Adult growth hormone replacement therapy and neuroimaging surveillance in brain tumour survivors.
Jostel, Andreas Mukherjee, Annice Hulse, Paul Shalet, Stephen M
Jostel, Andreas
Mukherjee, Annice
Hulse, Paul
Shalet, Stephen M
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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.
Description
Date
2005-06
Publisher
Collections
Keywords
Cancer
Brain Cancer
Cancer Recurrence
Cancer Metastasis
Second Primary Cancer
Brain Cancer
Cancer Recurrence
Cancer Metastasis
Second Primary Cancer
Type
Article
Citation
Adult growth hormone replacement therapy and neuroimaging surveillance in brain tumour survivors. 2005, 62 (6):698-705 Clin. Endocrinol. (Oxf)