Long-term follow-up of endocrine function among young children with newly diagnosed malignant central nervous system tumors treated with irradiation-avoiding regimens

Endocrine Disorders in Children with Brain Tumors: At Diagnosis, after Surgery, Radiotherapy and Chemotherapy

INTRODUCTION

Brain tumors are the second most frequent type of all pediatric malignancies. Depending on their localization, patients with brain tumors may present neurological or ophthalmological symptoms, but also weight anomalies and endocrine disorders ranging from growth hormone deficiency, anomalies of puberty, diabetes insipidus to panhypopituitarism. Immediately at diagnosis, all patients with brain tumors require a complete assessment of the hypothalamic-pituitary function in order to address eventual endocrine disorders. Moreover, children and adolescents undergoing brain surgery must receive peri- and postoperative hydrocortisone stress therapy. Post-operative disorders of water homeostasis are frequent, ranging from transient diabetes insipidus, as well as syndrome of inappropriate antidiuretic hormone secretion to persistent diabetes insipidus. Late endocrine disorders may result from surgery near or within the hypothalamic-pituitary region. Pituitary deficits are frequent after radiotherapy, especially growth hormone deficiency. Thyroid nodules or secondary thyroid cancers may arise years after radiotherapy. Gonadal dysfunction is frequent after chemotherapy especially with alkylating agents.

CONCLUSION

Early detection and treatment of specific endocrine disorders at diagnosis, perioperatively, and during long-term follow-up result in improved general and metabolic health and quality of life.

Cranial irradiation alters neuroinflammation and neural proliferation in the pituitary gland and induces late-onset hormone deficiency

Cranial radiotherapy induces endocrine disorders and reproductive abnormalities, particularly in long-term female cancer survivors, and this might in part be caused by injury to the pituitary gland, but the underlying mechanisms are unknown. The aim of this study was to investigate the influence of cranial irradiation on the pituitary gland and related endocrine function. Female Wistar rat pups on postnatal day 11 were subjected to a single dose of 6 Gy whole-head irradiation, and hormone levels and organ structure in the reproductive system were examined at 20 weeks after irradiation. We found that brain irradiation reduced cell proliferation and induced persistent inflammation in the pituitary gland. The whole transcriptome analysis of the pituitary gland revealed that apoptosis and inflammation-related pathways were up-regulated after irradiation. In addition, irradiation led to significantly decreased levels of the pituitary hormones, growth hormone, adrenocorticotropic hormone, thyroid-stimulating hormone and the reproductive hormones testosterone and progesterone. To conclude, brain radiation induces reduction of pituitary and reproduction-related hormone secretion, this may due to reduced cell proliferation and increased pituitary inflammation after irradiation. Our results thus provide additional insight into the molecular mechanisms underlying complications after head irradiation and contribute to the discovery of preventive and therapeutic strategies related to brain injury following irradiation.

Treatment of pediatric high-grade central nervous system tumors with high-dose methotrexate in combination with multiagent chemotherapy: A single-institution experience

BACKGROUND

Effective treatment for pediatric embryonal brain tumors includes dose-intensive multiagent chemotherapy (DIMAC) followed by high-dose chemotherapy with stem cell rescue (HDCSCR). Use of repeated cycles of DIMAC including high-dose methotrexate (HDMTX) without HDCSCR has not been described.

PROCEDURE

We retrospectively reviewed the responses/toxicities in 13 patients (aged 2-155 months, median 22 months) with central nervous system (CNS) tumors (atypical teratoid rhabdoid tumors, CNS embryonal tumors not otherwise specified, pineoblastoma, embryonal tumor with multilayered rosettes, and CNS sarcoma) treated over a 12-year period with repeated cycles of HDMTX followed by etoposide, cisplatin, cyclophosphamide, and vincristine.

RESULTS

Six patients (46.2%) had disseminated disease at presentation and five (38.5%) had gross total resection. A total of 64 courses of therapy were administered with a median of five courses per patient.  Eight patients (61.5%) received radiation therapy (one at relapse). By completion of therapy, 11 patients (84.6%) achieved a response (six complete, five partial).  Six of the 13 patients (46.2%) remain alive with a median follow-up of 48 months (6-146).  Acute toxicities included fever/neutropenia (70.3%), bacteremia (15.6%), and grade 3 mucositis (18.8%).  Long-term complications included learning disability, seizure disorder, and brain necrosis, without treatment-related deaths.

CONCLUSIONS

DIMAC with HDMTX without HDCSCR may be an effective treatment option for selected patients with embryonal or high-grade CNS tumors.

Prevalence of Endocrine Disorders in Childhood Brain Tumor Survivors in South Korea

BACKGROUND/AIM

This longitudinal study aimed to analyze the prevalence of endocrine disorders in childhood brain tumor survivors in South Korea using claims data.

PATIENTS AND METHODS

We identified in 1,058 patients from a nationwide cohort of patients diagnosed with brain tumors between January 1st 2009 to March 29th 2016. Multivariable logistic regression was used to evaluate associations between clinical factors and endocrine disorders.

RESULTS

After a median follow-up of 60.0 months, 393 (37.1%) patients had at least 1 endocrine disorder. The commonest endocrine disorders were hypopituitarism (17.4%) and hypothyroidism (6.1%). Female gender (odds ratio(OR)=1.45, p=0.005) and age <10 years (OR=1.65, p=0.001) conferred a higher risk. Patients who received radiotherapy were more likely to have endocrine disorders compared to those who did not (OR=1.79, p<0.001).

CONCLUSION

Regular assessment of endocrine function and timely interventions are necessary for childhood brain tumor survivors with a risk of endocrine disorders.

Degradation of UV-filter Benzophenon-3 in aqueous solution using TiO2 coated on quartz tubes

BACKGROUND

Benzophenone-3 (BP-3), one of the emerging pollutants, is commercially synthesized as UV filter used in cosmetics and other personal care products and its occurrence in the aquatic environment has widely been reported. The goal of this study was to enhance an AOP method for degradation of UV filter Benzophenone-3 in aqueous solutions.

METHOD

In this study, sol-gel method was applied to synthesis TiO₂ nanoparticles. Subsequently, the nanoparticles were successfully coated on quartz tubes. The synthesized catalyst was characterized using XRD, FE-SEM and EDX analysis. Then, the efficiency of photocatalytic process using TiO₂ coated quartz tubes for BP-3 degradation from synthetic and real aqueous solution was assessed.

RESULT

The optimum contact time and solution pH for the highest BP-3 degradation in the synthetic solution were found at 15 min and 10, respectively. The maximum degradation (98%) of BP-3 by photocatalytic process was observed at 1 mg/L initial BP-3 concentration using 225 cm² of catalyst surface area. Among the three applied kinetic models, the experimental data were found to follow the first-order equation more closely with the rate constant of 0.2, 0.048 and 0.035 1/min for 1, 3 and 5 mg/L of initial BP-3 concentration, respectively. In order to investigate the potential of this process for real effluent, the treatment of swimming pool water and wastewater treatment plant was examined and BP-3 degradation close to 88% and 32.1 was achieved, respectively.

CONCLUSION

Based on the obtained data, the photocatalytic process could successfully be applied for water treatment in swimming pools and other effluent containing BP-3 with low turbidity. The advantage of this study is that the synthesized catalyst can be used repeatedly needless to remove catalyst from the treated solution. In addition, AOP_s can effectively eliminate organic compounds in aqueous phase, rather than transferring pollutants into another phase. The limitation of this study is that in solution with high turbidity photocatalytic degradation can be hampered and pre- treatment is needed to reduce turbidity.

The hypothalamic-pituitary-adrenal axis in childhood cancer survivors

Endocrine abnormalities are common among childhood cancer survivors. Abnormalities of the hypothalamic-pituitary-adrenal axis (HPAA) are relatively less common, but the consequences are severe if missed. Patients with tumours located and/or had surgery performed near the hypothalamic-pituitary region and those treated with an accumulative cranial radiotherapy dose of over 30 Gy are most at risk of adrenocorticotrophic hormone (ACTH) deficiency. Primary adrenal insufficiency may occur in patients with tumours located in or involving one or both adrenals. The effects of adjunct therapies also need to be considered, particularly, new immunotherapies. High-dose and/or prolonged courses of glucocorticoid treatment can result in secondary adrenal insufficiency, which may take months to resolve and hence reassessment is important to ensure patients are not left on long-term replacement steroids inappropriately. The prevalence and cumulative incidences of HPAA dysfunction are difficult to quantify because of its non-specific presentation and lack of consensus regarding its investigations. The insulin tolerance test remains the gold standard for the diagnosis of central cortisol deficiency, but due to its risks, alternative methods with reduced diagnostic sensitivities are often used and must be interpreted with caution. ACTH deficiency may develop many years after the completion of oncological treatment alongside other pituitary hormone deficiencies. It is essential that health professionals involved in the long-term follow-up of childhood cancer survivors are aware of individuals at risk of developing HPAA dysfunction and implement appropriate monitoring and treatment.

PTMAc-PEG-PTMAc hydrogel modified by RGDC and hyaluronic acid promotes neural stem cells' survival and differentiation in vitro

The enhancement of the biological properties of hydrogels by surface modifying with bioactive molecules is of great significance, especially for the treatment of central nervous system injury by combining engrafted cells.