Does growth hormone therapy increase the frequency of tumor recurrence in children with brain tumors?

Rodens, Klaus; Kaplan, Selna L.; Grumbach, M.M.; Teller, W. M.

doi:10.1530/acta.0.114s188

Cited by 15 publications

(5 citation statements)

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“…In patients with acromegaly, in which a high growth hormone concentration is pathologically sustained, there is a significantly increased incidence of cancer in general.12 Development of acute lymphoblastic leukaemia has been reported de novo in children receiving growth hormone either for idiopathic growth hormone deficiency or after treatment of a brain tumour. 3 14 But although the incidence of leukaemia may be slightly increased after growth hormone treatment in growth hormone deficient patients, it is not clear that this can be attributed to growth hormone. '5 In our study the only child with acute lymphoblastic leukaemia who relapsed while taking growth hormone was at high risk because of the two previous relapses of leukaemia; furthermore, no child with a primary diagnosis of brain tumour developed acute lymphoblastic leukaemia after receiving growth hormone.…”

Section: Discussionmentioning

confidence: 99%

“…In children treated for a brain tumour the median dose was 3000 cGy (range 1500-4750) in 20 (8-28) fractions over 27 days. In addition, 36 children received a boost to the tumour site (median dose 1500 cGy (range 1000-2000) in 10 (4-11) fractions over 13 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) days). In children treated for acute lymphoblastic leukaemia the median cranial dose was 2400 (1800-4200) cGy in 16 (11-50) fractions over 15 days.…”

Section: Methodsmentioning

confidence: 99%

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Growth hormone and tumour recurrence.

Ogilvy-Stuart

Ryder

Gattamaneni

et al. 1992

BMJ

116

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Results-Among children with brain tumour, five (11%) who received growth hormone had recurrences compared with 42 (26%) who did not receive growth hormone. Also adjusting for other variables that might affect tumour recurrence the estimated relative risk of recurrence was 0-82 (95% confidence interval 0*28 to 2 37). The only child with acute lymphoblastic leukaemia who relapsed while taking growth hormone had relapsed previously before starting treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Growth hormone and tumour recurrence.

Ogilvy-Stuart

Ryder

Gattamaneni

et al. 1992

BMJ

116

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“…24,25 Although GH therapy does not appear to affect the late relapse rate of brain tumors, it seems reasonable to delay initiating GH therapy until 2 years after completion of brain tumor therapy because the contribution of exogenous GH to relapse would be difficult to interpret. 26,27 One patient with a medulloblastoma in our study recurred during this 2-year period.…”

Section: Discussionmentioning

confidence: 74%

Growth Failure After Treatment of Pediatric Brain Tumors

Clarson

Maestro

1999

Pediatrics

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ABSTRACT. Objectives. Primary brain tumors are the most common solid tumors that occur in childhood. With improved management of these tumors, there are more survivors with long-term sequelae of radiation and chemotherapy including growth failure. The aim of this study was to assess growth prospectively in children with nonpituitary-related primary brain tumors.Methods. Forty-one children 3.1 to 13.8 years of age diagnosed consecutively between 1989 and 1992 with a primary nonpituitary-related brain tumor were studied.Results. Of 34 prepubertal children, 14 (41%) were diagnosed as having growth hormone (GH) deficiency. All 14 children were treated with cranial irradiation. During the first year from completion of brain tumor therapy, the annual height velocity of those children confirmed subsequently as being GH-deficient was 3.06 ؎ 1.19 cm compared with 5.29 ؎ 2.21 cm for those who were not GH-deficient. During the second year, the annual height velocity was 3.29 ؎ 1.14 cm per year for the GHdeficient group compared with 5.48 ؎ 1.24 cm per year for the non-GH-deficient group. All children with GH deficiency received cranial irradiation and chemotherapy. Two of 34 children developed precocious puberty. Primary hypothyroidism was diagnosed in 6 of 41 children (12%).Conclusion. We conclude that GH deficiency and primary hypothyroidism are common after cranial irradiation and chemotherapy for nonpituitary-related brain tumors. Linear growth appears to reflect GH status accurately in children with brain tumors. Precise auxologic evaluation is simple and noninvasive and may reflect more accurately GH status than provocative GH testing. These findings reflect the need for prospective growth monitoring of children with nonpituitary-related brain tumors treated with cranial irradiation and chemotherapy. Early diagnosis of GH deficiency facilitates early initiation of GH therapy and optimization of final height. Pediatrics 1999;103(3). URL: http://www. pediatrics.org/cgi/content/full/103/3/e37; brain tumors, cranial irradiation, growth, growth hormone deficiency, hypothyroidism.

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“…The use of GH in children with radiationinduced GH deficiency is now widely accepted, but ques tions still exist about the safety of this mitogenic hor mone, and whether it might cause tumour recurrence. Earlier studies with small numbers of patients from this centre [II] and others [12,13] suggested that GH is not responsible for the recurrence of brain tumours. In none of these studies, however, was any statistical analysis applied.…”

Section: Tumour Recurrence a Fter Treatment With Gii In Childhoodmentioning

confidence: 88%

Tumour Occurrence and Recurrence

Ogilvy-Stuart

Shalet²

1992

Horm Res

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There is growing concern about the oncogenic potential of growth hormone (GH) used therapeutically. In rat experiments, a variety of malignant tumours have been induced following administration of supraphysiological doses of GH, whilst in other studies in hypophysectomized animals a lower than normal incidence of carcinogen-induced neoplasms was reported. In acromegaly, in which there is a pathologically sustained high GH level, there is a significantly increased incidence of cancer in general and specifically of colonic neoplasia. To determine whether the use of GH in the treatment of radiation-induced GH deficiency causes tumour recurrence, a comparison was made of tumour recurrence rates between 47 children treated with GH for radiation-induced GH deficiency after treatment for a brain tumour and a control population from the North West Children’s Cancer Registry who did not receive GH (n = 160). All cases of acute lymphoblastic leukaemia (ALL), including those that were (n = 15) and were not (n = 146) treated with GH were reviewed. The computerized tomography (CT) scans in the children with brain tumours were reviewed at the time of GH commencement and subsequently. There were 5 brain tumour recurrences after GH therapy: 1 astrocytoma, 2 ependymomas and 2 medulloblastomas. Adjusting for variables other than GH which might affect tumour recurrence, the estimated relative risk of tumour recurrence was 0.82 (95% confidence interval: 0.28-2.37). In each tumour category there was no association between the use of GH and subsequent tumour recurrence. The only child treated with GH after treatment of ALL, who relapsed, had previously relapsed before GH therapy. Nineteen of 44 CT scans were abnormal at the time of GH commencement, 10 reported as demonstrating residual tumour. Two of the 5 children with brain tumours who subsequently relapsed had abnormal scans when GH was started and all 5 had abnormal scans after clinical relapse. Fourteen of the 39 children, who clinically remain relapse free, have had follow-up scans and in none has there been a deterioration in radiological appearance during GH therapy for a mean duration of 3.7 years. In our population there is no evidence of an increased risk of tumour recurrence following GH in replacement dosage, however, because of the confidence interval range, continued surveillance is essential. An abnormal CT scan is not a contraindication to GH therapy.

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Does growth hormone therapy increase the frequency of tumor recurrence in children with brain tumors?

Cited by 15 publications

References 0 publications

Growth hormone and tumour recurrence.

Growth hormone and tumour recurrence.

Growth Failure After Treatment of Pediatric Brain Tumors

Tumour Occurrence and Recurrence

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