Growth Hormone Replacement Therapy in Children With Medulloblastoma: Use and Effect on Tumor Control

Packer, Roger J.; Boyett, James M.; Janss, Anna J.; Stavrou, Theodora; Kun, Larry E.; Wisoff, Jeffrey H.; Russo, Carolyn; Geyer, Russell; Phillips, Peter C.B.; Kieran, Mark W.; Greenberg, Mark; Goldman, Stewart; Hyder, Douglas J.; Heideman, Richard L.; Jones-Wallace, Dana; August, Gilbert P.; Smith, Sharon H.; Moshang, Thomas

doi:10.1200/jco.2001.19.2.480

Cited by 103 publications

(60 citation statements)

References 17 publications

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“…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].…”

Section: Resultsmentioning

confidence: 99%

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

Shen

Sun

et al. 2015

Neurol Sci

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Growth hormone deficiency is common in intracranial tumors, which is usually treated with surgery and radiotherapy. A number of previous studies have investigated the relationship between the growth hormone replacement therapy (GHRT) and risk of tumor recurrence/ progression; however, the evidence remains controversial. We conducted a meta-analysis of published studies to estimate the potential relation between GHRT and intracranial tumors recurrence/progression. Three comprehensive databases, PUBMED, EMBASE, and Cochrane Library, were researched with no limitations, covering all published studies till the end of July, 2014. Reference lists from identified studies were also screened for additional database. The summary relative risks (RR) and 95 % confidence intervals (CI) were calculated by fixed-effects models for estimation. Fifteen eligible studies, involving more than 2232 cases and 3606 controls, were included in our meta-analysis. The results indicated that intracranial tumors recurrence/progression was not associated with GHRT (RR 0.48, 95 % CI 0.39-0.56), and for children, the pooled RR was 0.44 and 95 % CI was 0.34-0.54. In subgroup analysis, risks of recurrence/progression were decreased for craniopharyngioma, medulloblastoma, astrocytoma, glioma, but not for pituitary adenomas, and non-functioning pituitary adenoma (NFPA), ependymoma.Results from our analysis indicate that GHRT decreases the risk of recurrence/progression in children with intracranial tumors, craniopharyngioma, medulloblastoma, astrocytoma, or glioma. However, GHRT for pituitary adenomas, NFPA, and ependymoma was not associated with the recurrence/progression of the tumors. GH replacement seems safe from the aspect of risk of tumor progression.

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Section: Resultsmentioning

confidence: 99%

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

Shen

Sun

et al. 2015

Neurol Sci

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“…12 However, the results of most studies suggest that GHT is not associated with an increased likelihood of disease relapse. 13 There is no report of OS developing following GHT, 14 however, two-thirds and one-half of Harper et al's 6 and our patients respectively received GHT when OS was identified. Nevertheless, this did not reach statistical significance.…”

Section: Discussionmentioning

confidence: 98%

Osteochondroma after pediatric hematopoietic stem cell transplantation: report of eight cases

Bordigoni

Clément

et al. 2002

Bone Marrow Transplant

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Summary:Eight children developed osteochondroma (OS) at a mean of 88 months after hematopoietic stem cell transplantation (HSCT). The mean age at HSCT was 56 months (12-84). This represents a cumulative incidence of 20% among patients less than 18 years of age transplanted from 1981 to 1997. These eight patients underwent allogeneic (n = 2) or autologous (n = 6) transplantation for either acute leukemia (n = 6) or neuroblastoma (n = 2) after a conditioning regimen including TBI (n = 7) or a combination of Bu and CY. OS was multiple in seven patients and solitary in one. Eight lesions were resected and all were benign. Four children received growth hormone before diagnosis of OS, but there was no clinical, radiological or histological difference between those who did not. Univariate analysis showed an increased rate associated only with autologous HSCT, with a 31.7% probability of a new OS at 12 years after HSCT. Osteochondroma should be added to the other adverse effects of HSCT in children.

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“…Há controvérsias na literatura quanto à indicação da reposição de GH em pacientes que desenvolveram déficit deste hormônio após radiação do crânio para tratamento oncológico na infâncial 11,12 . O GH possui ação mitogênica, podendo estimular células neoplá-sicas residuais e promover a recorrência do tumor 11 .…”

Section: Discussionunclassified

“…Os questionamentos quanto aos efeitos do tratamento com GH no controle do tumor a longo prazo foram contestados recentemente por Packer et al 12 em análise retrospectiva de 545 crianças tratadas com GH após radioterapia por meduloblastoma. Estes autores verificaram que o tratamento com GH não teve efeito sobre a evolução do tumor e ponderaram que a reposição do GH tem sido pouco utilizada e indicada relativamente tarde na evolução do déficit deste hormônio 12 .…”

Section: Discussionunclassified

“…Estes autores verificaram que o tratamento com GH não teve efeito sobre a evolução do tumor e ponderaram que a reposição do GH tem sido pouco utilizada e indicada relativamente tarde na evolução do déficit deste hormônio 12 . No presente caso, apesar da indicação do tratamento com GH ter sido relativamente tardia, o paciente vem apresentando incremento na estatura.…”

Section: Discussionunclassified

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Deficiência de hormônio do crescimento após radioterapia por meduloblastoma na infância: relato de caso

Goldberg

Rodrigues

Takata

et al. 2003

Arq. Neuro-Psiquiatr.

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A radiação do crânio para tratamento das neoplasias do sistema nervoso central na infância pode evoluir com sequelas neuroendócrinas, sendo a deficiência de hormônio do crescimento (GH) com retardo do crescimento linear, uma das mais frequentes. Relatamos o caso de menino de 10 anos com cefaléia occipital associada a vertigem, náuseas e vômitos. A tomografia do crânio demonstrou processo expansivo no hemisfério cerebelar esquerdo, que foi retirado cirurgicamente. O exame histopatológico revelou meduloblastoma e o paciente foi submetido a radioterapia crânio-espinhal. Evoluiu sem recidiva da neoplasia e sem déficits neurológicos durante 4 anos. Apresentou retardo do crescimento estatural, sendo confirmada a hipótese de deficiência de GH. Atualmente, encontra-se em uso de GH 0,1 U/kg/dia, tendo apresentado incremento de 4cm na estatura em 6 meses. O presente caso destaca a importância do acompanhamento criterioso de pacientes submetidos à radiação do crânio para tratamento oncológico na infância, visto que podem evoluir com deficiências neuroendócrinas e serem beneficiados com reposição hormonal.

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Growth Hormone Replacement Therapy in Children With Medulloblastoma: Use and Effect on Tumor Control

Abstract: This large retrospective review demonstrates that GHRT is underutilized in survivors of medulloblastoma and is used relatively late in the course of the illness. GHRT is not associated with an increased likelihood of disease relapse.

Cited by 103 publications

References 17 publications

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

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

Osteochondroma after pediatric hematopoietic stem cell transplantation: report of eight cases

Deficiência de hormônio do crescimento após radioterapia por meduloblastoma na infância: relato de caso

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