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

From: Validation of questionnaire-reported chest wall abnormalities with a telephone interview in Swiss childhood cancer survivors

First author, year, country Treatment era Inclusion criteria Type of outcome assessment Sample Size (n) Age at diagnosis in years Years of follow-up Chest wall abnormality
Definition n %
Study sample unselected with regard to cancer diagnosis and treatment
 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%
Studies focusing on selected diagnoses
 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%
Studies focusing on specific cancer treatments
 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%
  1. Abbreviation: CNS Central nervous system, CT Computer tomography, ctCAE Common terminology criteria for adverse events; n.m Not mentioned