ABSTRACT
The treatment of stage four neuroblastoma in those greater than one year of age is multimodal and includes maturation therapy with 13-cis-retinoic acid after myeloablative chemotherapy with stem cell rescue and radiotherapy. Systemic corticosteroids and local radiotherapy have been implicated in the development of avascular necrosis in cancer patients. Corticosteroids form an important part of acute lymphoblastic leukaemia treatment but radiotherapy does not. It is therefore most likely that the avascular necrosis is caused by the corticosteroid therapy. Increased use of dexamethasone has resulted in an increase in the numbers of paediatric leukaemia patients presenting with symptomatic avascular necrosis. Gabapentin is a gamma-aminobutyric acid analogue originally developed for epilepsy but is also effective against neuropathic pain. The history of previous radiotherapy to this area suggests that there would be limited scope for additional radiotherapy because of the risk of exceeding local tissue tolerance.
