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The late effects of cranial irradiation in childhood on the hypothalamic-pituitary axis: a radiotherapist's perspective
Lovgren, Isabelle Abravan, Azadeh Bryce-Atkinson, Abigail Van Herk, Marcel
Lovgren, Isabelle
Abravan, Azadeh
Bryce-Atkinson, Abigail
Van Herk, Marcel
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Abstract
Brain tumours make up nearly one-third of paediatric malignancies. Over time,
advancements in oncological treatments like radiotherapy have helped reduce
normal-tissue toxicity when treating cancers in the brain. However, clinicians are still facing
a trade-off between treatment efficacy and potential side effects. The aim of this review is to
address the late effects of cranial irradiation on the neuroendocrine system and to identify
factors that make patients more vulnerable to radiation-induced endocrine sequelae.
Radiation damage to the hypothalamic–pituitary axis, which orchestrates hormone release,
can lead to endocrinopathy; up to 48.8% of children who have undergone cranial irradiation
develop a hormone deficiency. This may lead to further health complications that can appear
up to decades after the last treatment, lowering the patients’ quality of life and increasing
long-term costs as lifelong hormone replacement therapy may be required. Growth hormone
deficiency is the most common sequelae, followed by either thyroid or gonadotropic
hormone deficiency. Adrenocorticotropic hormone deficiency tends to be the least common.
Identified factors that increase the risk of late endocrine deficiency include total radiation
dose, age at treatment, and time since last treatment. However, as there are various other
factors tha t may potentiate the damage, a universal solution proven to be most effective in
sparing the endocrine tissues is yet to be identified. Until then, accounting for the identified
risk factors during treatment planning may in some cases help reduce the development of endocrine sequelae in childhood cancer survivors.
Description
Date
2022
Publisher
Collections
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36269600.pdf
Adobe PDF, 1.68 MB
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Article
Citation
Lovgren I, Abravan A, Bryce-Atkinson A, Van Herk M. The late effects of cranial irradiation in childhood on the hypothalamic-pituitary axis: a radiotherapist's perspective. Endocrine Connections. 2022 Dec;11(12). PubMed PMID: WOS:000904170800005.