OBJECTIVE: Systematic collections of neuroimaging data are nonexistent in brain tumour survivors treated with adult growth hormone replacement therapy (AGHRT). We present our surveillance data. DESIGN: In 1993, our unit implemented a policy of performing brain scans on every brain tumour survivor before starting AGHRT, with repeat neuroimaging at least once after 12-18 months' treatment. Reports for baseline scans and most recent scans were analysed for this retrospective study. PATIENTS: All brain tumour survivors who received AGHRT (60 patients) were included in the analysis. MEASUREMENTS: Evidence and extent of residual tumour, tumour progression, tumour recurrence, and secondary neoplasms (SN) on baseline scan and latest follow-up scan. RESULTS: All patients had baseline scans performed. Follow-up scans were available in 41/45 (91%) patients who received AGHRT for more than 1 year (mean duration +/- SD of GHRT was 6.7 +/- 3.6 years). Sixteen patients had residual tumours, and SNs (all meningiomas) were demonstrated in three patients on baseline scans. Appearances remained stable in 34 (83%) patients during follow-up (extending to 17.4 +/- 8.3 years after tumour diagnosis). Of the 16 residual primary tumours, an incurable ependymoma continued to grow, and one meningioma progressed slightly in size over 7.7 years. Follow-up scans also revealed continued growth of the SNs detected at baseline, and five additional meningiomas (two in patients with a previous SN, confirming an excess risk in this subgroup, P = 0.02). All SNs occurred on average 22.8 (range 17-37) years after radiotherapy. CONCLUSIONS: Our data do not suggest an increased rate of recurrence or progression of childhood brain tumours during AGHRT. Nonetheless, vigilance and long-term surveillance are needed in these patients in order to detect and monitor SNs, in particular in patients with a previous history of a SN. We endorse a proactive neuroimaging policy, preferably as part of a larger, controlled trial in the future.
OBJECTIVE: Systematic collections of neuroimaging data are nonexistent in brain tumour survivors treated with adult growth hormone replacement therapy (AGHRT). We present our surveillance data. DESIGN: In 1993, our unit implemented a policy of performing brain scans on every brain tumour survivor before starting AGHRT, with repeat neuroimaging at least once after 12-18 months' treatment. Reports for baseline scans and most recent scans were analysed for this retrospective study. PATIENTS: All brain tumour survivors who received AGHRT (60 patients) were included in the analysis. MEASUREMENTS: Evidence and extent of residual tumour, tumour progression, tumour recurrence, and secondary neoplasms (SN) on baseline scan and latest follow-up scan. RESULTS: All patients had baseline scans performed. Follow-up scans were available in 41/45 (91%) patients who received AGHRT for more than 1 year (mean duration +/- SD of GHRT was 6.7 +/- 3.6 years). Sixteen patients had residual tumours, and SNs (all meningiomas) were demonstrated in three patients on baseline scans. Appearances remained stable in 34 (83%) patients during follow-up (extending to 17.4 +/- 8.3 years after tumour diagnosis). Of the 16 residual primary tumours, an incurable ependymoma continued to grow, and one meningioma progressed slightly in size over 7.7 years. Follow-up scans also revealed continued growth of the SNs detected at baseline, and five additional meningiomas (two in patients with a previous SN, confirming an excess risk in this subgroup, P = 0.02). All SNs occurred on average 22.8 (range 17-37) years after radiotherapy. CONCLUSIONS: Our data do not suggest an increased rate of recurrence or progression of childhood brain tumours during AGHRT. Nonetheless, vigilance and long-term surveillance are needed in these patients in order to detect and monitor SNs, in particular in patients with a previous history of a SN. We endorse a proactive neuroimaging policy, preferably as part of a larger, controlled trial in the future.
Authors: Sripriya Raman; Adda Grimberg; Steven G Waguespack; Bradley S Miller; Charles A Sklar; Lillian R Meacham; Briana C Patterson Journal: J Clin Endocrinol Metab Date: 2015-04-03 Impact factor: 5.958
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Authors: Briana C Patterson; Yan Chen; Charles A Sklar; Joseph Neglia; Yutaka Yasui; Ann Mertens; Gregory T Armstrong; Anna Meadows; Marilyn Stovall; Leslie L Robison; Lillian R Meacham Journal: J Clin Endocrinol Metab Date: 2014-02-25 Impact factor: 5.958
Authors: Sina Jasim; Fares Alahdab; Ahmed T Ahmed; Shrikant U Tamhane; Anu Sharma; Diane Donegan; Todd B Nippoldt; M Hassan Murad Journal: Endocrine Date: 2016-11-04 Impact factor: 3.633
Authors: Christopher J Child; Alan G Zimmermann; Whitney W Woodmansee; Daniel M Green; Jian J Li; Heike Jung; Eva Marie Erfurth; Leslie L Robison Journal: Eur J Endocrinol Date: 2011-06-06 Impact factor: 6.664
Authors: Mark L Hartman; Rong Xu; Brenda J Crowe; Leslie L Robison; Eva Marie Erfurth; David L Kleinberg; Alan G Zimmermann; Whitney W Woodmansee; Gordon B Cutler; John J Chipman; Shlomo Melmed Journal: J Clin Endocrinol Metab Date: 2013-01-23 Impact factor: 5.958