Differential Effects of 18- and 24-Gy Cranial Irradiation on Growth Rate and Growth Hormone Release in Children With Prolonged Survival After Acute Lymphocytic Leukemia

Cicognani, Alessandro; Cacciari, E; Vecchi, Vico; Cau, Marco; Balsamo, Antonio; Pirazzoli, Piero; Tosi, Maria Teresa; Rosito, P; Paolucci, G

doi:10.1001/archpedi.1988.02150110077023

Cited by 15 publications

(14 citation statements)

References 22 publications

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“…Those who received any form of spinal radiotherapy had the shortest adult heights among all survivor groups. Prior studies had not been consistent in finding differences in final height between survivors treated with 18 Gy versus 24 Gy cranial radiotherapy (3)(4)(5)7,12,(15)(16)(17), or between 18 Gy and treatment with chemotherapy alone (3,6,14). These studies had relatively few subjects who reached adult height (N <200), limiting their statistical power to detect differences.…”

Section: Discussionmentioning

confidence: 99%

“…Growth deficits have been reported consistently following doses of ≥24 Gy cranial radiotherapy, but the data are less consistent for doses <20 Gy (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). The effect on loss of stature was greater in children who also received radiotherapy to the spine, secondary to direct inhibition of vertebral growth (13).…”

Section: Introductionmentioning

confidence: 99%

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Decreased Adult Height in Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study

Chow

Friedman

Yasui

et al. 2007

The Journal of Pediatrics

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Objectives-To determine risk factors associated with reduced adult height in survivors of childhood acute lymphoblastic leukemia (ALL).Study design-Cross-sectional study. Attained adult height was determined among 2,434 ALL survivors participating in the Childhood Cancer Survivor Study, a cohort of five-year survivors of common pediatric cancers diagnosed from [1970][1971][1972][1973][1974][1975][1976][1977][1978][1979][1980][1981][1982][1983][1984][1985][1986], and compared with 3,009 siblings.Results-All survivor treatment exposure groups (chemotherapy alone, chemotherapy with cranial or craniospinal radiotherapy) had decreased adult heights and an increased risk of adult short stature (height standard deviation score < −2) compared with siblings (p<0.001). Compared with siblings, the risk of short stature for survivors treated with chemotherapy alone was elevated (OR 3.4, 95% CI 1.9, 6.0). Among survivors, significant risk factors for short stature included diagnosis of ALL prior to puberty, higher dose cranial radiotherapy (≥20 Gy versus <20 Gy), any radiotherapy to the spine, and female sex.Conclusions-Survivors of childhood ALL are at increased risk of adult short stature, including those treated with chemotherapy alone. Risk is highest for those treated with cranial and craniospinal radiotherapy at a young age. PO Box 19024, Seattle, WA 98109-1024. Phone (206) 667-7724, Fax (206) 667-5948, email: ericchow@u.washington.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.The authors disclose no potential conflicts of interest. Cranial and craniospinal radiotherapy were commonly used in the 1970s and early 1980s to treat as well as to prevent the spread of acute lymphoblastic leukemia (ALL) to the central nervous system (CNS) in children. While radiotherapy was effective, it was associated with adverse endocrine and neurocognitive outcomes(1). As a result, over the past three decades, radiotherapy doses have been reduced or eliminated in an attempt to decrease these adverse long-term outcomes, and have been replaced by more intensive chemotherapy.Several studies have examined growth in ALL survivors. Growth deficits have been reported consistently following doses of ≥24 Gy cranial radiotherapy, but the data are less consistent for doses <20 Gy(2-17). The effect on loss of stature was greater in children who also received radiotherapy to the spine, secondary to direct inhibition of vertebral growth(13). For most studies in which the impact of chemotherapy without radiotherapy was examined, growth suppression during treatment was followed by catch-up growth (...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Decreased Adult Height in Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study

Chow

Friedman

Yasui

et al. 2007

The Journal of Pediatrics

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“…Ao que parece, o efeito da radioterapia é dose dependente. Em estudo realizado por Cicognani et al 8 , observou-se que o grupo de meninas submetido a 18Gy apresentou recuperação completa do crescimento após dois anos do tratamento, ao contrário do grupo submetido a 24Gy. Em nosso estudo, os resultados mostraram deficiência do crescimento após o término do tratamento, nos dois grupos.…”

Section: Resultsunclassified

“…Em nosso estudo, os resultados mostraram deficiência do crescimento após o término do tratamento, nos dois grupos. As diferenças entre este estudo e o de Cicognani et al 8 podem ser explicadas pelo maior número de pacientes submetidas a 18Gy e pelo maior tempo de acompanhamento em nosso estudo.…”

Section: Resultsunclassified

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Tratamento de leucemia linfóide aguda e crescimento

Monteiro¹,

Bedone²,

Pinto³

et al. 1998

Rev. Assoc. Med. Bras.

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RESUMO -OBJETIVO. Determinar alterações no INTRODUÇÃODurante o tratamento de leucemia linfóide aguda (LLA), vários aspectos têm sido apontados como causadores de alterações no crescimento. Entre estes, pode-se citar a própria doença, a nutrição deficiente, a ocorrência de infecções, a quimioterapia e a radioterapia cranial. A somatória de todos esses fatores determina uma desaceleração do crescimento 1 . Parece haver consenso que a radioterapia é o principal causador dessas alterações, por levar a uma diminuição de secreção do hormônio de crescimento (GH) 2-6 . A deficiência de GH pode ser parcial e persistir vários anos após o tratamento. A manifestação dessa deficiência depende do estádio puberal em que a criança está sendo observada. Na fase pré-puberal são suficientes pequenas quantidades de GH para assegurar o crescimento normal; nessa fase, os efeitos nem sempre são bem dimensionados. Entretanto, quando a criança atinge a puberdade, o aumento da demanda de GH não é suprido, tornando mais evidentes as alterações do crescimento, com achatamento do estirão puberal 7 . A dose de radioterapia parece ter importância nas repercussões futuras sobre o crescimento. A comparação entre crianças tratadas com 18 ou 24Gy evidenciou que o primeiro grupo apresentou recuperação completa da curva de crescimento 8 . Entretanto, há estudos que mostraram alterações persistentes do crescimento, mesmo com essas doses. Observou-se deficiência de GH em crianças com doses de 18Gy 9-11 , permanecendo, portanto, algumas controvérsias a respeito dos efeitos dessa dose de radioterapia sobre o crescimento.O aumento nas taxas de sobrevida e as novas possibilidades de cura de LLA têm permitido que um maior número de sobreviventes chegue a idade adulta. O crescimento pode ser retardado pela radioterapia, e tanto a dose de radioterapia como a idade em que o tratamento é realizado podem ter influência na estatura final.Este trabalho teve como objetivo avaliar a influência da idade por ocasião do diagnóstico e a dose de radioterapia cranial utilizada.

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Erratum: “Review: An overview about the structure‐function relationship of marine sulfated homopolysaccharides with regular chemical structures” biopolymers 91(8), 601–609, (2009)

Pomin

2010

Biopolymers

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Differential Effects of 18- and 24-Gy Cranial Irradiation on Growth Rate and Growth Hormone Release in Children With Prolonged Survival After Acute Lymphocytic Leukemia

Cited by 15 publications

References 22 publications

Decreased Adult Height in Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study

Decreased Adult Height in Survivors of Childhood Acute Lymphoblastic Leukemia: A Report from the Childhood Cancer Survivor Study

Tratamento de leucemia linfóide aguda e crescimento

Erratum: “Review: An overview about the structure‐function relationship of marine sulfated homopolysaccharides with regular chemical structures” biopolymers 91(8), 601–609, (2009)

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