Comparison of hypothyroidism, growth hormone deficiency, and adrenal insufficiency following proton and photon radiotherapy in children with medulloblastoma.
Comparison of hypothyroidism, growth hormone deficiency, and adrenal insufficiency following proton and photon radiotherapy in children with medulloblastoma.
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DOI：
10.1007/s11060-021-03847-y
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发表时间：
2021-10
影响因子：
3.9
通讯作者：
Brown AL
中科院分区：
文献类型：
--
作者：
Aldrich KD;Horne VE;Bielamowicz K;Sonabend RY;Scheurer ME;Paulino AC;Mahajan A;Chintagumpala M;Okcu MF;Brown AL
内分泌缺陷是常见的颅脊髓照射（CSI）的儿童脑肿瘤，但经验数据比较质子（PRT）和光子放射治疗（XRT）的结果是有限的。这项回顾性病历审查比较了1997年至2016年期间接受XRT和PRT治疗的髓母细胞瘤患者的甲状腺功能减退症、生长激素缺乏症（GHD）和肾上腺功能不全（AI）的发生率。所有患者均接受CSI，并进行常规内分泌筛查实验室检查，以评估甲状腺功能障碍、GHD和AI。我们使用比例风险回归计算风险比（HR）和95%置信区间（CI），比较不同放射方式之间甲状腺功能减退症、AI和GHD的发展，调整诊断时的年龄、性别、种族/民族和CSI剂量。我们确定了118例髓母细胞瘤患者，从放疗结束后中位随访时间为5.6年。35例（31%）患者发生甲状腺功能减退症，71例（66%）发生GHD，20例（18%）发生AI。与PRT相比，XRT与原发性甲状腺功能减退症的发生率较高相关（28% vs. 6%; HR=4.61，95% CI 1.2-17.7，p=0.03）。两组间的中枢性甲状腺功能减退症、GHD和AI发生率相似。与XRT CSI相比，PRT CSI后原发性甲状腺功能减退症的发生率较低。这表明，甲状腺和垂体腺接受较少的辐射后，脊柱和后颅窝的提升RT，分别使用PRT。
Endocrine deficiencies are common following craniospinal irradiation (CSI) in children with brain tumors, but empirical data comparing outcomes following proton (PRT) and photon radiation therapy (XRT) are limited. This retrospective chart review compared the incidence of hypothyroidism, growth hormone deficiency (GHD), and adrenal insufficiency (AI) in patients with medulloblastoma treated with XRT and PRT between 1997 and 2016. All patients received CSI and had routine endocrine screening labs to evaluate for thyroid dysfunction, GHD, and AI. We used proportional hazards regression to calculate hazard ratios (HR) and 95% confidence intervals (CI) comparing the development of hypothyroidism, AI, and GHD between radiation modalities, adjusting for age at diagnosis, sex, race/ethnicity, and CSI dose. We identified 118 patients with medulloblastoma who were followed for a median of 5.6 years from the end of radiotherapy. Thirty-five (31%) patients developed hypothyroidism, 71 (66%) GHD, and 20 (18%) AI. Compared to PRT, XRT was associated with a higher incidence of primary hypothyroidism (28% vs. 6%; HR=4.61, 95% CI 1.2–17.7, p=0.03). Central hypothyroidism, GHD, and AI incidence rates were similar between the groups. Primary hypothyroidism occurs less often after PRT CSI, compared to XRT CSI. This suggests that the thyroid and pituitary glands receive less radiation after spine and posterior fossa boost RT, respectively, using PRT.
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DOI：
10.1016/j.ijrobp.2013.03.034
发表时间：
2013-07-15
影响因子：
7
作者：
Mueller, Sabine;Fullerton, Heather J.;Stratton, Kayla;Leisenring, Wendy;Weathers, Rita E.;Stovall, Marilyn;Armstrong, Gregory T.;Goldsby, Robert E.;Packer, Roger J.;Sklar, Charles A.;Bowers, Daniel C.;Robison, Leslie L.;Krull, Kevin R.
通讯作者：
Krull, Kevin R.
影响因子：
45.3
作者：
Clement, Sarah C.;Schouten-van Meeteren, Antoinette Y. N.;van Santen, Hanneke M.
通讯作者：
van Santen, Hanneke M.
DOI：
10.1016/j.ijrobp.2005.01.060
发表时间：
2005-10-01
影响因子：
7
作者：
Lee, CT;Bilton, SD;Smith, AR
通讯作者：
Smith, AR
影响因子：
3.2
作者：
Merchant, Thomas E.;Hua, Chia-Ho;Oelfke, Uwe
通讯作者：
Oelfke, Uwe
影响因子：
1.7
作者：
Bielamowicz, Kevin;Okcu, M. Fatih;Chintagumpala, Murali
通讯作者：
Chintagumpala, Murali