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GH and Childhood-onset Craniopharyngioma: When to Initiate GH Replacement Therapy?
Adrien Nguyen Quoc1,2, Kévin Beccaria2,3, Laura González Briceño1
1Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, 75015 Paris, France.
Insights
Initiating growth hormone replacement therapy (GHRT) sooner after childhood craniopharyngioma treatment does not increase tumor recurrence risk. This suggests GHRT can safely begin 6 months post-treatment for pediatric craniopharyngioma patients.
Area of Science:
- Pediatric Endocrinology
- Pediatric Oncology
- Neuro-oncology
Background:
- Craniopharyngioma, a benign brain tumor, frequently recurs or progresses post-treatment.
- Children with craniopharyngioma often develop growth hormone deficiency (GHD).
- Growth hormone replacement therapy (GHRT) is standard for GHD in these pediatric patients.
Purpose of the Study:
- To determine if delaying GHRT initiation after craniopharyngioma treatment impacts the risk of tumor recurrence or progression.
- To evaluate the safety and efficacy of earlier GHRT initiation in pediatric patients.
Main Methods:
- Retrospective, observational, monocenter study of 71 pediatric patients with craniopharyngioma.
- Patients were divided into groups based on GHRT initiation timing: >12 months vs. <12 months post-treatment.
- The primary outcome was the risk of tumor new events (progression or recurrence) analyzed using survival analysis and regression models.
Main Results:
- Event-free survival rates at 2 and 5 years were similar between groups (>12 months vs. <12 months).
- No statistically significant difference in event-free survival was observed between patients treated earlier (<12 months) or later (>12 months) after craniopharyngioma treatment.
- Univariate and multivariate analyses confirmed no association between GHRT time delay and increased risk of tumor recurrence or progression.
Conclusions:
- Delaying GHRT initiation after childhood craniopharyngioma treatment is not associated with an increased risk of tumor recurrence or progression.
- GHRT can be safely initiated as early as 6 months after the completion of craniopharyngioma treatment.
- This finding supports earlier intervention with GHRT for growth hormone deficiency in pediatric survivors of craniopharyngioma.
Context:
Craniopharyngioma is a benign brain tumor with frequent local recurrence or progression after treatment. GH replacement therapy (GHRT) is prescribed in children with GH deficiency resulting from childhood-onset craniopharyngioma.
Objective:
To evaluate whether a shorter delay of GHRT initiation after childhood-onset craniopharyngioma completion therapy increased the risk of a new event (progression or recurrence).
Methods:
Retrospective, observational, monocenter study. We compared a cohort of 71 childhood-onset patients with craniopharyngiomas treated with recombinant human GH (rhGH). Twenty-seven patients were treated with rhGH at least 12 months after craniopharyngioma treatment (>12-month group) and 44 patients before 12 months (<12-month group), among which 29 patients were treated between 6 and 12 months (6-12 month group). The main outcome was the risk of tumor new event (progression of residual tumor or tumor recurrence after complete resection) after primary treatment in the >12-month group and in the <12 month or in the 6- to 12-month group patients.
Results:
In the >12-month group, the 2- and 5-year event-free survivals were respectively 81.5% (95% CI, 61.1-91.9) and 69.4% (95% CI, 47.9-83.4) compared with 72.2% (95% CI, 56.3-83.1) and 69.8% (95% CI, 53.8-81.2) in the <12-month group. The 2- and 5-year event-free survivals were the same in the 6- to 12-month group (72.4%; 95% CI, 52.4-85.1). By log-rank test, the event-free survival was not different between groups (P = .98 and P = .91).The median time for event was not statistically different.In univariate and multivariate analysis, the risk of craniopharyngioma new event was not associated with the GHRT time delay after craniopharyngioma treatment.
Conclusions:
No association was found between GHRT time delay after childhood-onset craniopharyngioma treatment and an increased risk of recurrence or tumor progression, suggesting GH replacement therapy can be initiated 6 months after last treatment for craniopharyngiomas.
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