Growth hormone exposure as a risk factor for the development of subsequent neoplasms of the central nervous system: A report from the childhood cancer survivor study

Briana C. Patterson, Yan Chen, Charles A. Sklar, Joseph Neglia, Yutaka Yasui, Ann Mertens, Gregory T. Armstrong, Anna Meadows, Marilyn Stovall, Leslie L. Robison, Lillian R. Meacham

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Abstract

Context: Cranial radiation therapy (CRT) predisposes toGHdeficiencyandsubsequent neoplasms (SNs) of the central nervous system (CNS). Increased rates of SNs have been reported in GH-treated survivors. Objective: The objective of the study was to evaluate the association between GH treatment and the development of CNS-SNs. Design: The study was designed with a retrospective cohort with longitudinal follow-up. Setting: The setting of the study was multiinstitutional. Participants:Atotal of 12 098 5-year pediatric cancer survivors from the Childhood Cancer Survivor Study, diagnosed with cancer prior toage21 years, ofwhom338 self-reportedGHtreatment, which was verified through medical record review. Interventions: Interventions included subject surveys, medical records abstraction, and pathological review. Outcome Measures: Incidence of meningioma, glioma, and other CNS-SNs was measured. Results:AmongGH-treated survivors, 16 (4.7%) developed CNS-SN, including 10 with meningioma and six with glioma.Twohundred three survivors withoutGHtreatment (1.7%) developed CNS-SN, including 138 with meningioma, 49 with glioma,and16 with other CNS-SNs. The adjusted rate ratio in GH-treated compared with untreated survivors for development of any CNS-SN was 1.0 [95% confidence interval (CI) 0.6 -1.8, P = .94], for meningiomas, 0.8 (95% CI 0.4 -1.7, P = .61), and for gliomas, 1.9 (95% CI 0.7- 4.8, P = .21). Factors associated with meningioma development included female gender (P=.001), younger age at primary cancer diagnosis (P.001), and CRT/longer time since CRT (P .001). Glioma was associated with CRT/shorter time since CRT (P .001). Conclusions: There was no statistically significant increased overall risk of the occurrence of a CNS-SN associated with GH exposure. Specifically, occurrence of meningiomas and gliomas were not associated with GH treatment.

Original languageEnglish (US)
Pages (from-to)2030-2037
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume99
Issue number6
DOIs
StatePublished - Jan 1 2014

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Central Nervous System Neoplasms
Neurology
Meningioma
Growth Hormone
Glioma
Central Nervous System
Radiotherapy
Neoplasms
Confidence Intervals
Medical Records
Pediatrics
Outcome Assessment (Health Care)
Incidence
Therapeutics

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Growth hormone exposure as a risk factor for the development of subsequent neoplasms of the central nervous system : A report from the childhood cancer survivor study. / Patterson, Briana C.; Chen, Yan; Sklar, Charles A.; Neglia, Joseph; Yasui, Yutaka; Mertens, Ann; Armstrong, Gregory T.; Meadows, Anna; Stovall, Marilyn; Robison, Leslie L.; Meacham, Lillian R.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 99, No. 6, 01.01.2014, p. 2030-2037.

Research output: Contribution to journalArticle

Patterson, Briana C. ; Chen, Yan ; Sklar, Charles A. ; Neglia, Joseph ; Yasui, Yutaka ; Mertens, Ann ; Armstrong, Gregory T. ; Meadows, Anna ; Stovall, Marilyn ; Robison, Leslie L. ; Meacham, Lillian R. / Growth hormone exposure as a risk factor for the development of subsequent neoplasms of the central nervous system : A report from the childhood cancer survivor study. In: Journal of Clinical Endocrinology and Metabolism. 2014 ; Vol. 99, No. 6. pp. 2030-2037.
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title = "Growth hormone exposure as a risk factor for the development of subsequent neoplasms of the central nervous system: A report from the childhood cancer survivor study",
abstract = "Context: Cranial radiation therapy (CRT) predisposes toGHdeficiencyandsubsequent neoplasms (SNs) of the central nervous system (CNS). Increased rates of SNs have been reported in GH-treated survivors. Objective: The objective of the study was to evaluate the association between GH treatment and the development of CNS-SNs. Design: The study was designed with a retrospective cohort with longitudinal follow-up. Setting: The setting of the study was multiinstitutional. Participants:Atotal of 12 098 5-year pediatric cancer survivors from the Childhood Cancer Survivor Study, diagnosed with cancer prior toage21 years, ofwhom338 self-reportedGHtreatment, which was verified through medical record review. Interventions: Interventions included subject surveys, medical records abstraction, and pathological review. Outcome Measures: Incidence of meningioma, glioma, and other CNS-SNs was measured. Results:AmongGH-treated survivors, 16 (4.7{\%}) developed CNS-SN, including 10 with meningioma and six with glioma.Twohundred three survivors withoutGHtreatment (1.7{\%}) developed CNS-SN, including 138 with meningioma, 49 with glioma,and16 with other CNS-SNs. The adjusted rate ratio in GH-treated compared with untreated survivors for development of any CNS-SN was 1.0 [95{\%} confidence interval (CI) 0.6 -1.8, P = .94], for meningiomas, 0.8 (95{\%} CI 0.4 -1.7, P = .61), and for gliomas, 1.9 (95{\%} CI 0.7- 4.8, P = .21). Factors associated with meningioma development included female gender (P=.001), younger age at primary cancer diagnosis (P.001), and CRT/longer time since CRT (P .001). Glioma was associated with CRT/shorter time since CRT (P .001). Conclusions: There was no statistically significant increased overall risk of the occurrence of a CNS-SN associated with GH exposure. Specifically, occurrence of meningiomas and gliomas were not associated with GH treatment.",
author = "Patterson, {Briana C.} and Yan Chen and Sklar, {Charles A.} and Joseph Neglia and Yutaka Yasui and Ann Mertens and Armstrong, {Gregory T.} and Anna Meadows and Marilyn Stovall and Robison, {Leslie L.} and Meacham, {Lillian R.}",
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T1 - Growth hormone exposure as a risk factor for the development of subsequent neoplasms of the central nervous system

T2 - A report from the childhood cancer survivor study

AU - Patterson, Briana C.

AU - Chen, Yan

AU - Sklar, Charles A.

AU - Neglia, Joseph

AU - Yasui, Yutaka

AU - Mertens, Ann

AU - Armstrong, Gregory T.

AU - Meadows, Anna

AU - Stovall, Marilyn

AU - Robison, Leslie L.

AU - Meacham, Lillian R.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Context: Cranial radiation therapy (CRT) predisposes toGHdeficiencyandsubsequent neoplasms (SNs) of the central nervous system (CNS). Increased rates of SNs have been reported in GH-treated survivors. Objective: The objective of the study was to evaluate the association between GH treatment and the development of CNS-SNs. Design: The study was designed with a retrospective cohort with longitudinal follow-up. Setting: The setting of the study was multiinstitutional. Participants:Atotal of 12 098 5-year pediatric cancer survivors from the Childhood Cancer Survivor Study, diagnosed with cancer prior toage21 years, ofwhom338 self-reportedGHtreatment, which was verified through medical record review. Interventions: Interventions included subject surveys, medical records abstraction, and pathological review. Outcome Measures: Incidence of meningioma, glioma, and other CNS-SNs was measured. Results:AmongGH-treated survivors, 16 (4.7%) developed CNS-SN, including 10 with meningioma and six with glioma.Twohundred three survivors withoutGHtreatment (1.7%) developed CNS-SN, including 138 with meningioma, 49 with glioma,and16 with other CNS-SNs. The adjusted rate ratio in GH-treated compared with untreated survivors for development of any CNS-SN was 1.0 [95% confidence interval (CI) 0.6 -1.8, P = .94], for meningiomas, 0.8 (95% CI 0.4 -1.7, P = .61), and for gliomas, 1.9 (95% CI 0.7- 4.8, P = .21). Factors associated with meningioma development included female gender (P=.001), younger age at primary cancer diagnosis (P.001), and CRT/longer time since CRT (P .001). Glioma was associated with CRT/shorter time since CRT (P .001). Conclusions: There was no statistically significant increased overall risk of the occurrence of a CNS-SN associated with GH exposure. Specifically, occurrence of meningiomas and gliomas were not associated with GH treatment.

AB - Context: Cranial radiation therapy (CRT) predisposes toGHdeficiencyandsubsequent neoplasms (SNs) of the central nervous system (CNS). Increased rates of SNs have been reported in GH-treated survivors. Objective: The objective of the study was to evaluate the association between GH treatment and the development of CNS-SNs. Design: The study was designed with a retrospective cohort with longitudinal follow-up. Setting: The setting of the study was multiinstitutional. Participants:Atotal of 12 098 5-year pediatric cancer survivors from the Childhood Cancer Survivor Study, diagnosed with cancer prior toage21 years, ofwhom338 self-reportedGHtreatment, which was verified through medical record review. Interventions: Interventions included subject surveys, medical records abstraction, and pathological review. Outcome Measures: Incidence of meningioma, glioma, and other CNS-SNs was measured. Results:AmongGH-treated survivors, 16 (4.7%) developed CNS-SN, including 10 with meningioma and six with glioma.Twohundred three survivors withoutGHtreatment (1.7%) developed CNS-SN, including 138 with meningioma, 49 with glioma,and16 with other CNS-SNs. The adjusted rate ratio in GH-treated compared with untreated survivors for development of any CNS-SN was 1.0 [95% confidence interval (CI) 0.6 -1.8, P = .94], for meningiomas, 0.8 (95% CI 0.4 -1.7, P = .61), and for gliomas, 1.9 (95% CI 0.7- 4.8, P = .21). Factors associated with meningioma development included female gender (P=.001), younger age at primary cancer diagnosis (P.001), and CRT/longer time since CRT (P .001). Glioma was associated with CRT/shorter time since CRT (P .001). Conclusions: There was no statistically significant increased overall risk of the occurrence of a CNS-SN associated with GH exposure. Specifically, occurrence of meningiomas and gliomas were not associated with GH treatment.

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