Adult growth hormone replacement therapy and neuroimaging surveillance in brain tumour survivors
Adult growth hormone replacement therapy and neuroimaging surveillance in brain tumour survivors
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DOI：
10.1111/j.1365-2265.2005.02282.x
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发表时间：
2005-06-01
影响因子：
3.2
通讯作者：
Shalet, SM
中科院分区：
文献类型：
--
作者：
Jostel, A;Mukherjee, A;Shalet, SM
目的系统收集接受成人生长激素替代治疗（AGHRT）的脑肿瘤幸存者的神经影像学资料是不存在的。设计在1993年，我们的单位实施了一项政策，进行脑扫描的每一个脑肿瘤幸存者开始AGHRT之前，重复神经影像学至少一次后12-18个月的治疗。基线扫描和最近的扫描报告进行了分析，为这项回顾性研究。患者所有接受AGHRT的脑肿瘤幸存者（60例患者）均纳入分析。测量基线扫描和最近的随访扫描的残留肿瘤，肿瘤进展，肿瘤复发和继发性肿瘤（SN）的证据和程度。41/45例（91%）接受AGHRT超过1年的患者进行了随访扫描（GHRT的平均持续时间+/- SD为6.7 +/- 3.6年）。16例患者有残留肿瘤，3例患者在基线扫描中显示SN（均为脑膜瘤）。34例（83%）患者在随访期间（延长至肿瘤诊断后17.4 +/- 8.3年）外观保持稳定。在16个残留的原发性肿瘤中，一个无法治愈的室管膜瘤继续生长，一个脑膜瘤的大小在7.7年内略有进展。随访扫描还显示，在基线时检测到的SN持续增长，以及5例额外的脑膜瘤（2例既往有SN的患者，证实该亚组的风险过高，P = 0.02）。所有SN发生在平均22.8（范围17-37）years after radiotherapy.Conclusions我们的数据并不表明在AGHRT期间儿童脑肿瘤复发或进展率增加。然而，需要对这些患者进行警戒和长期监测，以检测和监测SN，特别是有SN既往史的患者。我们赞同积极的神经影像学政策，最好是作为未来更大的对照试验的一部分。
Objective Systematic collections of neuroimaging data are nonexistent in brain tumour survivors treated with adult growth hormone replacement therapy (AGHRT). We present our surveillance data.Design In 1993, our unit implemented a policy of performing brain scans on every brain tumour survivor before starting AGHRT, with repeat neuroimaging at least once after 12-18 months' treatment. Reports for baseline scans and most recent scans were analysed for this retrospective study.Patients All brain tumour survivors who received AGHRT (60 patients) were included in the analysis.Measurements Evidence and extent of residual tumour, tumour progression, tumour recurrence, and secondary neoplasms (SN) on baseline scan and latest follow-up scan.Results All patients had baseline scans performed. Follow-up scans were available in 41/45 (91%) patients who received AGHRT for more than 1 year (mean duration +/- SD of GHRT was 6.7 +/- 3.6 years). Sixteen patients had residual tumours, and SNs (all meningiomas) were demonstrated in three patients on baseline scans. Appearances remained stable in 34 (83%) patients during follow-up (extending to 17.4 +/- 8.3 years after tumour diagnosis). Of the 16 residual primary tumours, an incurable ependymoma continued to grow, and one meningioma progressed slightly in size over 7.7 years. Follow-up scans also revealed continued growth of the SNs detected at baseline, and five additional meningiomas (two in patients with a previous SN, confirming an excess risk in this subgroup, P = 0.02). All SNs occurred on average 22.8 (range 17-37) years after radiotherapy.Conclusions Our data do not suggest an increased rate of recurrence or progression of childhood brain tumours during AGHRT. Nonetheless, vigilance and long-term surveillance are needed in these patients in order to detect and monitor SNs, in particular in patients with a previous history of a SN. We endorse a proactive neuroimaging policy, preferably as part of a larger, controlled trial in the future.