Growth hormone replacement therapy in children with medulloblastoma: Use and effect on tumor control

R. J. Packer, J. M. Boyett, A. J. Janss, T. Stavrou, L. Kun, J. Wisoff, C. Russo, R. Geyer, P. Phillips, M. Kieran, M. Greenberg, S. Goldman, D. Hyder, R. Heideman, D. Jones-Wallace, G. P. August, S. H. Smith, T. Moshang

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Abstract

Purpose: Progress has been mode in the treatment of medulloblastoma, the most common childhood malignant brain tumor: However, many long-term survivors will have posttherapy growth hormone insufficiency with resultant linear growth retardation. Growth hormone replacement therapy (GHRT) may significantly improve growth, but there is often reluctance to initiate GHRT because of concerns of on increased likelihood of tumor relapse. Patients and Methods: This study retrospectively reviewed the use of GHRT for survivors of medulloblastoma in 11 neuro-oncology centers in North America who received initial treatment for disease between 1980 and 1993 to determine its impact on disease control. A Landmark analysis was used to evaluate the relative risk of relapse in surviving patients. Results: Five hundred forty-five consecutive patients less than 15 years of age at diagnosis were identified. Six-year progression-free survival (mean ± SD) was 40% ± 5% in children less than 3 years of age at diagnosis compared with 59% ± 3% for older patients. Older patients with total or near-total resections (P = .003) and localized disease at diagnosis (P < .0001) had the highest likelihood of survival. One hundred seventy patients (33% ± 3% of the cohort) received GHRT. GHRT use varied widely among institutions, ranging from 5% to 73%. GHRT was begun o mean of 3.9 years after diagnosis, later in children younger than 3 years at diagnosis (5.4 years). By Landmark analyses, for those surviving 2, 3, and 5 years after diagnosis, there was no evidence that GHRT increased the rate of disease relapse. Conclusion: This large retrospective review demonstrates that GHRT is underutilized in survivors of medulloblastoma and is used relatively late in the course of the illness. GHRT is not associated with an increased likelihood of disease relapse.

Original languageEnglish (US)
Pages (from-to)480-487
Number of pages8
JournalJournal of Clinical Oncology
Volume19
Issue number2
DOIs
StatePublished - Jan 15 2001

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Medulloblastoma
Hormone Replacement Therapy
Growth Hormone
Neoplasms
Survivors
Recurrence
Delayed Diagnosis
Growth
North America
Brain Neoplasms
Disease-Free Survival

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Packer, R. J., Boyett, J. M., Janss, A. J., Stavrou, T., Kun, L., Wisoff, J., ... Moshang, T. (2001). Growth hormone replacement therapy in children with medulloblastoma: Use and effect on tumor control. Journal of Clinical Oncology, 19(2), 480-487. https://doi.org/10.1200/JCO.2001.19.2.480

Growth hormone replacement therapy in children with medulloblastoma : Use and effect on tumor control. / Packer, R. J.; Boyett, J. M.; Janss, A. J.; Stavrou, T.; Kun, L.; Wisoff, J.; Russo, C.; Geyer, R.; Phillips, P.; Kieran, M.; Greenberg, M.; Goldman, S.; Hyder, D.; Heideman, R.; Jones-Wallace, D.; August, G. P.; Smith, S. H.; Moshang, T.

In: Journal of Clinical Oncology, Vol. 19, No. 2, 15.01.2001, p. 480-487.

Research output: Contribution to journalArticle

Packer, RJ, Boyett, JM, Janss, AJ, Stavrou, T, Kun, L, Wisoff, J, Russo, C, Geyer, R, Phillips, P, Kieran, M, Greenberg, M, Goldman, S, Hyder, D, Heideman, R, Jones-Wallace, D, August, GP, Smith, SH & Moshang, T 2001, 'Growth hormone replacement therapy in children with medulloblastoma: Use and effect on tumor control', Journal of Clinical Oncology, vol. 19, no. 2, pp. 480-487. https://doi.org/10.1200/JCO.2001.19.2.480
Packer, R. J. ; Boyett, J. M. ; Janss, A. J. ; Stavrou, T. ; Kun, L. ; Wisoff, J. ; Russo, C. ; Geyer, R. ; Phillips, P. ; Kieran, M. ; Greenberg, M. ; Goldman, S. ; Hyder, D. ; Heideman, R. ; Jones-Wallace, D. ; August, G. P. ; Smith, S. H. ; Moshang, T. / Growth hormone replacement therapy in children with medulloblastoma : Use and effect on tumor control. In: Journal of Clinical Oncology. 2001 ; Vol. 19, No. 2. pp. 480-487.
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abstract = "Purpose: Progress has been mode in the treatment of medulloblastoma, the most common childhood malignant brain tumor: However, many long-term survivors will have posttherapy growth hormone insufficiency with resultant linear growth retardation. Growth hormone replacement therapy (GHRT) may significantly improve growth, but there is often reluctance to initiate GHRT because of concerns of on increased likelihood of tumor relapse. Patients and Methods: This study retrospectively reviewed the use of GHRT for survivors of medulloblastoma in 11 neuro-oncology centers in North America who received initial treatment for disease between 1980 and 1993 to determine its impact on disease control. A Landmark analysis was used to evaluate the relative risk of relapse in surviving patients. Results: Five hundred forty-five consecutive patients less than 15 years of age at diagnosis were identified. Six-year progression-free survival (mean ± SD) was 40{\%} ± 5{\%} in children less than 3 years of age at diagnosis compared with 59{\%} ± 3{\%} for older patients. Older patients with total or near-total resections (P = .003) and localized disease at diagnosis (P < .0001) had the highest likelihood of survival. One hundred seventy patients (33{\%} ± 3{\%} of the cohort) received GHRT. GHRT use varied widely among institutions, ranging from 5{\%} to 73{\%}. GHRT was begun o mean of 3.9 years after diagnosis, later in children younger than 3 years at diagnosis (5.4 years). By Landmark analyses, for those surviving 2, 3, and 5 years after diagnosis, there was no evidence that GHRT increased the rate of disease relapse. Conclusion: This large retrospective review demonstrates that GHRT is underutilized in survivors of medulloblastoma and is used relatively late in the course of the illness. GHRT is not associated with an increased likelihood of disease relapse.",
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T1 - Growth hormone replacement therapy in children with medulloblastoma

T2 - Use and effect on tumor control

AU - Packer, R. J.

AU - Boyett, J. M.

AU - Janss, A. J.

AU - Stavrou, T.

AU - Kun, L.

AU - Wisoff, J.

AU - Russo, C.

AU - Geyer, R.

AU - Phillips, P.

AU - Kieran, M.

AU - Greenberg, M.

AU - Goldman, S.

AU - Hyder, D.

AU - Heideman, R.

AU - Jones-Wallace, D.

AU - August, G. P.

AU - Smith, S. H.

AU - Moshang, T.

PY - 2001/1/15

Y1 - 2001/1/15

N2 - Purpose: Progress has been mode in the treatment of medulloblastoma, the most common childhood malignant brain tumor: However, many long-term survivors will have posttherapy growth hormone insufficiency with resultant linear growth retardation. Growth hormone replacement therapy (GHRT) may significantly improve growth, but there is often reluctance to initiate GHRT because of concerns of on increased likelihood of tumor relapse. Patients and Methods: This study retrospectively reviewed the use of GHRT for survivors of medulloblastoma in 11 neuro-oncology centers in North America who received initial treatment for disease between 1980 and 1993 to determine its impact on disease control. A Landmark analysis was used to evaluate the relative risk of relapse in surviving patients. Results: Five hundred forty-five consecutive patients less than 15 years of age at diagnosis were identified. Six-year progression-free survival (mean ± SD) was 40% ± 5% in children less than 3 years of age at diagnosis compared with 59% ± 3% for older patients. Older patients with total or near-total resections (P = .003) and localized disease at diagnosis (P < .0001) had the highest likelihood of survival. One hundred seventy patients (33% ± 3% of the cohort) received GHRT. GHRT use varied widely among institutions, ranging from 5% to 73%. GHRT was begun o mean of 3.9 years after diagnosis, later in children younger than 3 years at diagnosis (5.4 years). By Landmark analyses, for those surviving 2, 3, and 5 years after diagnosis, there was no evidence that GHRT increased the rate of disease relapse. Conclusion: This large retrospective review demonstrates that GHRT is underutilized in survivors of medulloblastoma and is used relatively late in the course of the illness. GHRT is not associated with an increased likelihood of disease relapse.

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