Background: Childhood cancer survivors (CCS) are at increased risk of endocrinopathies; as a consequence of cranial/craniospinal radiotherapy and alkylating agents. Hypothalamic-pituitary dysfunction, thyroid dysfunction and gonadal failure are frequently seen.
Aim: To explore the endocrine monitoring following completion of treatment for central nervous system (CNS) tumours within a regional paediatric oncology service.
Methods: Children who received radiotherapy as part of treatment of CNS tumours, 2004-2019, were included. Records of growth hormone (GH) stimulation tests, thyroid function tests (TFT), ACTH stimulation tests, gonadotrophins, oestradiol/AMH (girls) and testosterone (boys) were collected.
Results: Of 100 CCS (38 treated for medulloblastoma, 62 for other CNS tumours), 43 (43%, 20 males) completed treatment successfully [19 (50%) for medulloblastoma and 24 (39%) for other CNS tumours (P = 0.303)]. Median age at diagnosis was 7.6 years (0.69-16.28). Median time since completion of treatment was 6.25 years (1.25-14.41). Median dose of total radiotherapy received was 5540cGy (4420-8000) for medulloblastoma and 5400cGy (50-6000) for other CNS tumours (P = 0.002). GH stimulation test was performed in 33/43 (76.7%) at a median time of 1.29 years (0.08-6.5) post-treatment. TFT were performed in 36/43 (83.7%), at a median time of 1.44 years (0.08-6.92) post-treatment. ACTH stimulation test was performed in 33/43 (76.7%), at a median time of 2.25 years (0.67-8.75) post-treatment. Gonadotrophins were tested in 33/43 (76.7%) children, at a median time of 1.69 years (0.14-6.89) post-treatment. Gonadal function was tested, in 24/43 (55.81%) children [15/19 (78.9%) with medulloblastoma and in 9/24 (37.5%) with other CNS tumours (P = 0.013)], at a median time of 3.02 years (0.14-6.62) post-treatment [2.9 years (0.1-6.6) and 4.9 years (1.0-6.6) for medulloblastoma and other tumours respectively (P = 0.022)]. GH deficiency was diagnosed in all 14/14 (100%) children tested with medulloblastoma and 16/19 (84.2%) with other CNS tumours (P = 0.887). Hypothyroidism was seen in 11/16 (68.8%) children with medulloblastoma and in 5/20 (25%) with other CNS tumours (P = 0.018). Inadequate cortisol response was noted in 1/15 (6.7%) for medulloblastoma and 4/19 (21.1%) for others (P = 0.577). Hypogonadism was diagnosed in 2/16 (12.5%) children for medulloblastoma and 8/17 (47.1%) with other CNS tumours (P = 0.057).
Conclusions: The majority of children had appropriate monitoring for endocrine sequelae following treatment of CNS tumours, however, there was variability in those endocrine axes included and timing of the initial endocrine evaluation with potential clinical compromise resulting from either delay or missing investigations. A systematic approach to monitoring would ensure timely management and treatment of all endocrine complications.
22 Sep 2021 - 26 Sep 2021