Long-term effects of cranial irradiation on endocrine function in children with brain tumors a prospective study

Abstract

This study prospectively evaluated the endocrine function of 11 children treated with cranial irradiation (CRT) for brain tumors. All tumors were remote from the hypothalamic-pituitary axis. Children were studied before treatment and at 3, 6, and 12 months after the completion of CRT. T4, thyroid-stimulating hormone, prolactin, plasma cortisol, and urinary follicle-stimulating hormone and luteinizing hormone values were normal before and after treatment in all patients. Growth hormone (GH) deficiency was identified in 0 of 7 patients before treatment, in 2 of 7 patients 3 months post-CRT, in 9 of 11 patients 6 months post-CRT, and in 7 of 8 patients 12 months post-CRT. Growth deceleration was identified in five of seven prepubertal patients. GH deficiency is an extremely common sequelae of CRT, beginning as early as 3 months after the completion of CRT. The deficit is progressive over time.

Irradiation-induced progenitor cell death in the developing brain is resistant to erythropoietin treatment and caspase inhibition

“…[8][9][10][11] In addition to these neuropsychological complications, short stature resulting from growth hormone secretory or regulatory dysfunction has also been reported in the majority of brain tumor patients who received RT. 4,[12][13][14] If the severe aftereffects of the anticancer therapy can be reduced, the overall quality of life would be greatly improved for the increasing number of children who survive their cancer.…”

Endocrine Complications Following Radiotherapy and Chemotherapy for Nasopharyngeal Carcinoma

“…This has been shown in animal models (Hochberg et al, 1983;Robinson et al, 2001) and reflected in clinical observations in irradiated patients. Epidemiological studies reveal that the growth hormone (GH) axis is the most radiosensitive followed by the gonadotrophin (FSH & LH), adrenocorticotrophic hormone (ACTH) and thyroid stimulating hormone (TSH) axes (Clayton & Shalet, 1991;Constine et al, 1993;Duffner et al, 1985;Lam et al, 1991;Littley et al, 1989a) (Figures 1& 2).…”

“…Low radiation doses of less than 40 Gy mostly affects the most vulnerable GH axis in isolation resulting in variable degrees of GH deficiency (Clayton & Shalet, 1991;Constine et al, 1993;Duffner et al, 1985;Littley et al, 1989a). Deficiencies of other anterior pituitary hormones start to occur when the total radiation dose delivered to the h-p axis exceeds 40 Gy, but much less frequently than GH deficiency.…”

Safety of liposomal cytarabine CNS prophylaxis in children, adolescent and young adult hematopoietic stem cell transplant recipients with acute leukemia and non-Hodgkin lymphoma

“…Cranial irradiation and chemotherapy have been shown to have significant long-term deleterious effects on children such as intellectual deterioration, multiple endocrinopathies, leukoencephalopathy and secondary oncogenesis. [13][14][15] In conclusion, these preliminary results suggest that prophylactic IT or intraommaya liposomal cytarabine is safe, tolerable and effective in pediatric autologous and allogeneic HSCT recipients with hematological malignancy at risk for CNS relapse. Larger phase II/III randomized studies with longer follow-up are needed in the future to compare this to other CNS prophylaxis regimens utilized in pediatric HSCT recipients.…”