Endocrine Deficiency As a Function of Radiation Dose to the Hypothalamus and Pituitary in Pediatric and Young Adult Patients With Brain Tumors

Vatner, Ralph; Niemierko, Andrzej; Misra, Madhusmita; Weyman, Elizabeth A.; Goebel, Claire P.; Ebb, David H.; Jones, Robin M.; Huang, Mary; Mahajan, Anita; Grosshans, David R.; Paulino, Arnold C.; Stanley, Takara L.; MacDonald, Shannon M.; Tarbell, Nancy J.; Yock, Torunn I.

doi:10.1200/jco.2018.78.1492

Cited by 126 publications

(128 citation statements)

References 40 publications

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“…As would be anticipated, the risk for developing primary hypothyroidism appears to be markedly decreased after craniospinal proton irradiation. In a recent large study, Vatner et al[59] found that only 3 (3%) patients treated with craniospinal irradiation developed primary hypothyroidism; all of these cases were compensated in nature and they had thyroid radiation doses similar to children without hypothyroidism. Although Eaton et al[60] did not distinguish the exact nature of hypothyroidism in a study of 77 children with standard risk medulloblastoma, they did find a significantly reduced risk of hypothyroidism in patients treated with protons compared with photons (23 vs. 69%).…”

Section: Radiation-induced Thyroid Diseasementioning

confidence: 99%

“…In the study by Vatner et al[59], the cumulative incidence of central hypothyroidism was 18%, which represented the second most common endocrinopathy. Eaton et al[60] also published their endocrine outcomes after proton therapy in 40 patients with medulloblastoma.…”

Section: Radiation-induced Thyroid Diseasementioning

confidence: 99%

“…Dissimilar from radiation-induced primary hypothyroidism, the risk for developing central hypothyroidism after irradiation is not clearly elevated in the youngest children [37, 59]. …”

Section: Radiation-induced Thyroid Diseasementioning

confidence: 99%

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Thyroid Sequelae of Pediatric Cancer Therapy

Waguespack

2018

Horm Res Paediatr

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The hypothalamic-pituitary-thyroid axis is a common site of unintended, acquired disease either during or after the treatment of cancer. Children treated with external radiation therapy are at the highest risk for developing a thyroid-related late effect, but thyroid dysfunction and second primary thyroid neoplasms can also occur after treatment with radiopharmaceutical agents such as ¹³¹I-metaiodobenzylguanidine. Increasingly recognized is the development of early thyroid dysfunction as an off-target consequence of the more novel cancer therapeutics such as the tyrosine kinase inhibitors and immune checkpoint inhibitors. Thyroid sequelae resulting from irradiation may manifest only after years to decades of follow-up, and their resultant clinical symptoms may be indolent and non-specific. Therefore, lifelong monitoring of the childhood cancer survivor at risk for thyroid disease is paramount. In this comprehensive review, the myriad thyroid adverse effects resulting from pediatric cancer treatment are discussed and an overview of screening and treatment of these thyroid sequelae provided.

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Section: Radiation-induced Thyroid Diseasementioning

confidence: 99%

Section: Radiation-induced Thyroid Diseasementioning

confidence: 99%

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Thyroid Sequelae of Pediatric Cancer Therapy

Waguespack

2018

Horm Res Paediatr

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“…Conversely, larger radiotherapy boost volumes and higher dose have been linked to declining intellectual trajectory . Dose‐response relationships have been observed for cochlear, endocrine, and cognitive outcomes …”

Section: Introductionmentioning

confidence: 99%

“…8 Dose-response relationships have been observed for cochlear, endocrine, and cognitive outcomes. [9][10][11] For patients with high-risk disease, limiting the boost target volumes to the tumor bed is not well established. Radiotherapy boost to the entire PF remains the most commonly employed strategy for children with high-risk disease.…”

Section: Introductionmentioning

confidence: 99%

Reduced‐volume tumor‐bed boost is not associated with inferior local control and survival outcomes in high‐risk medulloblastoma

Tian

Sudmeier

Chao

et al. 2019

Pediatric Blood & Cancer

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Background Radiotherapy boost to the entire posterior fossa (PF) is standard of care for high‐risk (H‐R) medulloblastoma patients; the utility of tumor bed (TB)‐only boost is unclear. The purpose of this study was to examine the impact of PF versus TB boost volume on tumor control and survival in the H‐R medulloblastoma population. Methods Single‐institution records for patients with H‐R medulloblastoma were reviewed. The median craniospinal irradiation dose was 36 Gy (range, 23.4‐45 Gy), and boost doses to either PF or TB were 54 to 55.8 Gy. PF (local) failures were scored as in‐field, marginal (between 80% and 95% isodose lines), or distant. Kaplan‐Meier methods and Cox proportional hazards were used to assess the impact of radiation boost technique on local control (LC) and survival endpoints. Results Thirty‐two patients with H‐R medulloblastoma were treated between 1990 and 2015, with a median follow‐up length of 5.12 years. Twenty‐two patients received PF boost, and 10 received TB boost. Patient and disease characteristic were comparable between groups. A total of 11 PF failures occurred, including 3 isolated LFs (2 in the PF and 1 in the TB group). Most PF failures were in‐field: three of four in the TB group and six of seven in the PF group; the remainder were marginal failures. TB boost was not associated with inferior LC (hazard ratio [HR] 0.86, log‐rank P = 0.81) or overall survival (HR 1.40, P = 0.56) compared with PF boost. Conclusion Reduced‐volume radiotherapy boost to the TB does not appear to compromise LC or survival in patients with H‐R medulloblastoma; it may reduce the risk of ototoxicity.

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