© 2004 by Society
© 2004 by the Society forNeuro-Oncology
Endocrine outcome in children with medulloblastoma treated with 18 Gy ofcraniospinal radiation therapy
Divisions of Endocrinology (W.X., T.M.) and Neurology and Oncology (A.J., P.P.) and Department ofPediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA19104; Department of Radiation Oncology, University ofPennsylvania School of Medicine, Philadelphia, PA 19104 (J.G.); and Department of Neurology and Oncology, Children's NationalMedical Center, The George Washington University, Washington, DC 20010(R.J.P.); USA
2 Address correspondence to Thomas Moshang Jr., Division of Endocrinology, TheChildren's Hospital of Philadelphia, 34th Street and Civic Center Boulevard,Philadelphia, PA 19104, USA(Moshang{at}email.chop.edu).
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Abstract |
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Craniospinal radiation therapy (CSRT) combined with chemotherapy results insignificant endocrine morbidity. Between 1987 and 1990, a trial using 18 Gywas conducted to treat 10 young children with medulloblastoma. There were 7survivors. We compared the endocrine outcome in these children (group 18 Gy)to that of a comparable group treated with conventional doses of CSRT thatranged from 23 to 39 Gy (group CD). Both groups had an identical history ofchemotherapy and tumor stage and were treated with recombinant growth hormonetherapy (rhGH). The mean age of group 18 Gy at diagnosis was 4.0 years, andrhGH treatment was initiated in 6 children at age 9.2 years. Group CD (12children) was diagnosed at a mean age of 5.8 years and rhGH started in 11children at a mean age of 9.6 years. The dose of rhGH used in both groups wasidentical (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) thanthose for group CD (mean standard deviation score of -2.04 ± 0.83 and-3.16 ± 1.43, respectively). Moreover, adult heights of group 18 Gywere not different from midparental heights, unlike group CD, whose adultheights were less than midparental heights (P < 0.0001). Of otherendocrine sequelae, 10 patients of the CD group were hypothyroid, 3 hadadrenal insufficiency, 3 had hypogonadism, and 2 had early puberty. Incontrast, within group 18 Gy, only 1 was hypothyroid (P = 0.006) and1 had early puberty. We conclude that endocrine morbidity was significantlyreduced with 18 Gy CSRT in young children with medulloblastoma.
Received August 12, 2003; Accepted September 25, 2003
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