Due to the poor prognosis of high-risk (HR) neuroblastoma (NBL), scant data exist on late effects after treatment. Recently, protocols utilizing intense multimodal treatment have resulted in improved long-term survival. The objective of this study was to determine the prevalence of late effects in survivors of HR NBL. A retrospective review of clinical data for serial patients completing treatment between September 1994 and October 2007 and surviving for at least 1 year was performed. Therapy included aggressive chemotherapy, surgery, radiation and single or tandem SCT. Oncology follow-up was standard; clinical criteria were utilized for referrals to endocrinology and other services. Fifty-one eligible patients were identified. Median follow-up was 6.1 years (range 1.0-15.2). Height was significantly impacted (DZ-score À 1.91 in those treated with TBI and À 0.77 in those without). Pre-diabetes or diabetes, hypothyroidism and ovarian insufficiency were observed in 50, 59 and 75% of at-risk survivors, respectively. Hearing loss and dental issues were common. Nine patients had relapse of NBL; seven died of progressive disease. As there is a high prevalence of late effects in long-term survivors of HR NBL, close monitoring and further studies after treatment are indicated, and in particular after more modern, non-TBI regimens.

Background Childhood cancer survivors are at high risk for reduced bone mineral density (BMD). Our objective was to determine whether post-pubertal adolescent survivors of brain tumors, whose tumor or treatments placed them at risk for pituitary hormone deficiencies, have low BMD near time of peak bone mass accrual, and to assess risk factors for decreased BMD. Procedure Chart review of 36 post-pubertal adolescents with history of tumor or radiation therapy (RT) of the hypothalamic-pituitary area who had undergone BMD screening via dual-energy x-ray absorptiometry (DXA). Results Age at DXA was 16.9 ±1.9 years (mean ± SD). Time since diagnosis was 8.5 ±3.6 years. Median BMD Z-scores were −0.95 (range −2.7 to 1.7) at the femoral neck, −1.20 (−3.6 to 1.8) at the hip, and −0.90 (−3.7 to 1.8) at the spine. Bone mineral apparent density (BMAD) Z-scores were −0.23 (−2.7 to 1.9) at the femoral neck and −0.45 (−3.0 to 2.3) at the spine. Those with history of ≥1 fracture had lower BMD Z-scores of the femoral neck, total hip and spine (P<0.05). Those with treated GH deficiency had a higher BMD Z-score at the femoral neck, total hip and spine (P<0.05) than those not treated. There was no difference in BMD with respect to treatment with chemotherapy, cranial or spinal RT, or hypogonadism. Spontaneous menarche and regular periods did not correlate with BMD. Conclusions In post-pubertal adolescent survivors of childhood brain tumors, fracture history and untreated GH deficiency are risk factors for decreased BMD.

Synthroid and an AB-rated generic L-T(4) are not bioequivalent for patients with severe hypothyroidism due to CH, probably because of diminished thyroid reserve. It would therefore seem prudent not to substitute L-T(4) formulations in patients with severe CH, particularly in those <3 yr of age. Our results may have important implications for other severely hypothyroid patients in whom precise titration of L-T(4) is necessary.