Pituitary Hormone Dysfunction After Proton Beam Radiation Therapy in Children with Brain Tumors |
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| Affiliation: | 1. Johns Hopkins University, Neuro-Oncology Outcomes Laboratory, 600 North Wolfe Street, Meyer 8-184, Baltimore, MD 21202, USA;2. Deapartment of Neurosurgery, Vanderbilt University, Nashville, TN, USA;3. Department of Neurosurgery, Stanford University, Stanford, CA, USA;1. Department of Radiation Oncology, University of Lübeck, Germany;2. Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Germany;3. Department of Radiotherapy, Oncology Institute Ion Ciricuta, Cluj-Napoca, Romania;4. Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia;5. Department of Radiation Oncology, University of Prague, Czech Republic;6. Department of Radiotherapy, Dr. Bernard Verbeeten Institute, Tilburg, The Netherlands;7. Department of Nuclear Medicine, Hanoi Medical University, Viet Nam;8. Center for Nuclear Medicine and Oncology, Bach Mai Hospital, Hanoi, Viet Nam;9. Department of Radiation Oncology, Mayo Clinic Scottsdale, USA;1. Department of Pediatrics, Columbia University Medical Center, New York, New York;2. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York;3. Columbia University, New York, New York;1. Department of Oncology, University of Torino, Torino, Italy;2. Hematology, Città della Salute e della Scienza, Torino, Italy;3. Hematology, Città della Salute e della Scienza and University of Torino, Torino, Italy;4. Nuclear Medicine, Città della Salute e della Scienza, Torino, Italy;6. Department of Medical Sciences, University of Torino, Torino, Italy;1. Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India;2. Department of Pathology, All India Institute of Medical Sciences, New Delhi, India |
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| Abstract: | Objectiveo characterize endocrine dysfunction in pediatric patients with brain tumors who received proton beam (PB) radiation therapy and to compare those treated with PB radiotherapy only versus combined conventional and PB irradiation.MethodsA retrospective review of medical records of patients ≤ 18 years of age who received PB radiation therapy for a brain tumor between 2000 and 2008 was performed. Variables analyzed included patient demographics, tumor type, therapeutic modalities, radiation doses, and types and timing of endocrine dysfunction.ResultsThirty-eight patients were identified, of whom 31 (19 boys and 12 girls; mean age, 11.9 ± 3.3 years) had undergone endocrine evaluation. Of these patients, 19 received PB radiotherapy only and 12 received conventional plus PB irradiation. Before irradiation, a cranial surgical procedure was performed in 28 study subjects, and 22 received chemotherapy. The mean duration of follow-up after radiation therapy was 1.8 ± 0.8 years. Nine patients (47%) in the PB only group and 4 (33%) in the conventional plus PB group developed endocrine dysfunction (no significant difference) after cranial irradiation. Children with endocrine sequelae treated with PB irradiation alone received fewer cobalt gray equivalents than those treated with conventional plus PB irradiation (5,384 ± 268 versus 5,775 ± 226, respectively; P < .02), and pituitary hormone deficiencies were detected later during follow-up in those who received PB radiotherapy only versus conventional plus PB irradiation (1.17 ± 0.4 years versus 0.33 ± 0.11 year, respectively; P < .01).ConclusionA high rate of endocrine sequelae was seen in our study. Children with brain tumors treated with conventional plus PB irradiation developed endocrine dysfunction faster and received a higher radiation dose than those receiving PB radiotherapy only. Prior surgical treatment and chemotherapy were additional risk factors. Large prospective studies are needed to evaluate further the incidence of endocrine sequelae after PB irradiation in children. (Endocr Pract. 2011;17:891-896) |
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