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Wheeler G, Grassberger C, Samers J, Dwyer M, Wiltshire K, Daly P, Alvarez B, Campbell BA, Kerr AJ, Kron T, Duane FK, Zacharin M, Downie P, Kyriakou E, Ronckers CM, Constine LS, Hiniker SM. Central Endocrine Complications Among Childhood Cancer Survivors Treated With Radiation Therapy: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2024; 119:457-466. [PMID: 37269265 DOI: 10.1016/j.ijrobp.2023.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Children who receive cranial radiation therapy (RT) as a component of treatment for malignancy are often at risk of long-term central endocrine toxicity secondary to radiation to the hypothalamic-pituitary axis (HPA). A comprehensive analysis was performed of central endocrine late effects in survivors of childhood cancer treated with RT as part of the Pediatric Normal Tissue Effects in the Clinic (PENTEC) consortium. METHODS AND MATERIALS A systematic review of the risk of RT-related central endocrine effects was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A total of 4629 publications were identified, of which 16 met criteria for inclusion in dose modeling analysis, with a total of 570 patients in 19 cohorts. Eighteen cohorts reported outcomes for growth hormone deficiency (GHD), 7 reported outcomes for central hypothyroidism (HT), and 6 reported outcomes for adrenocorticotropic hormone (ACTH) deficiency. RESULTS Normal tissue complication probability modeling for GHD (18 cohorts, 545 patients) yielded D50 = 24.9 Gy (95% CI, 20.9-28.0) and γ50 = 0.5 (95% CI, 0.27-0.78). The normal tissue complication probability model fit for whole brain irradiation in children with a median age of >5 years indicated a 20% risk of GHD for patients who receive a mean dose of 21 Gy in 2-Gy fractions to the HPA. For HT, among 7 cohorts (250 patients), D50 = 39 Gy (95% CI, 34.1-53.2) and γ50 = 0.81 (95% CI, 0.46-1.35), with a 20% risk of HT in children who receive a mean dose of 22 Gy in 2-Gy fractions to the HPA. For ACTH deficiency (6 cohorts, 230 patients), D50 = 61 Gy (95% CI, 44.7-119.4) and γ50 = 0.76 (95% CI, 0.5-1.19); there is a 20% risk of ACTH deficiency in children who receive a mean dose of 34 Gy in 2-Gy fractions to the HPA. CONCLUSIONS RT dose to the HPA increases the risk of central endocrine toxicity, including GHD, HT, and ACTH deficiency. In some clinical situations, these toxicities may be difficult to avoid, and counseling of patients and families with respect to anticipated outcomes is important.
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Affiliation(s)
- Greg Wheeler
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia
| | - Clemens Grassberger
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Josephine Samers
- Alfred Health, GP Liaison Late Effects Service, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Mary Dwyer
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Kirsty Wiltshire
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Patricia Daly
- St. Luke's Radiation Oncology Network, Dublin, Ireland
| | - Beatriz Alvarez
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain
| | - Belinda A Campbell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia; Department of Clinical Pathology, University of Melbourne, Parkville, Australia
| | - Amanda J Kerr
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England
| | - Tomas Kron
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Frances K Duane
- Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain; Trinity St. James Cancer Institute, Dublin, Ireland
| | - Margaret Zacharin
- Department of Endocrinology, Murdoch Children's Research Unit, University of Melbourne, Victoria, Australia
| | - Peter Downie
- Department of Paediatric Haematology-Oncology, Monash Children's Hospital, Clayton, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Elizabeth Kyriakou
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - Cecile M Ronckers
- Division of Organizational Health Services Research, Department of Health Services Research, University of Oldenburg, Oldenburg, Germany
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York.
| | - Susan M Hiniker
- Department of Radiation Oncology, Stanford University, Stanford, California.
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Shahriari A, Etemadrezaie H, Zabihyan S, Amirabadi A, Aalami AH. Alterations in hypothalamic-pituitary axis (HPA) hormones 6 months after cranial radiotherapy in adult patients with primary brain tumors outside the HPA region. Mol Biol Rep 2024; 51:373. [PMID: 38418676 DOI: 10.1007/s11033-024-09257-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/15/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Cranial radiotherapy is a common treatment for brain tumors, but it can affect the hypothalamic-pituitary (H-P) axis and lead to hormonal disorders. This study aimed to compare serum levels of HPA hormones before and after cranial radiation. MATERIALS AND METHODS This study involved 27 adult patients who underwent brain tumor resection before the initiation of radiotherapy, and none had metastatic brain tumors. All participants had the HPA within the radiation field, and their tumors were located in brain areas outside from the HPA. Serum levels of HPA hormones were recorded both before and 6 months after cranial radiotherapy. RESULTS A total of 27 adult patients, comprising 16 (59.3%) males and 11 (40.7%) females, with a mean age of 56.37 ± 11.38 years, were subjected to evaluation. Six months post-radiotherapy, serum levels of GH and TSH exhibited a significant decrease. Prior to radiotherapy, a substantial and direct correlation was observed between TSH and FSH (p = 0.005) as well as LH (p = 0.014). Additionally, a significant and direct relationship was noted between serum FSH and LH (p < 0.001) before radiotherapy. After radiotherapy, a significant and direct correlation persisted between TSH and FSH (p = 0.003) as well as LH (p = 0.005), along with a significant and direct relationship between serum FSH and LH (p < 0.001). Furthermore, a significant and direct association was identified between changes in serum GH levels and FSH (p = 0.04), as well as between serum LH and FSH (p < 0.001). CONCLUSION Reduced serum levels of HPA hormones are a significant complication of cranial radiotherapy and should be evaluated in follow-up assessments.
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Affiliation(s)
- Ali Shahriari
- Department of Internal Medicine, Faculty of Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Hamid Etemadrezaie
- Department of Neurosurgery, Ghaem Teaching Hospital, Mashhad University of Medical Sciences, Mashhad, Razavi Khorasan, Iran.
| | - Samira Zabihyan
- Department of Neurosurgery, Ghaem Teaching Hospital, Mashhad University of Medical Sciences, Mashhad, Razavi Khorasan, Iran
| | - Amir Amirabadi
- Department of Internal Medicine, Faculty of Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
- Innovative Medical Research Center, Faculty of Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Amir Hossein Aalami
- Department of Nutrition and Integrative Physiology, College of Health, University of Utah, Salt Lake City, UT 84112, USA.
- Division of Nephrology and Hypertension, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT 84132, USA.
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3
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Zhang ZD, Fang HY, Pang C, Yang Y, Li SZ, Zhou LL, Bai GH, Sheng HS. Giant Pediatric Supratentorial Tumor: Clinical Feature and Surgical Strategy. Front Pediatr 2022; 10:870951. [PMID: 35558365 PMCID: PMC9086618 DOI: 10.3389/fped.2022.870951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/23/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To analyze the clinical character of giant pediatric supratentorial tumor (GPST) and explore prognostic factors. MATERIALS AND METHODS We analyzed the clinical data comprising of 35 cases of GPST from a single center between January 2015 and December 2020. The tumor volume was measured by 3D slicer software based on preoperative magnetic resonance imaging (MRI). Glasgow Outcome Scale (GOS) was used to evaluate the short-term prognosis. RESULT The tumor volume varied from 27.3 to 632.8 ml (mean volume 129.8 ml/ median volume 82.8 ml). Postoperative histopathological types include ependymoma, pilocytic astrocytoma, choroid plexus papilloma (CPP), craniopharyngioma, primitive neuroectoderm tumor (PNET), choroid plexus carcinoma (CPC), immature teratoma, atypical teratoid rhabdoid tumor (AT/RT), anaplastic astrocytoma, and gangliocytoma. Tumors in children younger than 3 years and tumors located at the hemispheres appeared to be larger than their respective counterparts, though no statistical significance was found. A patient with giant immature teratoma died during the operation because of excessive bleeding. Postoperative complications include cerebrospinal fluid subgaleal collection/effusion, infection, neurological deficits, and seizures. The mean GOS score of patients with GPST in 6 months is 3.43 ± 1.12, and 83% of patients (29/35) showed improvement. Favorable GPST characteristics to indicated better GOS included small tumor (≤100 ml) (p = 0.029), low-grade (WHO I-II) (p = 0.001), and gross total resection (GTR) (p = 0.015). WHO grade was highly correlated with GOS score (correlation coefficient = -0.625, p < 0.001). GTR and tumor volume were also correlated (correlation coefficient = -0.428, p = 0.010). CONCLUSION The prognosis of GPST is highly correlated with the histopathological type. Smaller tumors are more likely to achieve GTR and might lead to a higher GOS score. Early diagnosis and GTR of the tumor are important for GPST management.
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Affiliation(s)
- Zhong-Ding Zhang
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Huang-Yi Fang
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Chen Pang
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Yue Yang
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Shi-Ze Li
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Ling-Li Zhou
- Department of Pathology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guang-Hui Bai
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Han-Song Sheng
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
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Datsieva A, Kadyrov S, Lubnin A. Surgical treatment of giant tumors of the cerebral hemispheres in children. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:24-28. [DOI: 10.17116/jnevro202212211124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Maciel J, Dias D, Cavaco D, Donato S, Pereira MC, Simões-Pereira J. Growth hormone deficiency and other endocrinopathies after childhood brain tumors: results from a close follow-up in a cohort of 242 patients. J Endocrinol Invest 2021; 44:2367-2374. [PMID: 33683662 DOI: 10.1007/s40618-021-01541-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Brain tumors are the most common solid tumor in children. The prevalence of survivors from these cancers has been increasing, presenting endocrine sequelae in more than 40% of the cases. Our aim was to characterize the endocrinopathies diagnosed in this population, exploring the outcomes of growth hormone treatment. METHODS We have performed a retrospective analysis of the survivors that were followed-up through a close protocol at our endocrine late-effects clinic. RESULTS 242 survivors, followed during 6.4 (0-23.4) years, were considered. The median age at tumor diagnosis was 6.7 (0-18) years and pilocytic astrocytoma was the most frequent neoplasm (33.5%). The prevalence of endocrinopathies was of 71.5%, with growth hormone deficiency being the most frequent (52.9%). An indirect correlation between the age at the beginning of somatropin and growth velocity in the first year of treatment was observed. Those treated with craniospinal radiotherapy presented a smaller final upper/lower segments ratio comparing with those that only received cranial radiotherapy. However, their final height was not compromised when compared to their family height target. We found pubertal delay in 12%; accelerated/precocious puberty in 13.2%; central and primary hypogonadism in 21.9% and 3.3%, respectively; primary and central hypothyroidism in 23.6% and 14.5%, respectively; thyroid nodules in 7.4%; ACTH deficiency in 10.3% and diabetes insipidus in 12%. CONCLUSION This study reveals a higher prevalence of endocrinopathies in brain tumors survivors and explores the influence of craniospinal irradiation in the adult body proportions. It reinforces the importance of routine follow-up among survivors.
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Affiliation(s)
- J Maciel
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
| | - D Dias
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - D Cavaco
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - S Donato
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - M C Pereira
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - J Simões-Pereira
- Endocrinology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
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6
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Shrivastava A, Mohammed N, Xu Z, Liščák R, Kosak M, Krsek M, Karim KA, Lee CC, Martínez-Moreno N, Lee Vance M, Lunsford LD, Sheehan JP. Outcomes After Gamma Knife Stereotactic Radiosurgery in Pediatric Patients with Cushing Disease or Acromegaly: A Multi-Institutional Study. World Neurosurg 2019; 125:e1104-e1113. [PMID: 30790739 DOI: 10.1016/j.wneu.2019.01.252] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Pituitary adenomas comprise about 3% of all intracranial tumors in pediatric patients. This study examines the role of stereotactic radiosurgery in the management of pediatric acromegaly or patients with Cushing disease (CD). METHODS From an international consortium, we retrospectively collected treatment and outcome data on pediatric adrenocorticotrophic hormone and growth hormone-secreting pituitary adenomas treated with Gamma Knife radiosurgery (GKRS). There were a total of 36 patients including 24 with CD and 12 with acromegaly. The data were analyzed to assess outcomes including tumor control, endocrine remission, and adverse effects. Statistical analysis was performed to determine correlation between clinical/treatment parameters and outcomes. RESULTS At the last follow-up after GKRS, endocrine remission rates for CD and acromegaly were 80% and 42%, respectively. Tumor control was achieved in 87.5% of patients with CD and in 42% of patients with acromegaly. New pituitary hormone deficiency occurred in 7 of the 36 patients at a median time of 18 months after GKRS (range, 12-81 months). The predictive factors for endocrine remission were age <15 years (P = 0.015) and margin dose (P = 0.042). The median endocrine follow-up was 63.7 months (range, 7-246 months). CONCLUSIONS GKRS affords reasonable rates of endocrine remission and tumor control in most pediatric patients with functioning adenomas. The most common post-GKRS complication was hypopituitarism, although this occurred in only a few patients. Given the larger at-risk period for pediatric patients, further study is required to evaluate for delayed recurrences and hypopituitarism.
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Affiliation(s)
- Adesh Shrivastava
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Nasser Mohammed
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Zhiyuan Xu
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Roman Liščák
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, USA
| | - Mikulas Kosak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, USA
| | - Michal Krsek
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, USA
| | | | - Cheng-Chia Lee
- Department of Neurosurgery, Taipei Veteran General Hospital, Taiwan, USA
| | - Nuria Martínez-Moreno
- Department of Neurological Surgery and Gamma Knife Radiosurgery, Ruber International Hospital, Madrid, USA
| | - Mary Lee Vance
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - L Dade Lunsford
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
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7
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ACOG Committee Opinion No. 747: Gynecologic Issues in Children and Adolescent Cancer Patients and Survivors. Obstet Gynecol 2018; 132:e67-e77. [DOI: 10.1097/aog.0000000000002763] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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8
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Pereira MC, Pereira JS, Dias D, Donato S, Salgado D. Endocrine Health Problems Detected in 764 Patients Evaluated in a Late Effects Clinic. Case Rep Oncol 2017; 10:958-963. [PMID: 29279699 PMCID: PMC5731110 DOI: 10.1159/000480494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 11/21/2022] Open
Abstract
Background Many pediatric cancer survivors have endocrine conditions. After treatment with alkylating agents, steroids, methotrexate, and radiation, several endocrine dysfunctions may appear. Surveillance for late effects is recommended by guidelines worldwide. Objective The objective of this study was to describe the endocrine outcomes of 764 patients followed during a 20 years' period in our out-patient clinic. Design We retrospectively reviewed the medical records. Patients The study included 764 patients whose oncological or hematological dangerous diseases appeared before they were 18 years old. Larger groups were constituted by leukemias, central nervous tumors, and lymphomas. Outcome Measures The frequency and types of endocrine conditions were analyzed. Results 1,091 endocrine conditions were observed in all groups. The most common types of endocrine conditions were problems with growth and the thyroid. We found puberty abnormalities and bone problems in third and fourth places of frequency. ACTH insufficiency was found in seventh place. Conclusion Endocrine dysfunctions are very common in survivor populations. Endocrinologists should be aware of international guidelines and make an effort to optimize screening and treatment of endocrine effects of cancer therapy. The crucial period is the puberty with growth spurt failure and accelerated maturity both of which can bring future social and professional difficulties.
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Affiliation(s)
- Maria Conceição Pereira
- *Maria Conceição Pereira, MD, Endocrine Department, Portuguese Cancer Institute FG, Rua Prof. Lima Basto, PT-1099-023 Lisbon (Portugal), E-Mail
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Greenfield BJ, Jaramillo S, Abboud M, Mahajan A, Paulino AC, McGovern S, McAleer MF, Chintagumpala M, Okcu MF, Khatua S, Su J, Grosshans DR. Outcomes for pediatric patients with central nervous system germ cell tumors treated with proton therapy. Clin Transl Radiat Oncol 2016; 1:9-14. [PMID: 29657988 PMCID: PMC5893478 DOI: 10.1016/j.ctro.2016.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose We assessed outcomes after proton therapy (PT) for central nervous system germinomas or non-germinomatous germ cell tumors (NGGCTs) in children. Patients and methods We identified children with germ cell tumors of the central nervous system who received proton therapy in 2006–2009 and extracted information on tumor response, treatment failures, and toxicity. Results Of the 20 identified patients (median age 12 years [range 3–16]), 9 had germinoma and 11 NGGCTs; 19 patients received three-dimensional conformal PT and 1 scanning-beam PT. Fourteen patients had craniospinal irradiation (CSI), 4 had ventricular irradiation that excluded the 4th ventricle, and 2 had whole-ventricle irradiation. All received involved-field boosts. At a median follow-up interval of 5.6 years (range, 0.3–8.2 years), 1 patient with germinoma had an out-of-field failure in the 4th ventricle and 2 with NGGCT died from disease progression after CSI. Rates of local control, progression-free survival, and overall survival at 5 years were 89%, 89%, and 100% for patients with germinoma; corresponding rates for NGGCTs were 82%, 82%, and 82%. The most common late toxicity (9 patients [45%]) was endocrinopathy. Conclusions PT for CNS germ cell tumors is associated with acceptable disease control rates and toxicity profiles.
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Affiliation(s)
- Brad J Greenfield
- Baylor College of Medicine, The University of Texas MD Anderson Cancer Center, USA
| | - Sergio Jaramillo
- Baylor College of Medicine, The University of Texas MD Anderson Cancer Center, USA.,Department of Internal Medicine, The University of Texas MD Anderson Cancer Center, USA
| | - Mirna Abboud
- Baylor College of Medicine, The University of Texas MD Anderson Cancer Center, USA
| | - Anita Mahajan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Susan McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Mary F McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Murali Chintagumpala
- Baylor College of Medicine, The University of Texas MD Anderson Cancer Center, USA.,Texas Children's Cancer and Hematology Center, USA
| | - M Fatih Okcu
- Baylor College of Medicine, The University of Texas MD Anderson Cancer Center, USA.,Texas Children's Cancer and Hematology Center, USA
| | - Soumen Khatua
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, USA
| | - Jack Su
- Baylor College of Medicine, The University of Texas MD Anderson Cancer Center, USA.,Texas Children's Cancer and Hematology Center, USA
| | - David R Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
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10
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Roddy E, Mueller S. Late Effects of Treatment of Pediatric Central Nervous System Tumors. J Child Neurol 2016; 31:237-54. [PMID: 26045296 DOI: 10.1177/0883073815587944] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/21/2015] [Indexed: 12/18/2022]
Abstract
Central nervous system tumors represent the most common solid malignancy in childhood. Improvement in treatment approaches have led to a significant increase in survival rates, with over 70% of children now surviving beyond 5 years. As more and more children with CNS tumors have longer survival times, it is important to be aware of the long-term morbidities caused not only by the tumor itself but also by tumor treatment. The most common side effects including poor neurocognition, endocrine dysfunction, neurological and vascular late effects, as well as secondary malignancies, are discussed within this article.
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Affiliation(s)
- Erika Roddy
- School of Medicine, University of California, San Francisco, CA, USA
| | - Sabine Mueller
- Department of Neurology, University of California, San Francisco, CA, USA Department of Pediatrics, University of California, San Francisco, CA, USA Department of Neurosurgery, University of California, San Francisco, CA, USA
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11
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Results of sequential chemoradiotherapy for intracranial germinoma. Jpn J Radiol 2015; 33:336-43. [PMID: 25943790 DOI: 10.1007/s11604-015-0424-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the efficacy of sequential chemoradiotherapy (CRT) for intracranial germinoma by long-term follow-up. MATERIALS AND METHODS We retrospectively evaluated 23 consecutive intracranial germinoma patients without spinal dissemination, who had been treated by sequential CRT. All patients except for one were biopsied or surgically resected before treatment and all patients received both cranial and spinal magnetic resonance imaging. Three cycles of induction chemotherapy composed of etoposide and platinum agents were administered. The prescription of radiotherapy was 24 Gy per 12 fractions. No patients received spinal irradiation. RESULTS All patients accomplished CRT and achieved complete remission. No severe acute and late toxicities were observed. Median follow-up time was 11.8 years. The 5- and 10-year overall survival rates were 100 and 100 %, and relapse-free survival rates were 96 and 89 %, respectively. Three patients developed intracranial recurrence and all of them were successfully salvaged by additional CRT. All patients were alive without disease at final follow-up. CONCLUSION Treatment of 24 Gy of sequential CRT for intracranial germinoma might be promising as an alternative to radiotherapy alone. Spinal irradiation may not be necessary for patients who had no spinal dissemination and who were treated with CRT.
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12
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Ruble K, George A, Gallicchio L, Gamaldo C. Sleep disordered breathing risk in childhood cancer survivors: an exploratory study. Pediatr Blood Cancer 2015; 62:693-7. [PMID: 25597930 PMCID: PMC4486064 DOI: 10.1002/pbc.25394] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/14/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Sleep disordered breathing (SDB) is emerging as a significant health condition for children. The purpose of this study is to evaluate SDB symptoms in childhood cancer survivors and identify associations with quality of life (QOL) and psychological symptoms. PROCEDURE A sample of 62 survivors aged 8-18 years were recruited during routine survivorship visits. All subjects and their parents completed questionnaires to evaluate sleep, QOL and psychological symptoms; scales included were: Pediatric Sleep Questionnaire, Sleep Disordered Breathing Subscale (PSQ-SDBS), Pediatric Quality of Life Inventory (PedsQL) and Depression Anxiety Stress Scale (DASS-21). Continuous data were used for all scales and a threshold score of >0.33 on the PSA-SDBS was used to identify risk of SDB. The relationships between measures of sleep and independent variables were examined using Pearson correlations and multiple linear regression models for significant associations. RESULTS Of the 62 subjects enrolled, underlying diagnoses included 29 leukemias, 30 solid tumors and 3 non-malignant diseases. Nineteen percent of subjects were identified as having SDB risk on the PSQ-SDBS. The lowest mean PedsQL subscale score for parent and child ratings were school QOL; Parent mean 73(±SD 19) and Child mean 71(±SD 20). The severity of SDB per the PSQ was significantly associated with reduced total and school QOL which remained significant after adjusting for stress. CONCLUSIONS Symptoms suggestive of SDB are common in childhood cancer survivors with negative implications for overall quality of life and school performance.
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Affiliation(s)
- Kathy Ruble
- Johns Hopkins University, School of Medicine, Division of Pediatric Oncology, Baltimore, Maryland,Correspondence to: Kathy Ruble, Johns Hopkins University, School of Medicine, Division of Pediatric, Oncology, Baltimore, MD, 1800 Orleans St, Bloomberg Children’s Center, Baltimore, MD, 21287.
| | - Anna George
- Johns Hopkins Hospital, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland
| | - Lisa Gallicchio
- The Prevention and Research Center, The Weinberg Center for Women’s Health and Medicine, Mercy Medical Center, Baltimore, Maryland
| | - Charlene Gamaldo
- Johns Hopkins University, School of Medicine, Division of Pulmonary and Critical Care, Baltimore, Maryland
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Brignardello E, Felicetti F, Castiglione A, Fortunati N, Matarazzo P, Biasin E, Sacerdote C, Ricardi U, Fagioli F, Corrias A, Arvat E. GH replacement therapy and second neoplasms in adult survivors of childhood cancer: a retrospective study from a single institution. J Endocrinol Invest 2015; 38:171-6. [PMID: 25344310 DOI: 10.1007/s40618-014-0179-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/16/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Growth hormone deficiency (GHD) is the most common endocrine late effect observed in childhood cancer survivors (CCS) previously submitted to cranial irradiation. Radiation therapy can also increase the risk of second neoplasms (SNs). Since in previous studies GH replacement therapy was associated with increased incidence of neoplasia, we explored the association between SNs and GH replacement therapy in a cohort of CCS with GHD. METHODS Within the clinical cohort of CCS referred to the Transition Unit for Childhood Cancer Survivors of Turin between November 2001 and December 2012, we considered all patients who developed GHD as a consequence of cancer therapies. GHD was always diagnosed in childhood. To evaluate the quality of data, our cohort was linked to the Childhood Cancer Registry of Piedmont. RESULTS GHD was diagnosed in 49 out of 310 CCS included in our clinical cohort. At least one SN was diagnosed in 14 patients, meningioma and basal cell carcinoma being the most common SNs. The cumulative incidence of SNs was similar in GH-treated and -untreated patients (8 SNs out of 26 GH-treated and 6 out of 23 GH-untreated patients; p = 0.331). Age, sex and paediatric cancer type had no impact on SNs development. CONCLUSIONS In our CCS, GH replacement therapy does not seem to increase the risk of SNs. Anyway, independently from replacement therapy, in these patients we observed an elevated risk of SNs, possibly related to previous radiation therapy, which suggests the need of a close long-term follow-up.
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Affiliation(s)
- E Brignardello
- Transition Unit for Childhood Cancer Survivors, Department of Oncology, AOU Città della Salute e della Scienza Hospital, Via Cherasco, 15, 10126, Turin, Italy.
| | - F Felicetti
- Transition Unit for Childhood Cancer Survivors, Department of Oncology, AOU Città della Salute e della Scienza Hospital, Via Cherasco, 15, 10126, Turin, Italy
- Oncological Endocrinology Unit, Department of Oncology, University of Torino, Turin, Italy
| | - A Castiglione
- Unit of Clinical Epidemiology, University of Torino and Centre for Cancer Epidemiology and Prevention (CPO Piemonte), Turin, Italy
| | - N Fortunati
- Transition Unit for Childhood Cancer Survivors, Department of Oncology, AOU Città della Salute e della Scienza Hospital, Via Cherasco, 15, 10126, Turin, Italy
- Oncological Endocrinology Unit, Department of Oncology, University of Torino, Turin, Italy
| | - P Matarazzo
- Paediatric Endocrinology Unit, Department of Paediatric Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - E Biasin
- Paediatric Hematology/Oncology Unit, Department of Paediatric Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - C Sacerdote
- Unit of Clinical Epidemiology, University of Torino and Centre for Cancer Epidemiology and Prevention (CPO Piemonte), Turin, Italy
| | - U Ricardi
- Radiation Oncology Unit, Department of Oncology, University of Torino, Turin, Italy
| | - F Fagioli
- Paediatric Hematology/Oncology Unit, Department of Paediatric Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - A Corrias
- Paediatric Endocrinology Unit, Department of Paediatric Sciences, Città della Salute e della Scienza Hospital, Turin, Italy
| | - E Arvat
- Oncological Endocrinology Unit, Department of Oncology, University of Torino, Turin, Italy
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The impact of surgical resection of giant supratentorial brain tumor in pediatric patients: safety and neurological outcome evaluated in 23 consecutive cases. Childs Nerv Syst 2015; 31:67-75. [PMID: 25374270 DOI: 10.1007/s00381-014-2583-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 10/29/2014] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study aims to evaluate the impact of gross total resection of giant supratentorial brain tumors (GSBT) on survival and neurological outcome in a consecutive single-center pediatric series. METHODS Clinical data of 23 patients under 18 years of age operated with GSBT (≥5 cm in diameter) were reviewed to determine epidemiological aspects, clinical presentation, associated factors, histopathological features, and outcome. Volumetric measurements were performed on magnetic resonance imaging or computed tomography scans obtained at the time of the initial surgical procedure. RESULTS The group included 23 patients (mean age 4.5 years). Signs and symptoms of raised intracranial pressure were present in 19 patients (82.6%). The most frequent tumor location was the parietal lobe in 19 patients (82.6%), and the mean tumor volume was 208 cm(3). Gross total or radical resection was achieved in all patients. Histopathological analysis revealed malignant brain tumors in 18 cases (78.2%). The most common neoplasm was choroid plexus carcinoma in seven (30.4 %). Mean intraoperative blood transfusion volume was 51.2 ml/kg. Chemotherapy and/or radiotherapy were performed as adjuvant treatment in 16 patients (69.5%). Mean length of follow-up was 36.7 months. Tumor malignancy grade significantly correlated with recurrence of the disease (P = 0.03) and death (P = 0.01), as opposed to tumor location, size, and extension to the ventricles. CONCLUSIONS Our clinical experience suggests that tumor mass reduction by en bloc surgery seems to be an effective approach in pediatric patients with GSBT, relieving symptoms related to raised intracranial pressure and providing a better response to adjuvant treatment.
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Clement SC, Meeteren AYNSV, Kremer LCM, van Trotsenburg ASP, Caron HN, van Santen HM. High prevalence of early hypothalamic-pituitary damage in childhood brain tumor survivors: need for standardized follow-up programs. Pediatr Blood Cancer 2014; 61:2285-9. [PMID: 25131941 DOI: 10.1002/pbc.25176] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/19/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Childhood brain tumor survivors (CBTS) are at increased risk to develop endocrine disorders. Alerted by two cases who experienced delay in diagnosis of endocrine deficiencies within the first 5 years after brain tumor diagnosis, our aim was to investigate the current screening strategy and the prevalence of endocrine disorders in survivors of a childhood brain tumor outside of the hypothalamic-pituitary region, within the first 5 years after diagnosis. PROCEDURES Firstly, we performed a retrospective study of 47 CBTS treated in our center, diagnosed between 2008 and 2012. Secondly, the literature was reviewed for the prevalence of endocrine disorders in CBTS within the first 5 years after diagnosis. RESULTS Of 47 CBTS eligible for evaluation, in 34% no endocrine parameters had been documented at all during follow up. In the other 66%, endocrine parameters had been inconsistently checked, with different parameters at different time intervals. In 19% of patients an endocrine disorder was found. At literature review 22 studies were identified. The most common reported endocrine disorder within the first 5 years after diagnosis was growth hormone deficiency (13-100%), followed by primary gonadal dysfunction (0-91%) central hypothyroidism (0-67%) and primary/subclinical hypothyroidism (range 0-64%). CONCLUSION Endocrine disorders are frequently seen within the first 5 years after diagnosis of a childhood brain tumor outside of the hypothalamic-pituitary region. Inconsistent endocrine follow up leads to unnecessary delay in diagnosis and treatment. Endocrine care for this specific population should be improved and standardized. Therefore, high-quality studies and evidence based guidelines are warranted.
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Affiliation(s)
- Sarah C Clement
- Department of Pediatric Endocrinology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Kyle UG, Shekerdemian LS, Coss-Bu JA. Growth failure and nutrition considerations in chronic childhood wasting diseases. Nutr Clin Pract 2014; 30:227-38. [PMID: 25378356 DOI: 10.1177/0884533614555234] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Growth failure is a common problem in many children with chronic diseases. This article is an overview of the most common causes of growth failure/growth retardation that affect children with a number of chronic diseases. We also briefly review the nutrition considerations and treatment goals. Growth failure is multifactorial in children with chronic conditions, including patients with cystic fibrosis, chronic kidney disease, chronic liver disease, congenital heart disease, human immunodeficiency virus, inflammatory bowel disease, short bowel syndrome, and muscular dystrophies. Important contributory factors to growth failure include increased energy needs, increased energy loss, malabsorption, decreased energy intake, anorexia, pain, vomiting, intestinal obstruction, and inflammatory cytokines. Various metabolic and pathologic abnormalities that are characteristic of chronic diseases further lead to significant malnutrition and growth failure. In addition to treating disease-specific abnormalities, treatment should address the energy and protein deficits, including vitamin and mineral supplements to correct deficiencies, correct metabolic and endocrinologic abnormalities, and include long-term monitoring of weight and growth. Individualized, age-appropriate nutrition intervention will minimize the malnutrition and growth failure seen in children with chronic diseases.
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Affiliation(s)
- Ursula G Kyle
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Lara S Shekerdemian
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Jorge A Coss-Bu
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
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Badhiwala J, Decker WK, Berens ME, Bhardwaj RD. Clinical trials in cellular immunotherapy for brain/CNS tumors. Expert Rev Neurother 2013; 13:405-24. [PMID: 23545055 DOI: 10.1586/ern.13.23] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
High-grade gliomas are the most common type of primary malignant brain/CNS tumor. There have been only modest advances in surgical techniques, radiotherapy and chemotherapy for high-grade gliomas over the past several decades. None of these have provided a major improvement in survival for patients. Recently, immunotherapy has been explored for the treatment of high-grade gliomas. Immunotherapy capitalizes on the specificity of the host immune system to selectively target tumor cells for destruction, while sparing normal brain parenchyma, thus making it a particularly attractive option. This article provides a comprehensive review of published clinical trials evaluating cellular immunotherapy in primary brain/CNS tumors.
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Affiliation(s)
- Jetan Badhiwala
- Michael G DeGroote School of Medicine, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4K1, Canada
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Tumor histology and location predict deep nuclei toxicity: Implications for late effects from focal brain irradiation. Med Dosim 2012; 37:276-9. [DOI: 10.1016/j.meddos.2011.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 10/10/2011] [Accepted: 10/10/2011] [Indexed: 11/23/2022]
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Patterson BC, Wasilewski-Masker K, Ryerson AB, Mertens A, Meacham L. Endocrine health problems detected in 519 patients evaluated in a pediatric cancer survivor program. J Clin Endocrinol Metab 2012; 97:810-8. [PMID: 22188743 DOI: 10.1210/jc.2011-2104] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Many pediatric cancer survivors have endocrine conditions. Surveillance for late effects is recommended by national guidelines. Endocrine surveillance is recommended after alkylating agents, steroids, methotrexate, and radiation. OBJECTIVE The objective of the study was to describe the endocrine outcomes in patients followed up in a program that uses national screening guidelines. DESIGN The design of the study was a medical records review. SETTING The study was conducted in the Comprehensive Cancer Survivor Program, an academic pediatric oncology program. PARTICIPANTS The study included 519 pediatric and young adult survivors of noncentral nervous system childhood malignancies between January 1, 2001, and December 15, 2005. INTERVENTION Patients were evaluated with history, physical examinations, and evaluations recommended in the Children's Oncology Group's Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancers. OUTCOME MEASURES The frequency and types of endocrine conditions were measured. RESULTS Four hundred eighty endocrine conditions were observed in 299 survivors (57.6% of survivors). The most common types of endocrine conditions were problems with weight and gonadal function. In a Cox regression model, stem cell transplant, radiation, and older age at cancer diagnosis were associated with higher hazard of an endocrine condition. Radiation, stem cell transplant, and sarcoma diagnosis were associated with growth problems. CONCLUSIONS Endocrine disorders were common after pediatric cancers. Endocrinologists should be aware of national guidelines, anticipate referral of pediatric cancer survivors, and participate in further research to optimize screening for and treatment of endocrine effects of cancer therapy.
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Affiliation(s)
- Briana C Patterson
- Emory University School of Medicine, Department of Pediatrics, M.S., Emory Children's Center, 2015 Uppergate Drive, Suite 232 NE, Atlanta, Georgia 30322, USA.
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Merchant TE, Rose SR, Bosley C, Wu S, Xiong X, Lustig RH. Growth hormone secretion after conformal radiation therapy in pediatric patients with localized brain tumors. J Clin Oncol 2011; 29:4776-80. [PMID: 22042949 DOI: 10.1200/jco.2011.37.9453] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Growth hormone deficiency (GHD) after radiation therapy negatively affects growth and development and quality of life in children with brain tumors. PATIENTS AND MATERIALS Between 1997 and 2008, 192 pediatric patients with localized primary brain tumors (ependymoma, n = 88; low-grade glioma, n = 51; craniopharyngioma, n = 28; high-grade glioma, n = 23; and other tumor types, n = 2) underwent provocative testing of GH secretion by using the secretogogues arginine and L-dopa before and after (6, 12, 36, and 60 months) conformal radiation therapy (CRT). A total of 664 arginine/l-dopa test procedures were performed. RESULTS Baseline testing revealed preirradiation GHD in 22.9% of tested patients. On the basis of data from 118 patients, peak GH was modeled as an exponential function of time after CRT and mean radiation dose to the hypothalamus. The average patient was predicted to develop GHD with the following combinations of the time after CRT and mean dose to the hypothalamus: 12 months and more than 60 Gy; 36 months and 25 to 30 Gy; and 60 months and 15 to 20 Gy. A cumulative dose of 16.1 Gy to the hypothalamus would be considered the mean radiation dose required to achieve a 50% risk of GHD at 5 years (TD(50/5)). CONCLUSION GH secretion after CRT can be predicted on the basis of dose and time after irradiation in pediatric patients with localized brain tumors. These findings provide an objective radiation dose constraint for the hypothalamus.
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Madaschi S, Sara M, Fiorino C, Claudio F, Losa M, Marco L, Lanzi R, Roberto L, Mazza E, Elena M, Motta M, Micaela M, Perna L, Lucia P, Brioschi E, Elena B, Scavini M, Marina S, Reni M, Michele R. Time course of hypothalamic-pituitary deficiency in adults receiving cranial radiotherapy for primary extrasellar brain tumors. Radiother Oncol 2011; 99:23-8. [PMID: 21458091 DOI: 10.1016/j.radonc.2011.02.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Revised: 02/17/2011] [Accepted: 02/27/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND No longitudinal data on hypothalamic-pituitary (HP) function are available in patients who had received cranial radiation therapy (CRT) for primary extrasellar brain tumors (PBT). PURPOSE To investigate the effects of CRT on HP function in adults with PBT. PATIENTS AND METHODS Twenty-six adults irradiated for PBT and six CRT naive controls were studied. CRT was delivered with 6 MV X-ray by a linear accelerator (2 Gy fraction schedule). Gross Tumor Volume (GTV) excluded the HP region that was contoured on the planning CT. Median dose to the HP region was 41.8 Gy (IQR: 30.7-49.8). RESULTS All controls maintained normal HP function. Hypopituitarism developed in 38% of CRT patients (GH deficiency 29%, ACTH 22%, TSH 14%, gonadotropin 4%, no abnormal prolactin level or diabetes insipidus). All HP failures occurred within 32 months after CRT. CONCLUSIONS Adults undergoing CRT for PBT are at increased risk for HP dysfunction within 3 years from CRT. Endocrine surveillance is recommended also in adults patients exposed to CRT for primary brain tumors distant from HP region.
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Affiliation(s)
- Sara Madaschi
- Endocrinology Unit, Department of Internal Medicine, San Raffaele Scientific Institute, Milan, Italy
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