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Clinical impact of hypothalamic‐pituitary disorders after conformal radiation therapy for pediatric low‐grade glioma or ependymoma
Author(s) -
Iersel Laura,
Santen Hanneke M.,
Potter Brian,
Li Zhenghong,
Conklin Heather M.,
Zhang Hui,
Chemaitilly Wassim,
Merchant Thomas E.
Publication year - 2020
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.28723
Subject(s) - medicine , short stature , growth hormone deficiency , pediatrics , gastroenterology , oncology , hormone , growth hormone
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.