Early disc degeneration in radiotherapy-treated childhood brain tumor survivors

Abstract

<p><strong>Background</strong><br></p><p>Childhood brain tumor (BT) survivors have an increased risk of treatment-related late effects, which can reduce health-related quality of life and increase morbidity. This study aimed to investigate lumbar disc degeneration in magnetic resonance imaging (MRI) in adult survivors of radiotherapy-treated childhood BT compared to age and sex-matched population controls.<br></p><p><strong>Methods</strong><br></p><p>In this cross-sectional comparative study, 127 survivors were identified from hospital registries. After a mean follow-up of 20.7 years (range 5-33.1), 67 survivors (mean age 28.4, range 16.2-43.5) were investigated with MRI and compared to 75 sex-matched population-based controls. Evaluated MRI phenotypes included Pfirrmann grading, , intervertebral disc protrusions, extrusions, and high-intensity-zone-lesions (HIZ). Groups were also compared for known risk factors of lumbar intervertebral disc (IVD) degeneration.<br></p><p><strong>Results</strong><br></p><p>Childhood BT survivors had higher Pfirrmann grades than controls at all lumbar levels (all <em>p</em> < 0.001). Lumbar disc protrusions at L4-5 (<em>p</em> = 0.02) and extrusions at L3-4 (<em>p</em> = 0.04), L4-5 (<em>p</em> = 0.004), and L5-S1 (<em>p</em> = 0.01) were significantly more common in the BT group compared to the control. The survivor cohort also had significantly more HIZ-lesons than the controls (n=13 and n=1, p=0.003). Age at diagnosis was associated with lower degree of IVD degeneration (<em>p</em> < 0.01). Blood pressure correlated with IVD degeneration (<em>P</em> < 0.05).<br></p><p><strong>Conclusions</strong><br></p><p>Signs of early disc degeneration related to tumor treatment can be seen in the IVDs of survivors. Disc degeneration was more severe in children treated in adolescence.<br></p>