ESPEYB21 9. Oncology and Chronic Disease Growth Problems in Cancer Survivors (3 abstracts)
9.13. GH and childhood-onset craniopharyngioma: when to initiate GH replacement therapy?
Nguyen Quoc A , Beccaria K , González Briceño L , Pinto G , Samara-Boustani D , Stoupa A , Beltrand J , Besançon A , Thalassinos C , Puget S , Blauwblomme T , Alapetite C , Bolle S , Doz F , Grill J , Dufour C , Bourdeaut F , Abbou S , Guerrini-Rousseau L , Leruste A , Brabant S , Cavadias I , Viaud M , Boddaert N , Polak M & Kariyawasam D
adrien.nguyenquoc@aphp.fr J Clin Endocrinol Metab. 2023 Jul 14;108(8):1929-1936. doi: 10.1210/clinem/dgad079. PMID: 36794424
Brief Summary: This retrospective, observational, single centre study compared the risk of tumor progression or recurrence in 71 patients with childhood-onset craniopharyngioma (CP) who started GH replacement therapy (GHRT) with different latency from the end of tumor treatment.
GHRT latency was defined as the time from end of CP treatment (last debulking procedure or radiotherapy, or from CP diagnosis for the 5 patients without any debulking procedure or radiotherapy) to start of GHRT. 27 patients had a GHRT latency 12+ months (median 17 months); while 44 patients had a GHRT latency <12 months (median 7 months, and between 6-12 months in 29 patients). Event-free survival rates at 2- and 5-years were similar between groups (82% and 69% in the >12-month group; 72% and 70% in the <12-month group; 72% and 72% in the 6-12-month group). The risk of CP new events was not associated with GHRT latency. The median final height, achieved by 41 patients, was higher in the >12 months group (males 185 cm, females 165 cm) than in the <12 months group (males 177 cm, females 163.5 cm).
This study suggests that the risk of relapse or progression of craniopharyngiomas is not influenced by the latency before starting growth hormone replacement therapy (GHRT). The authors conclude that GHRT can be initiated 6 months after the last treatment. The higher final height in the >12 months group may be related to younger age at diagnosis, allowing more prolonged GHRT, or confounded by the indication to start GHRT sooner in shorter patients.
Strengths of this study are the homogeneous cohort and the long duration of follow-up (8 years). The main weakness is the low number of events, reflecting the rarity of CP. In light of recent reassuring evidence on the safety of GHRT in craniopharyngiomas, prospective studies on larger cohorts are needed not only to support these findings but also to assess the potential negative effects of delayed GHRT on body composition and physical and psychological well-being.
Reference: 1. Boguszewski MCS, Boguszewski CL, Chemaitilly W, et al. Safety of growth hormone replacement in survivors of cancer and intracranial and pituitary tumours: a consensus statement. Eur J Endocrinol. 2022; 186 (6): P35-P52. doi: 10.1530/EJE-21-1186
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ESPE Yearbook of Paediatric Endocrinology
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