Adult growth hormone replacement therapy and neuroimaging surveillance in brain tumour survivors.

2.50
Hdl Handle:
http://hdl.handle.net/10541/74899
Title:
Adult growth hormone replacement therapy and neuroimaging surveillance in brain tumour survivors.
Authors:
Jostel, Andreas; Mukherjee, Annice; Hulse, Paul; Shalet, Stephen M
Abstract:
OBJECTIVE: Systematic collections of neuroimaging data are nonexistent in brain tumour survivors treated with adult growth hormone replacement therapy (AGHRT). We present our surveillance data. DESIGN: In 1993, our unit implemented a policy of performing brain scans on every brain tumour survivor before starting AGHRT, with repeat neuroimaging at least once after 12-18 months' treatment. Reports for baseline scans and most recent scans were analysed for this retrospective study. PATIENTS: All brain tumour survivors who received AGHRT (60 patients) were included in the analysis. MEASUREMENTS: Evidence and extent of residual tumour, tumour progression, tumour recurrence, and secondary neoplasms (SN) on baseline scan and latest follow-up scan. RESULTS: All patients had baseline scans performed. Follow-up scans were available in 41/45 (91%) patients who received AGHRT for more than 1 year (mean duration +/- SD of GHRT was 6.7 +/- 3.6 years). Sixteen patients had residual tumours, and SNs (all meningiomas) were demonstrated in three patients on baseline scans. Appearances remained stable in 34 (83%) patients during follow-up (extending to 17.4 +/- 8.3 years after tumour diagnosis). Of the 16 residual primary tumours, an incurable ependymoma continued to grow, and one meningioma progressed slightly in size over 7.7 years. Follow-up scans also revealed continued growth of the SNs detected at baseline, and five additional meningiomas (two in patients with a previous SN, confirming an excess risk in this subgroup, P = 0.02). All SNs occurred on average 22.8 (range 17-37) years after radiotherapy. CONCLUSIONS: Our data do not suggest an increased rate of recurrence or progression of childhood brain tumours during AGHRT. Nonetheless, vigilance and long-term surveillance are needed in these patients in order to detect and monitor SNs, in particular in patients with a previous history of a SN. We endorse a proactive neuroimaging policy, preferably as part of a larger, controlled trial in the future.
Affiliation:
Department of Endocrinology, Christie Hospital, Wilmslow Road, Manchester, M20 4BX, UK.
Citation:
Adult growth hormone replacement therapy and neuroimaging surveillance in brain tumour survivors. 2005, 62 (6):698-705 Clin. Endocrinol. (Oxf)
Journal:
Clinical Endocrinology
Issue Date:
Jun-2005
URI:
http://hdl.handle.net/10541/74899
DOI:
10.1111/j.1365-2265.2005.02282.x
PubMed ID:
15943832
Type:
Article
Language:
en
ISSN:
0300-0664
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorJostel, Andreas-
dc.contributor.authorMukherjee, Annice-
dc.contributor.authorHulse, Paul-
dc.contributor.authorShalet, Stephen M-
dc.date.accessioned2009-07-22T09:27:29Z-
dc.date.available2009-07-22T09:27:29Z-
dc.date.issued2005-06-
dc.identifier.citationAdult growth hormone replacement therapy and neuroimaging surveillance in brain tumour survivors. 2005, 62 (6):698-705 Clin. Endocrinol. (Oxf)en
dc.identifier.issn0300-0664-
dc.identifier.pmid15943832-
dc.identifier.doi10.1111/j.1365-2265.2005.02282.x-
dc.identifier.urihttp://hdl.handle.net/10541/74899-
dc.description.abstractOBJECTIVE: Systematic collections of neuroimaging data are nonexistent in brain tumour survivors treated with adult growth hormone replacement therapy (AGHRT). We present our surveillance data. DESIGN: In 1993, our unit implemented a policy of performing brain scans on every brain tumour survivor before starting AGHRT, with repeat neuroimaging at least once after 12-18 months' treatment. Reports for baseline scans and most recent scans were analysed for this retrospective study. PATIENTS: All brain tumour survivors who received AGHRT (60 patients) were included in the analysis. MEASUREMENTS: Evidence and extent of residual tumour, tumour progression, tumour recurrence, and secondary neoplasms (SN) on baseline scan and latest follow-up scan. RESULTS: All patients had baseline scans performed. Follow-up scans were available in 41/45 (91%) patients who received AGHRT for more than 1 year (mean duration +/- SD of GHRT was 6.7 +/- 3.6 years). Sixteen patients had residual tumours, and SNs (all meningiomas) were demonstrated in three patients on baseline scans. Appearances remained stable in 34 (83%) patients during follow-up (extending to 17.4 +/- 8.3 years after tumour diagnosis). Of the 16 residual primary tumours, an incurable ependymoma continued to grow, and one meningioma progressed slightly in size over 7.7 years. Follow-up scans also revealed continued growth of the SNs detected at baseline, and five additional meningiomas (two in patients with a previous SN, confirming an excess risk in this subgroup, P = 0.02). All SNs occurred on average 22.8 (range 17-37) years after radiotherapy. CONCLUSIONS: Our data do not suggest an increased rate of recurrence or progression of childhood brain tumours during AGHRT. Nonetheless, vigilance and long-term surveillance are needed in these patients in order to detect and monitor SNs, in particular in patients with a previous history of a SN. We endorse a proactive neuroimaging policy, preferably as part of a larger, controlled trial in the future.en
dc.language.isoenen
dc.subjectCanceren
dc.subjectBrain Canceren
dc.subjectCancer Recurrenceen
dc.subjectCancer Metastasisen
dc.subjectSecond Primary Canceren
dc.subject.meshAdolescent-
dc.subject.meshAdult-
dc.subject.meshAged-
dc.subject.meshBrain Neoplasms-
dc.subject.meshDisease Progression-
dc.subject.meshFemale-
dc.subject.meshFollow-Up Studies-
dc.subject.meshGrowth Hormone-
dc.subject.meshHormone Replacement Therapy-
dc.subject.meshHumans-
dc.subject.meshMagnetic Resonance Imaging-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshNeoplasm Metastasis-
dc.subject.meshNeoplasm Recurrence, Local-
dc.subject.meshNeoplasm, Residual-
dc.subject.meshNeoplasms, Second Primary-
dc.subject.meshTomography, X-Ray Computed-
dc.titleAdult growth hormone replacement therapy and neuroimaging surveillance in brain tumour survivors.en
dc.typeArticleen
dc.contributor.departmentDepartment of Endocrinology, Christie Hospital, Wilmslow Road, Manchester, M20 4BX, UK.en
dc.identifier.journalClinical Endocrinologyen

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