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Long-Term Effect of Cranial Radiotherapy on Pituitary-Hypothalamus Area in Childhood Acute Lymphoblastic Leukemia Survivors

Follin, Cecilia LU and Erfurth, Eva Marie LU (2016) In Current Treatment Options in Oncology 17(9).
Abstract

Survival rates of childhood cancer have improved markedly, and today more than 80 % of those diagnosed with a pediatric malignancy will become 5-year survivors. Nevertheless, survivors exposed to cranial radiotherapy (CRT) are at particularly high risk for long-term morbidity, such as endocrine insufficiencies, metabolic complications, and cardiovascular morbidity. Deficiencies of one or more anterior pituitary hormones have been described following therapeutic CRT for primary brain tumors, nasopharyngeal tumors, and following prophylactic CRT for childhood acute lymphoblastic leukemia (ALL). Studies have consistently shown a strong correlation between the total radiation dose and the development of pituitary deficits. Further, age at... (More)

Survival rates of childhood cancer have improved markedly, and today more than 80 % of those diagnosed with a pediatric malignancy will become 5-year survivors. Nevertheless, survivors exposed to cranial radiotherapy (CRT) are at particularly high risk for long-term morbidity, such as endocrine insufficiencies, metabolic complications, and cardiovascular morbidity. Deficiencies of one or more anterior pituitary hormones have been described following therapeutic CRT for primary brain tumors, nasopharyngeal tumors, and following prophylactic CRT for childhood acute lymphoblastic leukemia (ALL). Studies have consistently shown a strong correlation between the total radiation dose and the development of pituitary deficits. Further, age at treatment and also time since treatment has strong implications on pituitary hormone deficiencies. There is evidence that the hypothalamus is more radiosensitive than the pituitary and is damaged by lower doses of CRT. With doses of CRT 50 Gy) may produce direct anterior pituitary damage, which contributes to multiple pituitary deficiencies. The large group of ALL survivors treated with CRT in the 70–80-ties has now reached adulthood, and these survivors were treated mainly with 24 Gy, and the vast majority of these patients suffer from GHD. Further, after long-term follow-up, insufficiencies in prolactin (PRL) and thyroid stimulating hormone (TSH) have also been reported and a proportion of these patients were also adrenocoticotrophic hormone (ACTH) deficient. CRT to the hypothalamus causes neuroendocrine dysfunction, which means that the choice of GH test is crucial for the diagnosis of GHD.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adrenocorticotrophic hormone, Childhood acute lymphoblastic leukemia, Cranial radiotherapy, Gonadotropin, Growth hormone, Hypothalamic-pituitary axis, Late complications, Pituitary hormone deficiency, Prolactin, Thyroid stimulating hormone
in
Current Treatment Options in Oncology
volume
17
issue
9
publisher
Springer New York
external identifiers
  • Scopus:84982706125
ISSN
1527-2729
DOI
10.1007/s11864-016-0426-0
language
English
LU publication?
yes
id
0cf6961d-f66b-4790-baa5-cc23bbf43819
date added to LUP
2016-09-01 16:00:34
date last changed
2016-09-01 16:00:34
@misc{0cf6961d-f66b-4790-baa5-cc23bbf43819,
  abstract     = {<p>Survival rates of childhood cancer have improved markedly, and today more than 80 % of those diagnosed with a pediatric malignancy will become 5-year survivors. Nevertheless, survivors exposed to cranial radiotherapy (CRT) are at particularly high risk for long-term morbidity, such as endocrine insufficiencies, metabolic complications, and cardiovascular morbidity. Deficiencies of one or more anterior pituitary hormones have been described following therapeutic CRT for primary brain tumors, nasopharyngeal tumors, and following prophylactic CRT for childhood acute lymphoblastic leukemia (ALL). Studies have consistently shown a strong correlation between the total radiation dose and the development of pituitary deficits. Further, age at treatment and also time since treatment has strong implications on pituitary hormone deficiencies. There is evidence that the hypothalamus is more radiosensitive than the pituitary and is damaged by lower doses of CRT. With doses of CRT 50 Gy) may produce direct anterior pituitary damage, which contributes to multiple pituitary deficiencies. The large group of ALL survivors treated with CRT in the 70–80-ties has now reached adulthood, and these survivors were treated mainly with 24 Gy, and the vast majority of these patients suffer from GHD. Further, after long-term follow-up, insufficiencies in prolactin (PRL) and thyroid stimulating hormone (TSH) have also been reported and a proportion of these patients were also adrenocoticotrophic hormone (ACTH) deficient. CRT to the hypothalamus causes neuroendocrine dysfunction, which means that the choice of GH test is crucial for the diagnosis of GHD.</p>},
  author       = {Follin, Cecilia and Erfurth, Eva Marie},
  issn         = {1527-2729},
  keyword      = {Adrenocorticotrophic hormone,Childhood acute lymphoblastic leukemia,Cranial radiotherapy,Gonadotropin,Growth hormone,Hypothalamic-pituitary axis,Late complications,Pituitary hormone deficiency,Prolactin,Thyroid stimulating hormone},
  language     = {eng},
  month        = {09},
  number       = {9},
  publisher    = {ARRAY(0xae2bb38)},
  series       = {Current Treatment Options in Oncology},
  title        = {Long-Term Effect of Cranial Radiotherapy on Pituitary-Hypothalamus Area in Childhood Acute Lymphoblastic Leukemia Survivors},
  url          = {http://dx.doi.org/10.1007/s11864-016-0426-0},
  volume       = {17},
  year         = {2016},
}