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Height after photon craniospinal irradiation in pediatric patients treated for central nervous system embryonal
Masashi Mizumoto1,2, Yoshiko Oshiro1,2, Haitao Pan3
1Department of Radiation Oncology, St Jude Children's Research Hospital, Memphis, Tennessee.
Insights
Craniospinal irradiation (CSI) significantly impairs pediatric cancer patient height. Younger age, higher radiation doses, and female sex are key factors affecting growth impairment in survivors.
Area of Science:
- Pediatric Oncology
- Endocrinology
- Radiation Oncology
Background:
- Central nervous system (CNS) embryonal tumors are a significant concern in pediatric oncology.
- Craniospinal irradiation (CSI) is a common treatment modality for these tumors.
- Understanding factors affecting stature post-CSI is crucial for long-term patient well-being.
Purpose of the Study:
- To model height outcomes in pediatric patients treated with CSI for CNS embryonal tumors.
- To identify specific factors contributing to growth impairment and reduced final height.
- To develop predictive models for final height based on clinical variables.
Main Methods:
- Retrospective analysis of 212 pediatric patients (1996-2012) with CNS embryonal tumors receiving CSI.
- Patients received CSI doses of 23.4 Gy or ≥36 Gy, followed by similar chemotherapy regimens.
- Statistical models, including linear mixed-effects models, were used to identify factors associated with growth impairment and estimate final height.
Main Results:
- Mean final height z-scores at 18 years were -1.3 (female) and -1.5 (male).
- Younger age at CSI, higher CSI dose, and female sex were significantly associated with height impairment.
- Older age at CSI, male sex, lower CSI dose, and hormone replacement therapy (growth hormone, central adrenal insufficiency) were linked to better growth rates.
Conclusions:
- CSI significantly impairs height in pediatric patients with CNS embryonal tumors at current therapeutic doses.
- Developing strategies to mitigate the impact of CSI on height is essential.
- The developed models can serve as benchmarks for predicting and understanding growth outcomes.
Background:
We modeled height after craniospinal irradiation (CSI) in pediatric patients with central nervous system (CNS) embryonal tumors to identify factors that impair stature.
Procedure:
During 1996-2012, 212 pediatric patients (131 male) with CNS embryonal tumors received postoperative CSI: 23.4 Gy (n = 147) or ≥36 Gy (n = 65), similar postirradiation chemotherapy, and were followed for at least 5 years without tumor progression or other event. The group was further characterized by age at CSI and hormone-replacement therapy received. Models were developed to identify factors associated with growth impairment and estimate final height.
Results:
With median follow up of 10.2 years (range 5.0-20.4 years), the mean final height z-scores at 18 years of age, compared to United States standards, were -1.3 for female and -1.5 for male survivors. Younger age at the time of CSI, higher CSI dose, and female sex were associated with height impairment. Factors associated with higher growth rates before 15 years of age were older age at CSI, male sex, CSI dose < 36 Gy, replacement therapy for growth hormone (GH) and central adrenal insufficiency, and white race. Growth after age 15 in male survivors was associated with treatment of gonadotropin deficiency. Linear mixed-effects models were developed using clinical factors to estimate final height, demonstrate the unique growth curve of this cohort, and interactions between clinical variable and radiation dose.
Conclusions:
CSI significantly impaired height at current doses used to treat standard- or high-risk CNS embryonal tumors. Measures to reduce the impact of CSI on height should be sought, with our models serving as benchmarks.
