Endocrine Deficiency As a Function of Radiation Dose to the Hypothalamus and Pituitary in Pediatric and Young Adult Patients With Brain Tumors
Autor: | Arnold C. Paulino, Elizabeth A. Weyman, Ralph E. Vatner, Andrzej Niemierko, David H. Ebb, Mary S. Huang, Torunn I. Yock, Shannon M. MacDonald, Claire P. Goebel, Robin M. Jones, David R. Grosshans, Nancy J. Tarbell, Takara L. Stanley, Madhusmita Misra, Anita Mahajan |
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Rok vydání: | 2018 |
Předmět: |
Male
0301 basic medicine Oncology Cancer Research medicine.medical_specialty Adolescent medicine.medical_treatment Hypothalamus MEDLINE Endocrine System Diseases Young Adult 03 medical and health sciences Clinical Trials Phase II as Topic 0302 clinical medicine Text mining Internal medicine Proton Therapy medicine Humans Endocrine system Young adult Child Radiation Injuries Brain Neoplasms business.industry Radiation dose Radiation therapy Clinical trial 030104 developmental biology Child Preschool Pituitary Gland 030220 oncology & carcinogenesis Female Cranial Irradiation business |
Zdroj: | Journal of Clinical Oncology. 36:2854-2862 |
ISSN: | 1527-7755 0732-183X |
DOI: | 10.1200/jco.2018.78.1492 |
Popis: | Purpose There are sparse data defining the dose response of radiation therapy (RT) to the hypothalamus and pituitary in pediatric and young adult patients with brain tumors. We examined the correlation between RT dose to these structures and development of endocrine dysfunction in this population. Materials and Methods Dosimetric and clinical data were collected from children and young adults (< 26 years of age) with brain tumors treated with proton RT on three prospective studies (2003 to 2016). Deficiencies of growth hormone (GH), thyroid hormone, adrenocorticotropic hormone, and gonadotropins were determined clinically and serologically. Incidence of deficiency was estimated using the Kaplan-Meier method. Multivariate models were constructed accounting for radiation dose and age. Results Of 222 patients in the study, 189 were evaluable by actuarial analysis, with a median follow-up of 4.4 years (range, 0.1 to 13.3 years), with 31 patients (14%) excluded from actuarial analysis for having baseline hormone deficiency and two patients (0.9%) because of lack of follow-up. One hundred thirty patients (68.8%) with medulloblastoma were treated with craniospinal irradiation (CSI) and boost; most of the remaining patients (n = 56) received involved field RT, most commonly for ependymoma (13.8%; n = 26) and low-grade glioma (7.4%; n = 14). The 4-year actuarial rate of any hormone deficiency, growth hormone, thyroid hormone, adrenocorticotropic hormone, and gonadotropin deficiencies were 48.8%, 37.4%, 20.5%, 6.9%, and 4.1%, respectively. Age at start of RT, time interval since treatment, and median dose to the combined hypothalamus and pituitary were correlated with increased incidence of deficiency. Conclusion Median hypothalamic and pituitary radiation dose, younger age, and longer follow-up time were associated with increased rates of endocrinopathy in children and young adults treated with radiotherapy for brain tumors. |
Databáze: | OpenAIRE |
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