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Differential effects of radiotherapy on growth and endocrine function among acute leukemia survivors: A childhood cancer survivor study report
Author(s) -
Chow Eric J.,
Liu Wei,
Srivastava Kumar,
Leisenring Wendy M.,
Hayashi Robert J.,
Sklar Charles A.,
Stovall Marilyn,
Robison Leslie L.,
Baker K. Scott
Publication year - 2013
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.24198
Subject(s) - medicine , underweight , radiation therapy , short stature , pediatrics , total body irradiation , pregnancy , overweight , myeloid leukemia , body mass index , cyclophosphamide , chemotherapy , biology , genetics
Background The differential effects of cranial radiotherapy (CRT), spinal radiotherapy (SRT), and total body irradiation (TBI) on growth and endocrine outcomes have rarely been examined in combination among childhood acute leukemia survivors. Procedure Self‐reported height/weight, hypothyroidism, and pregnancy/live birth were determined among acute lymphoblastic and myeloid leukemia survivors (n = 3,467) participating in the Childhood Cancer Survivor Study, an ongoing cohort study of 5‐year survivors of pediatric cancers diagnosed from 1970 to 1986. Results Compared with no radiotherapy, risk estimates were consistent across outcomes (adult short stature, hypothyroidism, absence of pregnancy/live birth) with CRT treatment associated with 2–3‐fold increased risks, TBI associated with 5–10 fold increased risks, and CRT + TBI associated with >10 fold increased risks. Exposure to any SRT further increased risk of these outcomes 2–3‐fold. Changes in body composition were more nuanced as CRT only was associated with an increased risk of being overweight/obese (OR 1.6, 95% CI 1.3–1.9) whereas TBI only was associated with an increased risk of being underweight (OR 6.0, 95% CI 2.4–14.9). Conclusions Although patients treated with CRT + TBI were at greatest risk for short stature, hypothyroidism, and a reduced likelihood of pregnancy/live birth, those treated with either modality alone had significantly increased risks as well, including altered body composition. Any SRT exposure further increased risk in an independent fashion. Pediatr Blood Cancer 2013; 60: 110–115. © 2012 Wiley Periodicals, Inc.