[The significance of preventive CNS irradiation during antineoplastic therapy in childhood with regard to late odontogenic and mandibulofacial injuries].

Abstract

The aim of the present study was to determine the adverse effects of antineoplastic chemotherapy and radiotherapy on tooth development, i.e., on dentition in general and on craniofacial growth. The patients studied consisted of 26 children with solid tumors treated with chemotherapy alone and 34 patients with acute lymphoblastic leukemia (ALL) who were treated with intensive and follow-on radiation therapy (18 and 24 Gy) to the neurocranium as a constituent of central nervous system prophylactics in treatment protocols for ALL. The treatment protocol employed in these children is known as the BFM (Berlin, Frankfurt, Münster) protocol. At the time of diagnosis the children ranged in age from 3 to 52 months. All treated patients had microdontia, enamel dysplasia, thinning and tapering of apical roots portions, and marked shortening of the roots. These defects were more pronounced in children treated for ALL, but it was not possible to establish statistically relevant evidence on the influence of adjuvant radiotherapy in this group. This indicates that there is a catch up in craniofacial growth 9 years after therapy and that the most serious long-term adverse effects are on dentition.