PURPOSE: Growth hormone deficiency (GHD) after radiation therapy negatively affects growth and development and quality of life in children with brain tumors. PATIENTS AND MATERIALS: Between 1997 and 2008, 192 pediatric patients with localized primary brain tumors (ependymoma, n = 88; low-grade glioma, n = 51; craniopharyngioma, n = 28; high-grade glioma, n = 23; and other tumor types, n = 2) underwent provocative testing of GH secretion by using the secretogogues arginine and L-dopa before and after (6, 12, 36, and 60 months) conformal radiation therapy (CRT). A total of 664 arginine/l-dopa test procedures were performed. RESULTS: Baseline testing revealed preirradiation GHD in 22.9% of tested patients. On the basis of data from 118 patients, peak GH was modeled as an exponential function of time after CRT and mean radiation dose to the hypothalamus. The average patient was predicted to develop GHD with the following combinations of the time after CRT and mean dose to the hypothalamus: 12 months and more than 60 Gy; 36 months and 25 to 30 Gy; and 60 months and 15 to 20 Gy. A cumulative dose of 16.1 Gy to the hypothalamus would be considered the mean radiation dose required to achieve a 50% risk of GHD at 5 years (TD(50/5)). CONCLUSION: GH secretion after CRT can be predicted on the basis of dose and time after irradiation in pediatric patients with localized brain tumors. These findings provide an objective radiation dose constraint for the hypothalamus.
PURPOSE:Growth hormone deficiency (GHD) after radiation therapy negatively affects growth and development and quality of life in children with brain tumors. PATIENTS AND MATERIALS: Between 1997 and 2008, 192 pediatric patients with localized primary brain tumors (ependymoma, n = 88; low-grade glioma, n = 51; craniopharyngioma, n = 28; high-grade glioma, n = 23; and other tumor types, n = 2) underwent provocative testing of GH secretion by using the secretogogues arginine and L-dopa before and after (6, 12, 36, and 60 months) conformal radiation therapy (CRT). A total of 664 arginine/l-dopa test procedures were performed. RESULTS: Baseline testing revealed preirradiation GHD in 22.9% of tested patients. On the basis of data from 118 patients, peak GH was modeled as an exponential function of time after CRT and mean radiation dose to the hypothalamus. The average patient was predicted to develop GHD with the following combinations of the time after CRT and mean dose to the hypothalamus: 12 months and more than 60 Gy; 36 months and 25 to 30 Gy; and 60 months and 15 to 20 Gy. A cumulative dose of 16.1 Gy to the hypothalamus would be considered the mean radiation dose required to achieve a 50% risk of GHD at 5 years (TD(50/5)). CONCLUSION: GH secretion after CRT can be predicted on the basis of dose and time after irradiation in pediatric patients with localized brain tumors. These findings provide an objective radiation dose constraint for the hypothalamus.
Authors: R Brauner; F Malandry; R Rappaport; J M Zucker; C Kalifa; A Pierre-Kahn; P Bataini; J L Dufier Journal: Eur J Pediatr Date: 1990-09 Impact factor: 3.183
Authors: Thomas E Merchant; Raymond K Mulhern; Matthew J Krasin; Larry E Kun; Tani Williams; Chenghong Li; Xiaoping Xiong; Raja B Khan; Robert H Lustig; Frederick A Boop; Robert A Sanford Journal: J Clin Oncol Date: 2004-08-01 Impact factor: 44.544
Authors: Matthew Mistry; Nataliya Zhukova; Daniele Merico; Patricia Rakopoulos; Rahul Krishnatry; Mary Shago; James Stavropoulos; Noa Alon; Jason D Pole; Peter N Ray; Vilma Navickiene; Joshua Mangerel; Marc Remke; Pawel Buczkowicz; Vijay Ramaswamy; Ana Guerreiro Stucklin; Martin Li; Edwin J Young; Cindy Zhang; Pedro Castelo-Branco; Doua Bakry; Suzanne Laughlin; Adam Shlien; Jennifer Chan; Keith L Ligon; James T Rutka; Peter B Dirks; Michael D Taylor; Mark Greenberg; David Malkin; Annie Huang; Eric Bouffet; Cynthia E Hawkins; Uri Tabori Journal: J Clin Oncol Date: 2015-02-09 Impact factor: 44.544
Authors: Kirsten K Ness; Gregory T Armstrong; Mondira Kundu; Carmen L Wilson; Tamara Tchkonia; James L Kirkland Journal: Cancer Date: 2014-12-19 Impact factor: 6.860
Authors: Michal Zapotocky; Kiran Beera; Jenny Adamski; Normand Laperierre; Sharon Guger; Laura Janzen; Alvaro Lassaletta; Liana Figueiredo Nobre; Ute Bartels; Uri Tabori; Cynthia Hawkins; Stacey Urbach; Derek S Tsang; Peter B Dirks; Michael D Taylor; Eric Bouffet; Donald J Mabbott; Vijay Ramaswamy Journal: Cancer Date: 2019-02-15 Impact factor: 6.860
Authors: Wassim Chemaitilly; Thomas E Merchant; Zhenghong Li; Nicole Barnes; Gregory T Armstrong; Kirsten K Ness; Ching-Hon Pui; Larry E Kun; Leslie L Robison; Melissa M Hudson; Charles A Sklar; Amar Gajjar Journal: Clin Endocrinol (Oxf) Date: 2015-11-16 Impact factor: 3.478
Authors: Laura van Iersel; Zhenghong Li; Deo Kumar Srivastava; Tara M Brinkman; Kari L Bjornard; Carmen L Wilson; Daniel M Green; Thomas E Merchant; Ching-Hon Pui; Rebecca M Howell; Susan A Smith; Gregory T Armstrong; Melissa M Hudson; Leslie L Robison; Kirsten K Ness; Amar Gajjar; Kevin R Krull; Charles A Sklar; Hanneke M van Santen; Wassim Chemaitilly Journal: J Clin Endocrinol Metab Date: 2019-12-01 Impact factor: 5.958