[en] OBJECTIVES: The treatment of brain tumors in childhood is frequently complicated by growth retardation with a high proportion of irradiation (Irr)-induced GH deficiency (GHD) resulting in reduced adult final height (AFH) even after GH therapy (GHT). In order to optimize future GHT protocols, more information on the factors influencing the growth response to GH in these children is needed. This retrospective study evaluated AFH and influencing auxological and treatment factors of a standardized daily biosynthetic GHT in childhood survivors of brain tumors with documented GHD after brain Irr. DESIGN AND METHODS: From the Belgian GH Registry, 57 children survivors of a brain tumor outside the hypothalamo-pituitary area with available AFH were stratified into two groups depending on cranial (C-Irr; n=25) or craniospinal (CS-Irr; n=32) Irr. RESULTS: In the C-Irr patients, results showed an AFH of -0.8 (-2.5, 1.4) SDS (median (range)) and in the CS-Irr patients, results showed a significantly (P<0.001) lower AFH of -1.8 (-4.2, 0.0) SDS. AFH SDS corrected for mid-parental height (MPH) in the C-Irr group was -0.5 (-2.2, 0.9) and -1.5 (-3.6, 0.0) SDS in the CS-Irr group. AFH was positively correlated with age at end of tumor therapy, height SDS at start GHT, height gain SDS first year GHT, and negatively correlated with CS-Irr. CONCLUSIONS: GHT failed to restore adult height to MPH in nearly half of Irr-induced GHD patients for brain tumor, especially those receiving CS-Irr, irradiated at a younger age or shorter at start GHT.
Clayton PE, Shalet SM & Price DA. Growth response to growth hormone therapy following cranial irradiaton. European Journal of Pediatrics 1988 147 593-596.
Clayton PE, Shalet SM & Price DA. Growth response to growth hormone therapy following craniospinal irradiation. European Journal of Pediatrics 1988 147 597-601.
Sulmont V, Brauner R, Fontoura M & Rappaport R. Response to growth hormone treatment and final height after cranial or craniospinal irradiation. Acta Paediatrica Scandinavica 1990 79 542-549.
Ogilvy-Stuart AL & Shalet SM. Growth and puberty after growth hormone treatment after irradiation for brain tumours. Archives of Disease in Childhood 1995 73 141-146.
Adan L, Sainte-Rose C, Souberbielle JC, Zucker JM, Kalifa C & Brauner R. Adult height after growth hormone (GH) treatment for GH deficiency due to cranial irradiation. Medical and Pediatric Oncology 2000 34 14-19.
Xu W, Janss A & Moshang T. Adult height and adult sitting height in childhood medulloblastoma survivors. Journal of Clinical Endocrinology and Metabolism 2003 88 4677-4681.
Gleeson HK, Stoeter R, Ogilvy-Stuart AL, Gattamaneni HR, Brennan BM & Shalet SM. Improvements in final height over 25 years in growth hormone (GH)-deficient childhood survivors of brain tumors receiving GH replacement. Journal of Clinical Endocrinology and Metabolism 2003 88 3682-3689.
Ranke MB. KIGS patients with acquired growth hormone deficiency. In Growth Hormone Therapy in Pediatrics - 20 years KIGS, pp 250-260. Eds MB Ranke, DA Price & EO Reiter, Basel: Karger, 2007.
Tanner JM. Growth and Adolescence Oxford: Blackwell, 1962.
Freeman JV, Cole TJ, Chinn S, Jones PR, White EM & Preece MA. Cross sectional stature and weight reference curves for the UK, 1990. Archives of Disease in Childhood 1995 73 17-24.
Cole TJ, Freeman JV & PreeceMA. Body mass index reference curves for the UK, 1990. Archives of Disease in Childhood 1995 73 25-29
Wit JM. Idiopathic short stature: reflections on its definition and spontaneous growth. Hormone Research 2007 67 (Suppl 1) 50-57.
Kiltie AE, Lashford LS & Gattamanemi HR. Survival and late effects in medulloblastoma patients treated with craniospinal irradiation under three years old. Medical and Pediatric Oncology 1997 28 348-354.
Shalet SM, Gibson B, Swindell R & Pearson D. Effect of spinal irradiation on growth. Archives of Disease in Childhood 1987 62 461-464.
Clayton PE & Shalet SM. The evolution of spinal growth after irradiation. Clinical Oncology 1991 3 220-222.
Eiffel PJ, Donaldson SS & Thomas PRM. Response to growing bone to irradiation: a proposed late effects scoring system. International Journal of Radiation Oncology, Biology, Physics 1995 31 1301-1307.
Miralbell R, Lomax A & Russo M. Potential role of proton therapy in the treatment of pediatric medulloblastoma/primitive neuroectodermal tumors: spinal theca irradiation. International Journal of Radiation Oncology, Biology, Physics 1997 38 805-811.
Ranke MB, Price DA, Lindberg A, Wilton P, Darendeliler F, Reiter EO & for the KIGS International Board. Final height in children with medulloblastoma treated with growth hormone. Hormone Research 2005 64 28-34.
Ogilvy-Stuart AL, Clayton PE & Shalet SM. Cranial irradiation and early puberty. Journal of Clinical Endocrinology and Metabolism 1994 78 1282-1286.
Lerner SE, Huang GJM, McMahon D, Sklar CA & Oberfield SE. Growth hormone therapy in children after cranial/craniospinal radiation therapy: sexually dimorphic outcomes. Journal of Clinical Endocrinology and Metabolism 2004 89 6100-6104.