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Endocrine
outcome in children with medulloblastoma treated with 18 Gy of craniospinal
radiation therapy
Weizhen
Xu, Anna Janss, Roger J. Packer, Peter Phillips, Joel Goldwein, Thomas M Oshang
Jr
Divisions of Endocrinology
(W.X., T.M.) and Neurology and Oncology (A.J., P.P.) and Department of
Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104;
Department of Radiation Oncology, University of Pennsylvania School of Medicine,
Philadelphia, PA 19104 (J.G.); and Department of Neurology and Oncology,
Children’s National Medical Center, The George Washington University,
Washington, DC 20010 (R.J.P.); USA
Craniospinal
radiation therapy (CSRT) combined with chemotherapy results in significant
endocrine morbidity.
Between 1987 and 1990, a trial using 18 Gy was conducted to treat 10 young
children with medulloblastoma.
There were 7 survivors.
We compared the endocrine outcome in these children (group 18 Gy) to that of a
comparable group treated with conventional doses of CSRT that ranged from 23 to
39 Gy (group CD).
Both groups had an identical history of chemotherapy and tumor stage and were
treated with recombinant growth hormone therapy (rhGH).
The mean age of group 18 Gy at diagnosis was 4.0 years, and rhGH treatment was
initiated in 6 children at age 9.2 years.
Group CD (12 children) was diagnosed at a mean age of 5.8 years and rhGH started
in 11 children at a mean age of 9.6 years.
The dose of rhGH used in both groups was identical (0.3 mg/kg/wk).
For group 18 Gy, adult heights and sitting heights (a mean standard deviation
score of -1.01 ± 1.11 and -1.62 ± 1.16, respectively) were statistically
greater (P < 0.05) than those for group CD (mean standard deviation
score of -2.04 ± 0.83 and -3.16 ± 1.43, respectively).
Moreover, adult heights of group 18 Gy were not different from midparental
heights, unlike group CD, whose adult heights were less than midparental heights
(P < 0.0001).
Of other endocrine sequelae, 10 patients of the CD group were hypothyroid, 3 had
adrenal insufficiency, 3 had hypogonadism, and 2 had early puberty.
In contrast, within group 18 Gy, only 1 was hypothyroid (P = 0.006) and 1
had early puberty.
We conclude that endocrine morbidity was significantly reduced with 18 Gy CSRT
in young children with medulloblastoma.
© 2004 Duke
University Press
Source: http://konstanza.ingentaselect.com/vl=1165413/cl=80/nw=1/rpsv/cgi-bin/linker?ini=dup_no&reqidx=/cw/dup/15228517/v6n2/s4/p113
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