Pediatr Blood Cancer 2014;61:1141

LETTER TO THE EDITOR RE: Slipped Capital Femoral Epiphysis After Total Body Irradiation

We thank Vedi et al. [1] for their supportive and thoughtful comments on Slipped Capital Femoral Epiphyses (SCFE) after Total Body Irradiation (TBI). Similarly, these authors report an increased risk of atypical valgus SCFE in their cohort of 104 children who received TBI conditioning for autologous hematopoietic stem cell transplantation as part of consolidation treatment for stage IV Neuroblastoma [1]. Importantly, three of four children with SCFE in Vedi et al.’s cohort were recombinant human growth hormone (rhGH) naı¨ve at the time of SCFE presentation, further emphasizing that the markedly greater SCFE incidence rate in childhood cancer survivors after TBI likely reflects radiation effects to the proximal femoral physis rather than treatment with rhGH. Likewise, there were no SCFE events in our survivors treated with rhGH after cranial radiation alone who served as a comparison group in our study. We agree that treatment with rhGH after TBI may serve as an additive risk, and future multicenter studies are imperative to identify additional and unique risk factors for orthopedic complications in survivors of childhood cancer.

Congruent results from these two separate cohorts serve as a critical reminder that TBI exposure, particularly at a young age, is a significant risk factor for atypical, often bilateral, valgus SCFE with sub acute clinical findings at presentation necessitating a high index of suspicion. As such, provider and parental education on presenting symptoms is key to allow for early diagnosis and prompt surgical treatment to further minimize long-term musculoskeletal complications in the growing at-risk population of childhood cancer survivors. Sogol Mostoufi-Moab, MD, MSCE  Mary B. Leonard The Children’s Hospital of Philadelphia Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania

REFERENCE 1. Vedi A, Neville K, Johnston K, et al. Slipped capital femoral epiphysis after total body irradiation. Pediatr Blood Cancer TBD.

Correspondence to: Sogol Mostoufi-Moab, The Children’s Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania, Philadelphia, PA 19104. E-mail: [email protected] Received 13 October 2013; Accepted 14 November 2013


2013 Wiley Periodicals, Inc. DOI 10.1002/pbc.24894 Published online 23 December 2013 in Wiley Online Library (

Re: Slipped capital femoral epiphysis after total body irradiation.

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