Clinical impact of hypothalamic-pituitary disorders after conformal radiation therapy for pediatric low-grade glioma or ependymoma.

Abstract

BACKGROUND:

To determine the impact of hypothalamic-pituitary (HP) disorders on health outcomes in children and adolescents who received conformal radiation therapy (RT) for central nervous system tumors.

PROCEDURE:

Cohort study including 355 patients (age ≤25 years at diagnosis) treated with high-dose (50.4-59.4 Gy) RT using photons for low-grade glioma or ependymoma. Patients (median age, 6.4 years at RT) received systematic endocrine follow-up (median duration, 10.1 years; range, 0.1-19.6). Associations between HP disorders and adverse health outcomes were determined by multivariable analysis.

RESULTS:

Prevalence was 37.2% for growth hormone deficiency (GHD), 17.7% for gonadotropin deficiency (LH/FSHD), 14.9% for thyroid-stimulating hormone deficiency (TSHD), 10.3% for adrenocorticotropic hormone deficiency (ACTHD), and 12.6% for central precocious puberty (CPP). Hypothalamus mean dose ≥ 36 Gy was associated with higher odds of any deficiency. GHD was associated with short stature (OR 2.77; 95% CI 1.34-5.70), low bone mineral density (OR 3.47; 95% CI 1.16-10.40), and TSHD with dyslipidemia (OR 5.54; 95% CI 1.66-18.52). Patients with ACTHD and CPP had lower intelligence quotient scores, and memory scores were impaired in patients with GHD (P = 0.02). Treatment of GHD was not associated with increased risk for tumor recurrence, secondary tumors, or mortality.

CONCLUSIONS:

HP disorders occur frequently in patients receiving high-dose RT and are related to physical and neurocognitive well-being. Future studies are needed to assess whether further optimization of endocrine management yields better health outcomes.

• Authors: Laura van Iersel, Hanneke M van Santen, Brian Potter, Zhenghong Li, Heather M Conklin, Hui Zhang, Wassim Chemaitilly, Thomas E Merchant
• Journal: Pediatric blood & cancer (Pediatr Blood Cancer) Vol. 67 Issue 12 Pg. e28723 (12 2020) ISSN: 1545-5017 [Electronic] United States
• PMID: 33037871 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2020 Wiley Periodicals LLC.

Chemical References

• Human Growth Hormone

Topics

• Adolescent
• Adult
• Child
• Child, Preschool
• Ependymoma (pathology, radiotherapy)
• Female
• Follow-Up Studies
• Glioma (pathology, radiotherapy)
• Growth Disorders (drug therapy, etiology, pathology)
• Human Growth Hormone (therapeutic use)
• Humans
• Hypothalamic Diseases (drug therapy, etiology, pathology)
• Infant
• Male
• Pituitary Diseases (drug therapy, etiology, pathology)
• Prognosis
• Radiotherapy, Conformal (adverse effects)
• Retrospective Studies
• Young Adult