Table 4.

Literature summary of systematic review on chest wall abnormalities in 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%

Abbreviation: CNS Central nervous system, CT Computer tomography, ctCAE Common terminology criteria for adverse events; n.m Not mentioned