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J Clin Endocrinol Metab. 2014 Jun;99(6):2030-7. doi: 10.1210/jc.2013-4159. Epub 2014 Feb 25.

Growth hormone exposure as a risk factor for the development of subsequent neoplasms of the central nervous system: a report from the childhood cancer survivor study.

Author information

1
Department of Pediatrics (B.C.P., A.Mer., L.R.M.) Emory University/Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia 30322; Department of Public Health Sciences (Y.C., Y.Y.), University of Alberta, Edmonton, Alberta, Canada T6G 1C9; Department of Pediatrics (C.A.S.), Memorial Sloan-Kettering Cancer Center, New York, New York 10065; Department of Pediatrics (J.N.), University of Minnesota Medical School, Minneapolis, Minnesota 55454; Department of Epidemiology and Cancer Control (G.T.A., L.L.R.), St Jude Children's Research Hospital, Memphis, Tennessee 38105; Division of Oncology (A.Mea.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; and Department of Radiation Physics (M.S.), The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030.

Abstract

CONTEXT:

Cranial radiation therapy (CRT) predisposes to GH deficiency and subsequent neoplasms (SNs) of the central nervous system (CNS). Increased rates of SNs have been reported in GH-treated survivors.

OBJECTIVE:

The objective of the study was to evaluate the association between GH treatment and the development of CNS-SNs.

DESIGN:

The study was designed with a retrospective cohort with longitudinal follow-up.

SETTING:

The setting of the study was multiinstitutional.

PARTICIPANTS:

A total of 12 098 5-year pediatric cancer survivors from the Childhood Cancer Survivor Study, diagnosed with cancer prior to age 21 years, of whom 338 self-reported GH treatment, which was verified through medical record review.

INTERVENTIONS:

INTERVENTIONS included subject surveys, medical records abstraction, and pathological review.

OUTCOME MEASURES:

Incidence of meningioma, glioma, and other CNS-SNs was measured.

RESULTS:

Among GH-treated survivors, 16 (4.7%) developed CNS-SN, including 10 with meningioma and six with glioma. Two hundred three survivors without GH treatment (1.7%) developed CNS-SN, including 138 with meningioma, 49 with glioma, and 16 with other CNS-SNs. The adjusted rate ratio in GH-treated compared with untreated survivors for development of any CNS-SN was 1.0 [95% confidence interval (CI) 0.6-1.8, P = .94], for meningiomas, 0.8 (95% CI 0.4-1.7, P = .61), and for gliomas, 1.9 (95% CI 0.7-4.8, P = .21). Factors associated with meningioma development included female gender (P = .001), younger age at primary cancer diagnosis (P < .001), and CRT/longer time since CRT (P < .001). Glioma was associated with CRT/shorter time since CRT (P < .001).

CONCLUSIONS:

There was no statistically significant increased overall risk of the occurrence of a CNS-SN associated with GH exposure. Specifically, occurrence of meningiomas and gliomas were not associated with GH treatment.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01120353.

PMID:
24606096
PMCID:
PMC4037726
DOI:
10.1210/jc.2013-4159
[Indexed for MEDLINE]
Free PMC Article
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