Growth Disturbances in Childhood Cancer Survivors

Antal, Zoltan; Balachandar, Sadana

doi:10.1159/000496354

Cited by 9 publications

(5 citation statements)

References 115 publications

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“…Patients with medulloblastoma diagnosis experienced steep growth loss after diagnosis, reflecting the severity of the disease and its treatments. The negative impact of these factors on growth has also been shown by others [9,[30][31][32].…”

Section: Plos Onesupporting

confidence: 64%

“…This often results in compromised adult height, especially when not treated accurately [4][5][6][7]. Previous studies have shown low adult height in long-term brain tumor survivors [8], but the knowledge of the disease's impact on growth potential, especially before diagnosis, is more limited [9]. Still, longitudinal studies on growth patterns during different growth periods in this patient group are lacking.…”

Section: Introductionmentioning

confidence: 99%

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Pre- and postdiagnosis growth failure, adult short stature, and untreated growth hormone deficiency in radiotherapy-treated long-term survivors of childhood brain tumor

Anttonen

Remes²,

Arikoski³

et al. 2022

PLoS ONE

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Purpose Growth failure is common in radiotherapy-treated long-term survivors of pediatric brain tumors, but studies on longitudinal growth in this patient group are lacking. Here, the aim was to assess the changes in growth patterns before and after brain tumor diagnosis, the adult height, and the risk factors for compromised growth. The incidence and treatment practices of growth hormone deficiency were analyzed. Methods A cohort of 73 survivors of childhood brain tumor (median age 27.2 years, range 16.2 to 43.8 years) was studied after a median follow-up period of 20.4 years from diagnosis (IQR 14.9 to 22.9 years). Patients were treated in five university hospitals in Finland between 1970 and 2008. Growth curves, final height, and patient- and disease-related risk factors for compromised growth during different growth periods were analyzed. Laboratory analyses for IGF-1 and IGFBP-3 were performed at the follow-up. Results Growth failure was evident at diagnosis, with a mean height decline of -0.6 SDS (standard deviation score) from birth (95% CI -1.15 to -0.05). Mean height SDS decline after the diagnosis was -1.09 SDS (95%CI -1.51 to -0.66). At follow-up, 37% of the study subjects (27/73) had true short stature (height < -2 SDS). The mean height deficit corrected for target height was -1.9 SDS (95% CI -1.45 to -2.40). Growth failure was associated with the age at diagnosis, corticosteroid dose, radiotherapy modality and mean dose of irradiation in the thalamic area. Low IGF-1 level (below -2.0 SDS) was found in 32% (23/72), and untreated growth hormone deficiency in 40% (29/72) of the subjects. Conclusion Longitudinal growth impairment was common in radiotherapy-treated survivors of childhood brain tumor, resulting in compromised adult height. Loss of growth potential was evident already at diagnosis and further accelerated by the treatments. At young adulthood, unrecognized growth hormone deficiency was common.

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Section: Plos Onesupporting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Pre- and postdiagnosis growth failure, adult short stature, and untreated growth hormone deficiency in radiotherapy-treated long-term survivors of childhood brain tumor

Anttonen

Remes²,

Arikoski³

et al. 2022

PLoS ONE

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“…Acute Lymphoblastic Leukemia survivors appear to present a deficit in the Z-score of height during chemotherapy and an increase in the BMI indexes, which is not followed by an appropriate catch up with growth [24]. Evaluating the Height per Age Index most of the patients had an adequate height for their age similar to the data found in another study [17].…”

Section: Discussionsupporting

confidence: 74%

Changes in nutritional status in adolescents surviving leukemia and lymphoma

et al. 2020

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Objective To examine the changes in the nutritional status of adolescents aged 10-19 years after a minimum 12 months interval following oncological treatment for leukemias and lymphomas. Methods Longitudinal design quantitative study conducted at Hospital de Clínicas, Porto Alegre. Adolescents aged 10-19 years after a minimum 12 months interval following oncological treatment for leukemias and lymphomas were included. The measures of weight, height, brachial circumference, triceps skinfold thickness, arm muscle circumference and abdominal circumference were collected. Results The sample comprised 50 adolescents who had survived leukemias and lymphomas. In the follow up 38% of the patients were classified as overweight according to the body mass index for their age. There was a significant increase in body mass index for age between the beginning and the end of treatment and follow up (p=0.013) in female individuals, compared to males. The results indicate a reduction in the Z-score means of height for age, with significant differences between the beginning of treatment and follow up (p=0.016); and end of treatment and follow up (p=0.006) in patients of both genders Conclusion The anthropometric indicators show an important frequency of excess weight and increased tricipital skinfold, as well as a significant increase of the body mass index for age and also a growth deficit among the survivors.

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“…In this study, the height SDS of survivors was inversely correlated to the WHO degree of the tumor. And, like other groups ( 49 ) we could show that growth was more stunted in children who received irradiation. Irradiated patients also displayed a higher number of impaired endocrine axes, pointing toward the intertwined effects of irradiation, the resulting hormonal deficiencies and the tumor stage on growth in children and adolescents.…”

Section: Discussionsupporting

confidence: 71%

Prevalence of osteopathologies in a single center cohort of survivors of childhood primary brain tumor

et al. 2022

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BackgroundChildhood primary brain tumors (CPBT) are the second largest group of childhood malignancies and associated with a high risk for endocrine late effects.ObjectiveTo assess endocrine late effects and their relevance for the development of osteopathologies in survivors.MethodsThis single center cross sectional study investigated data from 102 CPBT survivors with a mean age of 13.0 years and a mean age at diagnosis of 8.7 years. Clinical, biochemical, radiographic, and anamnestic data regarding endocrine and bone health were obtained at study visits. In addition, data regarding tumor stage and therapy was obtained by chart review. An expert opinion was applied to define presence of osteopathologies.ResultsImpaired bone health, defined by at least one pathological screening parameter, was present in 65% of patients. 27.5% were found to have overt osteopathologies per expert opinion. 37.8% displayed a severe vitamin D deficiency (25-OH vitamin D < 10 ng/ml) and 11% a secondary hyperparathyroidism. Patients with osteopathologies had lower 25-OH vitamin D levels compared to patients without osteopathologies. Multiple endocrine late effects were present: diabetes insipidus in 10.8%, aberrant pubertal development in 13.7%, central hypocortisolism in 14.9%, thyroid dysfunction in 23.8% and growth hormone deficiency in 21.8%. A total of 31.3% of survivors displayed any endocrinopathy. Tumors located near hypothalamic structures and patients who received irradiation had a higher likelihood of endocrine morbidity.ConclusionThis study indicates that endocrine deficiencies are common in pediatric survivors of CPBTs. Osteopathologies are present in this cohort. A prominent effect of hormonal deficiencies on bone health was not detected, possibly because patients were sufficiently treate for their endocrine conditions or indicating resilience of the childhood bone remodeling process. Vitamin D deficiency is frequent and should be treated as recommended.

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Growth Disturbances in Childhood Cancer Survivors

Cited by 9 publications

References 115 publications

Pre- and postdiagnosis growth failure, adult short stature, and untreated growth hormone deficiency in radiotherapy-treated long-term survivors of childhood brain tumor

Pre- and postdiagnosis growth failure, adult short stature, and untreated growth hormone deficiency in radiotherapy-treated long-term survivors of childhood brain tumor

Changes in nutritional status in adolescents surviving leukemia and lymphoma

Prevalence of osteopathologies in a single center cohort of survivors of childhood primary brain tumor

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