Long-Term Safety of Growth Hormone Replacement after CNS Irradiation
ABSTRACT Radiotherapy is a central component in the treatment of many brain tumors, but long-term sequelae include GH deficiency and increased risk of secondary neoplasms. It is unclear whether replacement therapy with GH (GHRT) further increases this risk.
The objective of the study was to assess the effect of GHRT on the incidence of secondary tumors and tumor recurrence after cranial irradiation.
We conducted a retrospective matched-pairs analysis of previously irradiated patients, with and without GHRT, attending a tertiary center between 1994 and 2009. Patients: We reviewed the records for all patients undergoing GHRT at our institution over the study period. Patients were included if they had received cranial irradiation, GHRT for at least 12 months, and records of serial magnetic resonance imaging data and data for dose and fractionation of irradiation were available. GH-naïve control patients were selected from a radiotherapy database of patients attending the same hospital. Patients were matched for date of radiotherapy, age, site of primary diagnosis, radiation dose, and fractionation.
The primary outcome measure was risk of tumor recurrence or secondary tumor.
Matched controls were identified for 110 GH-treated patients. Median follow-up was 14.5 yr. No significant differences were apparent in the number of tumor recurrences (six vs. eight, GHRT vs. control group) or secondary tumors (five vs. three, respectively) between groups.
Our study demonstrates no increased risk for recurrent or secondary neoplasms in patients receiving GHRT, thus supporting a high safety profile of GHRT after central nervous system irradiation.
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ABSTRACT: Human growth hormone (hGH) replacement therapy has been widely available for clinical purposes for more than fifty years. Starting in 1958, hGH was obtained from cadaveric pituitaries, but in 1985 the association between hGH therapy and Creutzfeldt-Jakob disease was reported. In the same year, the use of recombinant hGH (rhGH) was approved. Side effects of rhGH replacement therapy in children and adolescents include rash and pain at injection site, transient fever, prepubertal gynecomastia, arthralgia, edema, benign intracranial hypertension, insulin resistance, progression of scoliosis, and slipped capital femoral epiphysis. Since GH stimulates cell multiplication, development of neoplasms is a concern. We will review the side effects reported in all rhGH indications.Arquivos brasileiros de endocrinologia e metabologia 11/2011; 55(8):559-65. DOI:10.1590/S0004-27302011000800009 · 0.68 Impact Factor
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ABSTRACT: Oregon Health & Science University (R.G.R.), Portland, Oregon 97239; University of California-Los Angeles (P.Co.), Los Angeles, California 90095; St. Jude Children's Research Hospital (L.L.R.), Memphis, Tennessee 38105; University of South Florida College of Medicine (B.B.B.), Tampa, Florida 33612; The University of Manchester (P.Cl.), Manchester M13 9PL, United Kingdom; Stanford University (A.R.H.), Stanford, California 94305; Johns Hopkins Medical Institutions (S.R.), Baltimore, Maryland 21287; Montefiore Medical Center (P.S.), Bronx, New York 10467; Saint Bartholomew's and the Royal London School of Medicine and Dentistry (M.O.S.), London E1 2AD, United Kingdom; and Leiden University Medical Center (J.M.W.), 2333 ZA Leiden, The NetherlandsThe Journal of Clinical Endocrinology and Metabolism 12/2011; 97(1):68-72. DOI:10.1210/jc.2011-2294 · 6.31 Impact Factor
- Journal of Clinical Oncology 12/2011; 29(36):4743-4. DOI:10.1200/JCO.2011.38.9833 · 18.43 Impact Factor