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Augdal T, Angenete O, Zadig P, Lundestad A, Nordal E, Shi X, Rosendahl K. The assessment of bone health in children with juvenile idiopathic arthritis; comparison of different imaging-based methods. Pediatr Rheumatol Online J 2024; 22:80. [PMID: 39210351 PMCID: PMC11363637 DOI: 10.1186/s12969-024-01018-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Osteoporosis is increasingly being recognized in children, mostly secondary to systemic underlying conditions or medication. However, no imaging modality currently provides a full evaluation of bone health in children. We compared DXA, a radiographic bone health index (BHI (BoneXpert) and cone-beam CT for the assessment of low bone mass in children with juvenile idiopathic arthritis (JIA). METHODS Data used in the present study was drawn from a large multicentre study including 228 children aged 4-16 years, examined between 2015 and 2020. All had a radiograph of the left hand, a DXA scan and a cone-beam CT of the temporomandibular joints within four weeks of each other. For the present study, we included 120 subjects, selected based on DXA BMD and BoneXpert BHI to secure values across the whole range to be tested. RESULTS One hundred and twenty children (60.0% females) were included, mean age 11.6 years (SD 3.1 years). There was a strong correlation between the absolute values of BHI and BMD for both total body less head (TBLH) (r = 0.75, p < 0.001) and lumbar spine (L1-L4) (r = 0.77, p < 0.001). The correlation between BHI standard deviation score (SDS) and BMD TBLH Z-scores was weak (r = 0.34) but significant (0 = 0.001), varying from weak (r = 0.31) to moderate (r = 0.42) between the three study sites. Categorizing BHI SDS and DXA BMD Z-scores on a 0-5 scale yielded a weak agreement between the two for both TBLH and LS, with w-kappa of 0.2, increasing to 0.3 when using quadratic weights. The agreement was notably higher for one of the three study sites as compared to the two others, particularly for spine assessment, yielding a moderate kappa value of 0.4 - 0.5. For cone-beam CT, based on a 1-3 scale, 59 out of 94 left TMJ's were scored as 1 and 31 as score 2 by the first observer vs. 87 and 7 by the second observer yielding a poor agreement (kappa 0.1). CONCLUSIONS Categorizing DXA LS and automated radiographic Z-scores on a 0-5 scale gave a weak to moderate agreement between the two methods, indicating that a hand radiograph might provide an adjuvant tool to DXA when assessing bone health children with JIA, given thorough calibration is performed.
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Affiliation(s)
- Thomas Augdal
- Section of Paediatric Radiology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Oskar Angenete
- Department of Radiology and Nuclear Medicine, St Olavs Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pia Zadig
- Section of Paediatric Radiology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | | | - Ellen Nordal
- Department of Paediatrics, and Research Group for Child and Adolescent Health, Department of Clinical Medicine, University Hospital of North Norway, UiT The Arctic University of Norway, Tromsø, Norway
| | - Xieqi Shi
- Department of Clinical Dentistry, The Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Oral and Maxillofacial Radiology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - Karen Rosendahl
- Section of Paediatric Radiology, University Hospital of North Norway, Tromsø, Norway.
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
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Cruz-Priego GA, Guagnelli MA, Miranda-Lora AL, Lopez-Gonzalez D, Clark P. Bone Age Reading by DXA Images should not Replace Bone Age Reading by X-ray Images. J Clin Densitom 2022; 25:456-463. [PMID: 36109296 DOI: 10.1016/j.jocd.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/02/2022] [Accepted: 08/14/2022] [Indexed: 10/15/2022]
Abstract
X-ray image of the hand is the most used technique to estimate bone age in children. For the analysis of bone mineral density using DXA in children, bone age may help to adjust such measurement in some cases. During image acquisition in DXA, an anteroposterior image of the hand may be acquired and used to evaluate bone age but few studies have evaluated the agreement between conventional X-ray and DXA images. The aim of the study was to determine bone age estimation agreement between conventional X-ray images and DXA in children and adolescents aged 5 to 16 years of age. We performed an analytical cross-sectional study of 711 healthy subjects. Subject´s bone age, both in conventional X-ray, and DXA images were read independently by two expert evaluators blinded for chronological age. Intraobserver and inter-observer reproducibility were evaluated using Intraclass Correlation Coefficient (ICC), and the agreement between bone age estimations made by both evaluators was analyzed using ICC and Bland-Altman analysis. General agreement between techniques measured through ICC was 0.99 with a mean difference of 6 months between techniques being older the ages obtained by DXA. The agreement limits were around ±2 years, which means that 95% of all differences between techniques were covered within this range. We found a high level of ICC agreement in bone age readings from X-ray and DXA images although we observed overestimation of bone age measurements in DXA. Differences between techniques were greater in women than in men, especially at the ages corresponding to puberty. Bone age measurement in DXA images appears not to be reliable; hence it should be suggested to perform conventional radiography of the hand to assess bone age taking into account that X-ray images have better resolution.
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Affiliation(s)
- Griselda-Adriana Cruz-Priego
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico; Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Miguel-Angel Guagnelli
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico; Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Desiree Lopez-Gonzalez
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico; Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Patricia Clark
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico; Universidad Nacional Autónoma de México, Mexico City, Mexico.
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Misakian A, McLoughlin M, Pyle LC, Kolon TF, Kelly A, Vogiatzi MG. Case Report: Low Bone and Normal Lean Mass in Adolescents With Complete Androgen Insensitivity Syndrome. Front Endocrinol (Lausanne) 2021; 12:727131. [PMID: 34526969 PMCID: PMC8435790 DOI: 10.3389/fendo.2021.727131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/22/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Osteopenia and osteoporosis have been reported in adults with Complete Androgen Insensitivity Syndrome (CAIS). Little is known about changes in bone mineral density (BMD) in adolescents with CAIS and whether it is affected by early gonadectomy. Body composition data have not been reported. METHODS Single-center, retrospective study of CAIS adolescents who underwent dual-energy x-ray absorptiometry (DXA) (Hologic, Horizon A). Body composition is presented as lean and fat mass indices (LMI, FMI). Z-scores for lumbar spine areal BMD (LBMD), total body less head (TBLH), bone mineral content (BMC), LMI, and FMI were calculated using female normative data. Results are expressed as median and min, max. RESULTS Six females with genetically confirmed CAIS were identified-one with intact gonads and five with history of gonadectomy at 2-11 months. In the subject with intact gonads, LBMD-Z and TBLH BMC-Z were -1.56 and -1.26, respectively, at age 16 years. Among those with gonadectomy, LBMD-Z was -1.8 (-3.59 to 0.49) at age 15.6 years (12-16.8) and decreased in all three subjects who had longitudinal follow-up despite hormone replacement therapy (HRT). Adherence to HRT was intermittent. LMI-Z and FMI-Z were 0.1 (-1.39 to 0.7) and 1.0 (0.22 to 1.49), respectively. CONCLUSIONS These limited data indicate that adolescents with CAIS have bone mass deficit. Further studies are needed to understand the extent of BMD abnormalities and the effect of gonadectomy, especially early in childhood, and to establish the optimal HRT regimen for bone accrual. Data on lean mass are reassuring.
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Affiliation(s)
- Aaron Misakian
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- *Correspondence: Aaron Misakian,
| | - Michelle McLoughlin
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Louisa C. Pyle
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Thomas F. Kolon
- Division of Urology, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Andrea Kelly
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Maria G. Vogiatzi
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
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Maspero M, Bentvelzen LG, Savenije MH, Guerreiro F, Seravalli E, Janssens GO, van den Berg CA, Philippens ME. Deep learning-based synthetic CT generation for paediatric brain MR-only photon and proton radiotherapy. Radiother Oncol 2020; 153:197-204. [DOI: 10.1016/j.radonc.2020.09.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
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Annexstad EJ, Bollerslev J, Westvik J, Myhre AG, Godang K, Holm I, Rasmussen M. The role of delayed bone age in the evaluation of stature and bone health in glucocorticoid treated patients with Duchenne muscular dystrophy. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2019; 2019:4. [PMID: 31889957 PMCID: PMC6927168 DOI: 10.1186/s13633-019-0070-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/23/2019] [Indexed: 12/17/2022]
Abstract
Background Low bone mineral density and an increased risk of appendicular and vertebral fractures are well-established consequences of Duchenne muscular dystrophy (DMD) and the risk of fractures is exacerbated by long-term glucocorticoid treatment. Monitoring of endocrine and skeletal health and timely intervention in at-risk patients is important in the management of children with DMD. Methods As part of the Norwegian Duchenne muscular dystrophy cohort study, we examined the skeletal maturation of 62 boys less than 18 years old, both currently glucocorticoid treated (n = 44), previously treated (n = 6) and naïve (n = 12). The relationship between bone age, height and bone mineral density (BMD) Z-scores was explored. Results The participants in the glucocorticoid treated group were short in stature and puberty was delayed. Bone age was significantly delayed, and the delay increased with age and duration of treatment. The difference in height between glucocorticoid treated and naïve boys was no longer significant when height was corrected for delayed skeletal maturation. Mean BMD Z-scores fell below − 2 before 12 years of age in the glucocorticoid treated group, with scores significantly correlated with age, duration of treatment and pubertal development. When BMD Z-scores were corrected for by retarded bone age, the increase in BMD Z-scores was significant for all age groups. Conclusion Our results suggest that skeletal maturation should be assessed in the evaluation of short stature and bone health in GC treated boys with DMD, as failing to consider delayed bone age leads to underestimation of BMD Z-scores and potentially overestimation of fracture risk.
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Affiliation(s)
- E J Annexstad
- 1Department of Neurology, Unit for Congenital and Inherited Neuromuscular Disorders, Oslo University Hospital, PoBox 4950, Nydalen, 0424 Oslo, Norway.,2Faculty of Medicine, University of Oslo, Oslo, Norway.,3Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway.,8Children's Department, Ostfold Hospital Trust, Sarpsborg, Norway
| | - J Bollerslev
- 4Department of Endocrinology, Section of Specialized Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway.,2Faculty of Medicine, University of Oslo, Oslo, Norway
| | - J Westvik
- 5Department of Radiology, Section for Paediatric Radiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - A G Myhre
- Frambu Resource Centre for Rare Disorders, Siggerud, Norway
| | - K Godang
- 4Department of Endocrinology, Section of Specialized Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - I Holm
- 2Faculty of Medicine, University of Oslo, Oslo, Norway.,7Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - M Rasmussen
- 1Department of Neurology, Unit for Congenital and Inherited Neuromuscular Disorders, Oslo University Hospital, PoBox 4950, Nydalen, 0424 Oslo, Norway.,3Department of Clinical Neurosciences for Children, Oslo University Hospital, Oslo, Norway
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Ekizoglu O, Inci E, Ors S, Kacmaz IE, Basa CD, Can IO, Kranioti EF. Applicability of T1-weighted MRI in the assessment of forensic age based on the epiphyseal closure of the humeral head. Int J Legal Med 2018; 133:241-248. [PMID: 29804276 DOI: 10.1007/s00414-018-1868-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 05/16/2018] [Indexed: 10/16/2022]
Abstract
This work investigates the value of magnetic resonance imaging analysis of proximal epiphyseal fusion in research examining the growth and development of the humerus and its potential utility in establishing forensic age estimation. In this study, 428 proximal humeral epiphyses (patient age, 12-30 years) were evaluated with T1-weighted turbo spin echo (T1 TSE) sequences in coronal oblique orientation on shoulder MRI images. A scoring system was created following a combination of the Schmeling and Kellinghaus methods. Spearman's rank correlation analysis revealed a significant positive relationship between age and ossification stage of the proximal humeral epiphysis (all subjects: rho = 0.664, p < 0.001; males: 0.631, p < 0.001; females: rho = 0.651, p < 0.001). The intra- and inter-observer reliability assessed using Cohen's kappa statistic was κ = 0.898 and κ = 0.828, respectively. The earliest age of epiphysis closure was 17 years for females and 18 years for males. MRI of the proximal humeral epiphysis can be considered advantageous for forensic age estimation of living individuals in a variety of situations, ranging from monitoring public health to estimating the age of illegal immigrants/asylum seekers, minors engaged in criminal activities, and illegal participants in competitive sports, without the danger of radiation exposure.
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Affiliation(s)
- Oguzhan Ekizoglu
- Department of Forensic Medicine, Tepecik Training and Research Hospital, Güney mahallesi 1140/1 Yenisehir-Konak, Izmir, Turkey.
| | - Ercan Inci
- Department of Radiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Suna Ors
- Department of Radiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ismail Eralp Kacmaz
- Department of Orthopaedics, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Can Doruk Basa
- Department of Orthopaedics, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ismail Ozgur Can
- Department of Forensic Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Elena F Kranioti
- Unit for Forensic Anthropology, School of History, Classics and Archaeology, University of Edinburgh, 4 Teviot Place, Edinburgh, EH8 9AG, Scotland.,Forensic Pathology Division Crete, Hellenic Republic Ministry of Justice and Human Rights, Heraklion, Crete, Greece.,Department of Medical Imaging, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece
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Remes TM, Arikoski PM, Lähteenmäki PM, Arola MO, Pokka TML, Riikonen VP, Sirkiä KH, Rantala HMJ, Harila-Saari AH, Ojaniemi MK. Bone mineral density is compromised in very long-term survivors of irradiated childhood brain tumor. Acta Oncol 2018; 57:665-674. [PMID: 29374996 DOI: 10.1080/0284186x.2018.1431401] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The increase in the number of childhood brain tumor survivors warrants detailed research to increase our knowledge regarding the possible physical and psychosocial adverse outcomes of tumor and tumor therapy. The aim of this study was to evaluate the current bone health by measuring the bone mineral density (BMD) in irradiated, adult long-term survivors of childhood brain tumors. MATERIAL AND METHODS We studied a national cohort of 74 adult survivors of childhood brain tumors treated with irradiation in Finland between 1970 and 2008. Dual X-ray absorptiometry (DXA) was performed for the femoral necks, total hips, and lumbar spine. Laboratory tests were conducted for evaluating the pituitary, thyroid, and gonadal functions. The participants were interviewed, examined clinically, and the disease and treatment related data were retrieved from the patient files. RESULTS One fourth of the patients (23.6%) had sex- and age-normalized z-scores below the expected range for age (z-score ≤ -2.0). Mean BMD scores were decreased in all the DXA measurement sites. Male sex was associated with low BMD (p < .05), while body mass index (BMI) had a significant positive association with BMD (p < .01). Mode of irradiation (with or without spinal irradiation) or inclusion of chemotherapy in the treatment did not affect BMD significantly. However, patients with a ventriculoperitoneal shunt had lower BMD than those without a shunt (p < .05). Follicle stimulating hormone (FSH) and luteinizing hormone (LH) were negatively associated with BMD in women (p < .05). However, a higher cumulative dose of glucocorticoids during treatment was not associated with lower BMD, while low BMD was significantly associated with previous fractures in long bones. DISCUSSION Low BMD should be taken in consideration in treatment of irradiated childhood brain tumor survivors especially in those with previous fractures in long bones.
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Affiliation(s)
- Tiina M. Remes
- Department of Pediatrics and Adolescence, PEDEGO Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Pekka M. Arikoski
- Department of Pediatrics and Adolescence, Kuopio University Hospital, Kuopio, Finland
| | - Päivi M. Lähteenmäki
- Department of Pediatrics and Adolescence, Turku University Hospital and Turku University, Turku, Finland
| | - Mikko O. Arola
- Department of Pediatrics and Adolescence, Tampere University Hospital, Tampere, Finland
| | - Tytti M.-L. Pokka
- Department of Pediatrics and Adolescence, PEDEGO Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - V. Pekka Riikonen
- Department of Pediatrics and Adolescence, Kuopio University Hospital, Kuopio, Finland
| | - Kirsti H. Sirkiä
- Department of Pediatrics and Adolescence, Helsinki University Hospital, Helsinki, Finland
| | - Heikki M. J. Rantala
- Department of Pediatrics and Adolescence, PEDEGO Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Arja H. Harila-Saari
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Marja K. Ojaniemi
- Department of Pediatrics and Adolescence, PEDEGO Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland
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Morgenroth VH, Hache LP, Clemens PR. Insights into bone health in Duchenne muscular dystrophy. BONEKEY REPORTS 2012; 1:9. [PMID: 23951421 DOI: 10.1038/bonekey.2012.5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 11/05/2011] [Indexed: 12/22/2022]
Abstract
Poor bone health is a significant problem for patients with Duchenne muscular dystrophy (DMD), a progressive, disabling disease. Although the primary focus of DMD disease pathogenesis is degeneration of striated muscle, impairment of bone health likely has a role in the disease that has only been superficially examined to date. Deficiency of bone mineral density and increased incidence of bone fractures are well-recognized clinical components of the DMD phenotype. Furthermore, therapy with corticosteroids, an approved treatment for DMD that prolongs ambulation, may have multiple effects on bone health in DMD patients. This review examines the evidence in preclinical models and in human DMD disease that provides insight into the role performed by bone in the disease pathogenesis and phenotype of DMD. The information reviewed here points toward the need for mechanistic and therapeutic studies to optimize bone health in DMD patients.
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Armstrong GT, Conklin HM, Huang S, Srivastava D, Sanford R, Ellison DW, Merchant TE, Hudson MM, Hoehn ME, Robison LL, Gajjar A, Morris EB. Survival and long-term health and cognitive outcomes after low-grade glioma. Neuro Oncol 2011; 13:223-34. [PMID: 21177781 PMCID: PMC3064628 DOI: 10.1093/neuonc/noq178] [Citation(s) in RCA: 154] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 10/23/2010] [Indexed: 11/13/2022] Open
Abstract
Long-term morbidity for children with low-grade glioma (LGG) requires exposure-specific characterization. Overall survival (OS) and progression-free survival (PFS) were estimated for 361 children diagnosed with LGG between 1985 and 2007 at a single institution. Five-year survivors (n = 240) received risk-based clinical assessment. Cumulative incidence of late effects 15 years from diagnosis were estimated. Risk factors for adverse health were identified using Fine and Gray's approach to Cox's proportional hazards model, accounting for death as a competing risk. OS at 15 years was 86% (95% confidence interval [CI] 82%-90%), and PFS was 55% (95% CI 51%-58%). Among the 240 5-year survivors, the 5-, 10-, and 15-year cumulative incidence of adverse outcomes included blindness: 10%, 13%, and 18%, respectively; hearing loss: 8%, 14%, and 22%; obesity/overweight: 18%, 35%, and 53%; hyperinsulinism: 1%, 5%, and 24%; growth hormone deficiency: 13%, 27%, and 29%;thyroid hormone deficiency: 16%, 28%, and 33%; and adrenocorticotropic hormone (ACTH) deficiency: 12%, 22%, and 26%. Multivariable models demonstrated radiation therapy to be a significant independent predictor of hearing loss, growth hormone deficiency, abnormal thyroid function, and ACTH deficiency. Diencephalic location was a statistically significant independent risk factor for blindness, growth hormone deficiency, abnormal thyroid function, and ACTH deficiency. Among the 182 5-year survivors assessed for intellectual function, 34% had an intelligence quotient (IQ) below average (<85), associated with younger age at diagnosis, epilepsy, and shunt placement. Survivors of childhood LGG experience substantial long-term adverse effects that continue to increase well beyond the 5-year survival time point.
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Affiliation(s)
- Gregory T Armstrong
- Department of Epidemiology & Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 735, Memphis, TN 38105, USA.
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