scholarly journals Late Effects of Conformal Radiation Therapy for Pediatric Patients With Low-Grade Glioma: Prospective Evaluation of Cognitive, Endocrine, and Hearing Deficits

2009 ◽  
Vol 27 (22) ◽  
pp. 3691-3697 ◽  
Author(s):  
Thomas E. Merchant ◽  
Heather M. Conklin ◽  
Shengjie Wu ◽  
Robert H. Lustig ◽  
Xiaoping Xiong
Keyword(s):  
Radiation Therapy ◽  
Radiation Dose ◽  
Late Effects ◽  
Cumulative Incidence ◽  
Pediatric Patients ◽  
Low Grade Glioma ◽  
Endocrine Function ◽  
Low Grade ◽  
Normal Brain ◽  
Conformal Radiation Therapy

Purpose We conducted a prospective trial to evaluate late effects in pediatric patients with low-grade glioma (LGG) treated with conformal radiation therapy (CRT). Patients and Methods Between August 1997 and August 2006, 78 pediatric patients with LGG (mean age, 9.7 years; standard deviation, ±4.4 years) received 54 Gy of CRT with a 10-mm clinical target volume margin. Tumor locations were diencephalon (n = 58), cerebral hemisphere (n = 3), and cerebellum (n = 17). Baseline and serial evaluations were performed to identify deficits in cognition, endocrine function, and hearing. Deficits were correlated with clinical factors and radiation dose within specific normal tissue volumes. Results Cognitive effects of CRT through 5 years after CRT correlated with patient age, neurofibromatosis type 1 status, tumor location and volume, extent of resection, and radiation dose. The effect of age exceeded that of radiation dose; patients younger than 5 years experienced the greatest decline in cognition. Before CRT, growth hormone (GH) secretion abnormality was diagnosed in 24% of tested patients, and 12% had precocious puberty. The 10-year cumulative incidence of GH replacement was 48.9%; of thyroid hormone replacement, 64.0%; of glucocorticoid replacement, 19.2%; and of gonadotropin-releasing hormone analog therapy, 34.2%. The mean ± standard errors of the cumulative incidence of hearing loss at 10 years did not exceed 5.7% ± 3.3% at any frequency. Conclusion To our knowledge, this is the largest series of prospectively followed children with LGG to undergo irradiation. Adverse effects are limited and predictable for most patients; however, this study provides additional evidence that CRT should be delayed for young patients and identifies the potential benefits of reducing radiation dose to normal brain.

scholarly journals Growth Hormone Secretion After Conformal Radiation Therapy in Pediatric Patients With Localized Brain Tumors

2011 ◽  
Vol 29 (36) ◽  
pp. 4776-4780 ◽  
Author(s):  
Thomas E. Merchant ◽  
Susan R. Rose ◽  
Christina Bosley ◽  
Shengjie Wu ◽  
Xiaoping Xiong ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Radiation Therapy ◽  
Radiation Dose ◽  
Brain Tumors ◽  
Pediatric Patients ◽  
Hormone Secretion ◽  
Growth Hormone Secretion ◽  
Low Grade ◽  
Conformal Radiation Therapy ◽  
Gh Secretion

Purpose Growth hormone deficiency (GHD) after radiation therapy negatively affects growth and development and quality of life in children with brain tumors. Patients and Materials Between 1997 and 2008, 192 pediatric patients with localized primary brain tumors (ependymoma, n = 88; low-grade glioma, n = 51; craniopharyngioma, n = 28; high-grade glioma, n = 23; and other tumor types, n = 2) underwent provocative testing of GH secretion by using the secretogogues arginine and l-dopa before and after (6, 12, 36, and 60 months) conformal radiation therapy (CRT). A total of 664 arginine/l-dopa test procedures were performed. Results Baseline testing revealed preirradiation GHD in 22.9% of tested patients. On the basis of data from 118 patients, peak GH was modeled as an exponential function of time after CRT and mean radiation dose to the hypothalamus. The average patient was predicted to develop GHD with the following combinations of the time after CRT and mean dose to the hypothalamus: 12 months and more than 60 Gy; 36 months and 25 to 30 Gy; and 60 months and 15 to 20 Gy. A cumulative dose of 16.1 Gy to the hypothalamus would be considered the mean radiation dose required to achieve a 50% risk of GHD at 5 years (TD50/5). Conclusion GH secretion after CRT can be predicted on the basis of dose and time after irradiation in pediatric patients with localized brain tumors. These findings provide an objective radiation dose constraint for the hypothalamus.

Clinical impact of hypothalamic‐pituitary disorders after conformal radiation therapy for pediatric low‐grade glioma or ependymoma

2020 ◽  
Vol 67 (12) ◽  
Author(s):  
Laura Iersel ◽  
Hanneke M. Santen ◽  
Brian Potter ◽  
Zhenghong Li ◽  
Heather M. Conklin ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Clinical Impact ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Conformal Radiation Therapy

scholarly journals Phase II Trial of Conformal Radiation Therapy for Pediatric Low-Grade Glioma

2009 ◽  
Vol 27 (22) ◽  
pp. 3598-3604 ◽  
Author(s):  
Thomas E. Merchant ◽  
Larry E. Kun ◽  
Shengjie Wu ◽  
Xiaoping Xiong ◽  
Robert A. Sanford ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Disease Control ◽  
Phase Ii ◽  
Standard Error ◽  
Phase Ii Trial ◽  
Young Patients ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Conformal Radiation Therapy ◽  
The Mean

Purpose The use of radiotherapy in pediatric low-grade glioma (LGG) is controversial, especially for young patients. We conducted a phase II trial of conformal radiation therapy (CRT) to estimate disease control by using a 10-mm clinical target volume (CTV) margin. Materials and Methods Between August 1997 and August 2006, 78 pediatric patients with LGG and a median age of 8.9 years (range, 2.2 to 19.8 years) received 54 Gy CRT by using a 10-mm CTV and by targeting with systematic magnetic resonance imaging (MRI) registration. Tumor locations were diencephalon (n = 58), cerebral hemisphere (n = 3), and cerebellum (n = 17). Sixty-seven patients had documented or presumed WHO grade 1 tumors, 25 patients had prior chemotherapy, and 13 patients had neurofibromatosis type 1. Results During a median follow-up of 89 months, 13 patients experienced disease progression. One patient experienced marginal treatment failure, eight experienced local failures, and four experienced metastatic failure. The mean and standard error 5- and 10-year event-free (87.4% ± 4.4% and 74.3% ± 15.4%, respectively) and overall (98.5% ± 1.6% and 95.9% ± 5.8%, respectively) survival rates were determined. The mean and standard error cumulative incidences of local failure at 5 and 10 years were 8.7% ± 3.5% and 16.4% ± 5.4%, respectively. The mean and standard error cumulative incidence of vasculopathy was 4.79% ± 2.73% at 6 years, and it was higher for those younger than 5 years of age (P = .0105) at the time of CRT. Conclusion This large, prospective series of irradiated children with LGG demonstrates that CRT with a 10-mm CTV does not compromise disease control. The results suggest that CRT should be delayed in young patients to reduce the risk of vasculopathy.

scholarly journals SAT-457 Hypothalamic-Pituitary Disorders after Conformal Radiation Therapy for Childhood and Young Adult Low-Grade Glioma or Ependymoma

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Laura van Iersel ◽  
Hanneke van Santen ◽  
Brian Potter ◽  
Zhenghong Li ◽  
Heather Conklin ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Young Adult ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Conformal Radiation Therapy

Late Effects Following Radiation Therapy for Childhood Low-Grade Glioma

2013 ◽  
Vol 87 (2) ◽  
pp. S594
Author(s):  
N.L. Williams ◽  
R.L. Rotondo ◽  
J.A. Bradley ◽  
D.W. Pincus ◽  
J.A. Fort ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Late Effects ◽  
Low Grade Glioma ◽  
Low Grade

Risk of secondary neoplasms after external-beam radiation therapy treatment of pediatric low-grade gliomas: a SEER analysis, 1973–2015

2021 ◽  
pp. 1-9
Author(s):  
Adrian J. Rodrigues ◽  
Michael C. Jin ◽  
Adela Wu ◽  
Hriday P. Bhambhvani ◽  
Gordon Li ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Cumulative Incidence ◽  
Pediatric Patients ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
Low Grade ◽  
External Beam ◽  
Beam Radiation ◽  
Secondary Neoplasms ◽  
Low Grade Gliomas

OBJECTIVE Although past studies have associated external-beam radiation therapy (EBRT) with higher incidences of secondary neoplasms (SNs), its effect on SN development from pediatric low-grade gliomas (LGGs), defined as WHO grade I and II gliomas of astrocytic or oligodendrocytic origin, is not well understood. Utilizing a national cancer registry, the authors sought to characterize the risk of SN development after EBRT treatment of pediatric LGG. METHODS A total of 1245 pediatric patient (aged 0–17 years) records from 1973 to 2015 were assembled from the Surveillance, Epidemiology, and End Results (SEER) database. Univariable and multivariable subdistribution hazard regression models were used to evaluate the prognostic impact of demographic, tumor, and treatment-related covariates. Propensity score matching was used to balance baseline characteristics. Cumulative incidence analyses measured the time to, and rate of, SN development, stratified by receipt of EBRT and controlled for competing mortality risk. The Fine and Gray semiparametric model was used to estimate future SN risk in EBRT- and non–EBRT-treated pediatric patients. RESULTS In this study, 366 patients received EBRT and 879 did not. Forty-six patients developed SNs after an LGG diagnosis, and 27 of these patients received EBRT (OR 3.61, 95% CI 1.90–6.95; p < 0.001). For patients alive 30 years from the initial LGG diagnosis, the absolute risk of SN development in the EBRT-treated cohort was 12.61% (95% CI 8.31–13.00) compared with 4.99% (95% CI 4.38–12.23) in the non–EBRT-treated cohort (p = 0.013). Cumulative incidence curves that were adjusted for competing events still demonstrated higher rates of SN development in the EBRT-treated patients with LGGs. After matching across available covariates and again adjusting for the competing risk of mortality, a clear association between EBRT and SN development remained (subhazard ratio 2.26, 95% CI 1.21–4.20; p = 0.010). CONCLUSIONS Radiation therapy was associated with an increased risk of future SNs for pediatric patients surviving LGGs. These data suggest that the long-term implications of EBRT should be considered when making treatment decisions for this patient population

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