Survivors of childhood cancer are at risk for treatment-related musculoskeletal
late effects. Early detection and orthopedic intervention can help ameliorate
musculoskeletal late effects and prevent subsequent complications. This systematic review
summarizes the literature describing associations between cancer, its treatment, and
musculoskeletal late effects. We searched PubMed and Web of Science for English language
articles published between January 1970 and December 2012. The search was limited to
investigations with at least 15 participants and conducted at least 2 years after
completion of therapy for childhood, adolescent, or young adult cancer. Some late skeletal
effects, including low bone mineral density, osteonecrosis, slipped capital femoral
epiphyses, oncogenic rickets, and hormone-related growth disturbances have been previously
reviewed and were excluded, as were outcomes following amputation and limb-salvage
procedures. Of 2347 references identified, 30 met inclusion criteria and were retained. An
additional 54 studies that met inclusion criteria were found in reference lists of
retained studies. Of 84 studies, 60 focused on associations between radiotherapy, six
between chemotherapy, and 18 between surgery and musculoskeletal late effects. We found
that younger age, higher radiation dosage, and asymmetric or partial bone radiation volume
influences the effects of radiation on the musculoskeletal system. Methotrexate and
vincristine are associated with long-term muscular strength and flexibility deficits.
Laminectomy and chest wall resection are associated with spinal malalignment, and
enucleation is associated with orbital deformities among survivors. Radiotherapy,
chemotherapy, and surgery are associated with musculoskeletal late effects independently
and additively. Associations are additionally influenced by host and treatment
characteristics.