Endocrine Late Effects of Radiation Therapy in Pediatric and Young Adult Patients with Brain Tumors

Abstract

With the improvement of treatment techniques, the survival rate for childhood and young adults with brain tumors has increased over the last 40 years. Endocrine late effects account for a large portion of the negative consequences in childhood brain tumor survivors. Treatment of childhood and young adult brain tumors, including radiation therapy, surgery, chemotherapy and other therapeutic techniques often results in endocrine late effects manifested by hypopituitarism, which can involve growth hormone deficiency, hypothyroidism, adrenal insufficiency, gonad disorders, diabetes insipidus, and metabolic complications. A literature search was conducted on Medline including longitudinal controlled studies, retrospective cohort studies, systematic reviews, recent evidence-based guidelines, meta-analyses, and case reports. An updated review of the latest results and analyses was provided on radiation-induced endocrine sequelae of brain tumor survivors in children and young adults.Endocrine late effects can occur many years after the initial radiation treatment of a brain tumor, so surveillance of growth, weight, puberty, bone age development, and endocrine status is recommended every 6 months to 2 years after tumor therapy. Pediatric and young adult survivors with brain tumors are important follow-up subjects. Early diagnosis and appropriate treatment may improve health outcomes. Newer radiation treatment techniques, such as proton radiotherapy, can reduce endocrine complications, but this benefit has not been proven as additional research is needed on short-term and long-term results.