Abstract
We have studied the long-term endocrine effects of treatment on 144 children treated for brain tumours. All received cranial irradiation, 86 also received spinal irradiation and 34 chemotherapy. Almost all patients (140 of 144) had evidence of growth hormone insufficiency. Treatment with growth hormone was effective in maintaining normal growth but could not restore a deficit incurred by delay in instituting treatment. The effect of spinal irradiation on spinal growth was not corrected by growth hormone. As spinal growth makes the major contribution to the pubertal growth spurt and limb length the major contribution to childhood growth, treatment with GH will have maximal effect on leg length if instituted before the onset of puberty. Primary thyroid dysfunction was found in 11 of 47 children (23%) treated with craniospinal irradiation but in none treated with cranial irradiation alone. The incidence rose to 69% of 29 children treated with spinal irradiation and chemotherapy and to 50% of four children treated with cranial irradiation and chemotherapy. This effect of chemotherapy has not previously been reported and was detected by us through measurement of serum TSH concentration. Primary thyroid dysfunction requires treatment with thyroxine to prevent increasing the risk of secondary thyroid tumours. Seven of 20 girls (35%) treated with spinal irradiation had primary ovarian dysfunction as determined by raised gonadotrophin levels. Chemotherapy increased this, but not significantly. Three of 15 boys (20%) treated with chemotherapy had primary testicular dysfunction. Gonadotrophin deficiency occurred in seven boys. Four of 90 children had deficiency of cortisol secretion in response to hypoglycaemia. These results confirm the requirement for long-term follow-up of children treated for brain tumours from the endocrine point of view. Anticipation of hormone deficiencies and replacement treatment can improve the quality of life of survivors.
Highlights
Thirty-three patients had completed their growth without endocrine intervention, providing information about natural history
Endocrine complications following cranial irradiation were recognised over 20 years ago (Tan & Kunaratnam, 1966) but their degree is still emerging
GH insufficiency (GHI) is known to be common (Harrop et al, 1976); we found that almost all children given cranial irradiation had GHI when assessed by ITT
Summary
We have studied the long-term effects of treatment on 144 children (77 boys and 67 girls) treated for brain tumours at two centres between 1972 and 1985. Eighty-seven children received spinal irradiation using a direct posterior field to treat the whole spine from the lower border of the cerebral fields to S2 (Bloom, 1978). As bony relationships have never been established and anatomical borders are not visible on planning films, CT brain scans were used to define these in a sample of 40 children. These observations were combined with the simulator or machine check films and isodose distribution planes to estimate hypothalamic dosimetry retrospectively without knowledge of individual outcome
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