Growth hormone treatment and risk of recurrence or development of secondary neoplasms in survivors of pediatric brain tumors.

Growth hormone (GH) is increasingly used for treatment of pediatric brain tumors. However, controversy remains over its safety. This meta-analysis assessed whether GH treatment was associated with risk of recurrence or development of secondary neoplasm for brain tumors in children. Systematic computerized searches of PubMed and Web of Knowledge were performed. Pooled relative risks (RR) with 95% confidence interval (CI) for recurrence and/or secondary neoplasm in children who were treated with GH versus those who did not receive GH were calculated. Ten studies were included. The pooled recurrence rates were 21.0% and 44.3% in the GH-treated group and non-GH-treated group, respectively. The pooled RR for recurrence was 0.470 (95% CI 0.372-0.593; z=6.33, p=0.000). Begg's test (p=0.060) and Egger's test (p=0.089) suggested there was no significant publication bias. The pooled RR in sensitivity analysis was 0.54 (95% CI 0.37-0.77; z=3.32, p=0.001), which showed the result was robust. The pooled RR for secondary neoplasm was 1.838 (95% CI 1.053-3.209; z=2.14, p=0.032). Begg's test (p=1.000) and Egger's test (p=0.553) suggested there was no significant publication bias. We found no evidence that GH therapy is associated with an increased risk of recurrence for pediatric brain tumors. However, because of our small sample size, the association of GH therapy with an increased risk of secondary neoplasm is uncertain. Further prospective cohorts are needed.