Radiation Oncology/Toxicity/Pituitary

Hypothalamus-Pituitary Axis RT Tolerance

• Childhood Cancer Survivor Study; 2009 (1970-1986) PMID 19364965 -- "Fertility of female survivors of childhood cancer: a report from the childhood cancer survivor study." (Green DM, J Clin Oncol. 2009 Jun 1;27(16):2677-85. Epub 2009 Apr 13.)
  • Retrospective. 5,149 femarle CCCS 5-year survivors not surgically sterile and cohort of 1,441 randomly selected female siblings
  • Outcome: RR for ever being pregnant 0.81 (SS)
  • Negative predictors: hypothalamic/pituitary RT dose >=30 Gy (RR 0.61), ovarian/uterine RT dose >5 Gy (RR 0.56) or RT dose >10 Gy (RR 0.18), treatment with lomustine or cyclophosphamide, or summed alkylating agent dose (AAD) 3-4
  • Conclusion: Fertility decreased among female pediatric cancer survivors

• St. Jude Hospital; 2008 PMID 18309946 -- "Endocrine outcomes for children with embryonal brain tumors after risk-adapted craniospinal and conformal primary-site irradiation and high-dose chemotherapy with stem-cell rescue on the SJMB-96 trial." (Laughton SJ, J Clin Oncol. 2008 Mar 1;26(7):1112-8.)
  • Prospective trial (SJMB-96). 88 children treated with risk-adapted CSI and conformal primary site RT. Median CSI dose for average risk 23.4 Gy, for high risk 39.6 Gy
  • Outcome: 4-year incidence of growth hormone deficiency 93%, adrenocorticotropic hormone deficiency 23%, primary hypothyroidism 65%.
  • Dose-response: Only for hypothyroidism: <42 Gy 11% vs. >=42 Gy 44% (SS)
  • Conclusion: Pediatric patients with CNS tumors at high risk for treatment-related hormone problems; RT dose >42 Gy associated with increased risk of hypothyroidism