33.9

Kyphosis, scoliosis and/or acquired deformity of the chest or ribs

15

0.4%

 Perwein 2011, A [2]

1984–09/2009

Stage 4 Neuroblastoma Regular presentation in follow-up program

Medical records review

16

Median: 1.8

Range: 0.2–10.7

Median: 4.3

Range: 0.4–23.2

Musculoskeletal late effects

4

25%

- Asymmetric pectus carinatum

1

6.3%

 Tröbs 2001, D ³

01/1974–12/1988

Wilms tumor

Medical records review

49

Median: 2.6

n.m

Chest wall deformity

3

6%

 Heaston 1979, USA [4]

01/1954–12/1975

Wilms tumor Survived 4 years Megavoltage therapy Detailed medical data and serial radiographs available

Medical records review

25

Mean: 3.5

Range: 0.1–9.3

Mean: 9.8

Range: 4–18

Axial Skeletal alternation (megavoltage)

- Radiographic evidence of abnormal skeletal development

24

96%

Extra axial skeletal alterations

- Hypoplasia of the pelvis and/or thorax

13

52%

 Venkatramani 2013, USA [8]

1999–2009

Childhood cancer Radiotherapy to the lungs without total body irradiation or whole lung irradiation

Medical records review

109

Median: 13.4

Range: 0.01–19.9

Median: 2.5

Range: 0.2–9

Chest wall abnormality

11

10%

- Hypoplasia of chest wall

1

1%

 Pintér 2003, HU [5]

01/01/1975–31/12/1983

Childhood cancer Operated for solid malign tumor excluding retinoblastomas and CNS tumors

Personal interviews, questionnaires

79

N = 17 < 1 year old

N = 62 < 29 days old:

Mean: 20

Range: 16–25

Subgroup analysis per treatment group

Surgical intervention (n = 15)

- Thoracic deformity

4

27%

- Scar formation resulting in psychological problems

12

80%

Multimodal therapy (surgical, chemo-, and radiotherapy, n = 64)

- Skin lesion following radiotherapy

2

3%

- Muscular deformity

7

11%

- Bone morbidity (underdevelopment)

5

8%

- Decreased physical ability to work

3

5%

- Thoracic deformity

4

6%

- Breast underdevelopment

7

11%

- Scar formation resulting in psychological problems

12

19%

 Butler 1990, USA [6]

1970–1987

Childhood cancer Survived to the age of skeletal maturity (14 years for females and 16 years for males)

One year follow-up after irradiation

Radiation to spine and/or extremities

Medical records review

143

Mean: 8.3

Range: 0.1–12.9

Mean: 9.9

Range: 2–18

Chest and rib deformity

51

36%

In girls: breast asymmetry, none had treatment, although there were severe cosmetic deformities

7

35%

Significant pain at the radiation sites (low back pain most common)

23

16.1%

 Taylor 1997, UK [7]

1980–1986

Childhood Wilms tumor Abdominal radiotherapy Assessment of late effects through physician available

Follow-up forms filled by doctors

138

N = 50 < 3 years old

N = 88 ≥ 3 years old

Median: 10.6

Musculoskeletal late effects 8 of 27 described as ‘mild’

27

19.6%

- Asymmetry

13

9.4%

- Hypoplasia

6

4.3%

- Breast asymmetry

1

0.7%

- Rib hypoplasia

1

0.7%