GH replacement does not increase the risk of recurrence in patients with craniopharyngioma

Abstract

Forty-one subjects received GH replacement. Nine of them did not have follow-up imaging during GH therapy and were not included in the statistical analyses. The remaining 32 (22 males/10 females) received GH for a mean period of 6.3 +/- 4.6 years (median 5.1, range 0.8-22); 21 started during childhood (13 of them continued after the achievement of final height with an adult dose) and 11 during adult life. The mean duration of their follow-up (from surgery until last assessment) was 10.8 +/- 9.2 years (range 1.9-40). Fifty-three subjects had not received GH therapy (30 men/23 women). The mean duration of their follow-up (from surgery until last assessment) was 8.3 +/- 8.8 years (range 0.5-36). During the observation period, 4 patients treated with GH and 22 non-GH treated ones developed tumour recurrence. After adjusting for sex, age at tumour diagnosis and type of tumour therapy (gross total removal, partial removal, surgery + irradiation), GH treatment was not a significant independent predictor of recurrence (P = 0.06; hazard ratio = 0.309). Similar results were obtained when the impact of GH replacement was assessed according to its duration (P = 0.18; hazard ratio = 0.991/month of treatment). None of the nine patients with insufficient imaging data for inclusion in the statistical analyses [5 men/4 women, 3 treated with GH during childhood/6 during adult life, mean duration of GH therapy 2.9 +/- 2.4 years (median 1.8, range 0.4-7)] showed clinical features suggestive of recurrence during the period of GH replacement. CONCLUSION Based on the data of the craniopharyngiomas database in Oxford, there is no evidence that GH replacement is associated with an increased risk of tumour recurrence.

Incidence of primary cancers and intracranial tumour recurrences in GH-treated and untreated adult hypopituitary patients: analyses from the Hypopituitary Control and Complications Study

“…The majority of studies in survivors of previous neoplasia, particularly brain tumours, have not indicated an association between GH treatment and increased tumour recurrence or occurrence of second neoplasms (26,27,28,29,30,31). Two analyses from the Childhood Cancer Survivor Study (CCSS) indicated that GH treatment is associated with an increase in the relative risk (RR) of second neoplasms in childhood cancer survivors (32,33); these findings are supported by earlier analyses from HypoCCS (34).…”

Growth hormone therapy and risk of recurrence/progression in intracranial tumors: a meta-analysis

“…Additional characteristics of the included studies are shown in Table 1. As shown in table, seven of the selected studies obtained seven or more scores, which indicated that the study quality was relatively higher [5][6][7][14][15][16][17][18][19][20][21][22]; whereas, other studies with relatively lesser scores were considered of lower quality [23][24][25].…”

“…A total of four studies [7,21,22,26] in our meta-analysis estimated the risk of craniopharyngioma. Figure 4 shows the forest plots for craniopharyngioma recurrence/progression in individuals with and without GHRT.…”

Safety aspects of GH replacement

“…In a study reporting the results of prospective imaging in 28 consecutive patients with craniopharyngioma and adult-onset GHD, an apparent increase in tumour volume was found in one subject 6 years after the commencement of GH (76). In another study, 32 patients with a mean age of 17.6 years at diagnosis of craniopharyngioma and with GH replacement for a mean period of 6.3 years were compared with 53 patients who had not received GH but otherwise with a similar tumour and treatment characteristics and follow-up period (77). During the period of observation, 4 patients treated with GH and 22 not receiving GH developed tumour recurrence (77).…”

“…In another study, 32 patients with a mean age of 17.6 years at diagnosis of craniopharyngioma and with GH replacement for a mean period of 6.3 years were compared with 53 patients who had not received GH but otherwise with a similar tumour and treatment characteristics and follow-up period (77). During the period of observation, 4 patients treated with GH and 22 not receiving GH developed tumour recurrence (77). Thus, in conclusion, data published so far are reassuring and there is, to date, no evidence that GH replacement increases the recurrence rate of craniopharyngiomas in children or adults.…”