PDF(Pubmed)
Abstract：
OBJECTIVE: To prospectively assess the incidence of Dropped Head Syndrome (DHS) in childhood cancer survivors (CCS) and to develop and evaluate a diagnostic algorithm for DHS.
METHODS: A systematic literature search for DHS in combination with neck radiotherapy (RT) exposure was performed. Analyses and a combination of the most common examination methods were integrated into a diagnostic algorithm. Almost all CCSs visiting the local late effects clinic between May 2020 and April 2022 were included in the study. CCS exposed to neck RT with doses ≥ 19 Gy received standardized clinical and neurological assessment and, in case of abnormal results, an MRI scan to confirm muscle atrophy.
RESULTS: Two hundred and five CCS were included of whom 41 received RT to the neck with ≥ 19 Gy. In the entire cohort and in the subgroup receiving RT, 2.4% and 12% of CCS were affected by DHS, respectively. Results of clinical and neurological assessment correlated well with MRI results. Neck circumference and neck/thigh ratio were lower after neck RT. Over 50% of CCS experienced neck disability and pain.
CONCLUSIONS: A relevant proportion of CCS exposed to neck RT is affected by DHS. High concordance of MRI results with the neurological examination supports the clinical value of the diagnostic algorithm. Measurement of neck circumference might be an easy tool for assessment of neck muscle atrophy in survivors at risk.
CONCLUSIONS: Integration of a diagnostic algorithm for DHS in standard long-term follow-up care facilitates diagnosis as well as initiation of early treatment and obviates the need for invasive examinations.
METHODS: A systematic literature search for DHS in combination with neck radiotherapy (RT) exposure was performed. Analyses and a combination of the most common examination methods were integrated into a diagnostic algorithm. Almost all CCSs visiting the local late effects clinic between May 2020 and April 2022 were included in the study. CCS exposed to neck RT with doses ≥ 19 Gy received standardized clinical and neurological assessment and, in case of abnormal results, an MRI scan to confirm muscle atrophy.
RESULTS: Two hundred and five CCS were included of whom 41 received RT to the neck with ≥ 19 Gy. In the entire cohort and in the subgroup receiving RT, 2.4% and 12% of CCS were affected by DHS, respectively. Results of clinical and neurological assessment correlated well with MRI results. Neck circumference and neck/thigh ratio were lower after neck RT. Over 50% of CCS experienced neck disability and pain.
CONCLUSIONS: A relevant proportion of CCS exposed to neck RT is affected by DHS. High concordance of MRI results with the neurological examination supports the clinical value of the diagnostic algorithm. Measurement of neck circumference might be an easy tool for assessment of neck muscle atrophy in survivors at risk.
CONCLUSIONS: Integration of a diagnostic algorithm for DHS in standard long-term follow-up care facilitates diagnosis as well as initiation of early treatment and obviates the need for invasive examinations.
摘要：
目的：前瞻性评估儿童癌症幸存者（CCS）中头部脱落综合征（DHS）的发生率，并开发和评估DHS的诊断算法。
方法：对DHS联合颈部放疗（RT）进行了系统的文献检索。分析和最常见检查方法的组合被集成到诊断算法中。几乎所有在2020年5月至2022年4月期间访问当地晚期效应诊所的CCS都被纳入研究。暴露于剂量≥19Gy的颈部RT的CCS接受了标准化的临床和神经系统评估，如果结果异常，MRI扫描确认肌肉萎缩.
结果：纳入250例CCS，其中41例接受颈部RT≥19Gy。在整个队列和接受RT的亚组中，2.4%和12%的CCS受到国土安全部的影响，分别。临床和神经系统评估的结果与MRI结果密切相关。颈部RT后，颈围和颈/大腿比降低。超过50%的CCS经历了颈部残疾和疼痛。
结论：暴露于颈部RT的CCS的相关比例受到DHS的影响。MRI结果与神经系统检查的高度一致性支持诊断算法的临床价值。测量颈围可能是评估有风险的幸存者颈部肌肉萎缩的简单工具。
结论：在标准的长期随访护理中整合DHS的诊断算法有助于诊断以及早期治疗的开始，并且消除了对侵入性检查的需要。
方法：对DHS联合颈部放疗（RT）进行了系统的文献检索。分析和最常见检查方法的组合被集成到诊断算法中。几乎所有在2020年5月至2022年4月期间访问当地晚期效应诊所的CCS都被纳入研究。暴露于剂量≥19Gy的颈部RT的CCS接受了标准化的临床和神经系统评估，如果结果异常，MRI扫描确认肌肉萎缩.
结果：纳入250例CCS，其中41例接受颈部RT≥19Gy。在整个队列和接受RT的亚组中，2.4%和12%的CCS受到国土安全部的影响，分别。临床和神经系统评估的结果与MRI结果密切相关。颈部RT后，颈围和颈/大腿比降低。超过50%的CCS经历了颈部残疾和疼痛。
结论：暴露于颈部RT的CCS的相关比例受到DHS的影响。MRI结果与神经系统检查的高度一致性支持诊断算法的临床价值。测量颈围可能是评估有风险的幸存者颈部肌肉萎缩的简单工具。
结论：在标准的长期随访护理中整合DHS的诊断算法有助于诊断以及早期治疗的开始，并且消除了对侵入性检查的需要。
