Growth disturbances and metabolic disorders in childhood cancer survivors

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Abstract


Background. Endocrine consequences such as growth hormone deficiency (GHD), growth disturbances and metabolic disorders are common in childhood cancer survivors.

Aim: to evaluate and compare the prevalence of growth disturbances and metabolic disorders in childhood posterior cranial fossa tumors (cPCFT) and acute lymphoblastic leukemia (cALL) survivors.

Materials and methods. 40 subjects (21 men, 19 women) who had undergone treatment for cPCFT (group 1) and 25 subjects (9 men, 16 women) after treatment for cALL (group 2) were assessed. Group 1 underwent surgery, chemotherapy (CT) and craniospinal irradiation in a dose of 34.9 ± 1.6 Gy with a boost to the PCF 51.3 ± 9.2 Gy. Group 2 underwent CT (23 subjects were treated with ALL-BFM-90 protocol; 2 subjects were treated with ALL-MB-2002 protocol). All subjects of the group 2 received cranial irradiation in a dose 12,7±2 Gy. Age at the time of the survey in a group 1 and 2 – 19.8 ± 3.05 and 21.2±3.9 years; age at the time of treatment – 10.9 ± 3.4 and 6.9±3.4 years; follow-up – 7.2 ± 4.2 and 13.8±4.9 years, respectively. 16 age and sex matched healthy controls were included. Patient’s anthropometric and laboratory parameters were measured, GHD was diagnosed in group 1 by 2 tests – insulin tolerance test (ITT) and glucagon stimulation test (GST). In group 2 these tests didn't perform. At the time of the survey no one in both groups received GH replacement therapy. Only 5 subjects (3 boys and 2 girls) in group 1 were treated with recombinant human GH during childhood.

Results.Final height SDS in the group 1 was significantly less than in the group 2 (p=0.001) and in healthy controls (p<0.001). In the group 1 and 2 there were significantly less patients reached target height compared to healthy controls (p<0.001). Subjects of group 1 rarely reached their target height in comparison to the group 2 (p=0.006). IGF-1 SDS was significantly less in the group 1 (-1.37±1.24) than in the group 2 (0.5±1.24, p<0.001). In group 1 GHD according to GST was diagnosed in 60% of subjects, according to ITT in 82.1% of subjects. Waist circumference was significantly bigger in group 2 compared to the group 1 (p=0.046) and to healthy controls (p=0.001). Overweight was registered in 10% of patients in group 1 and in 16% - in group 2. Dyslipidemia was diagnosed in 50% in group 1, in 19% in group 2 (p=0.226). In group 1 16.7% and in group 2 66.7% of subjects were insulin resistant.

Conclusions. After treatment for cPCFT growth disturbances occurred more often than after cALL therapy. Metabolic disorders were diagnosed with different frequency in both cPCFT and cALL survivors. These patients need endocrinologist’ observation.


Tatyana Y. Tselovalnikova

Author for correspondence.
t.tselovalnikova@gmail.com
ORCID iD: 0000-0003-4262-2724
I.M. Sechenov First Moscow State Medical University
Russian Federation

M.D.endocrinologist, Chair of endocrinology

Alla E. Yudina

alla1301@yandex.ru
ORCID iD: 0000-0002-4704-8453
I.M. Sechenov First Moscow State Medical University
Russian Federation

Postgraduate student, M.D. Chair of endocrinology

Maria G. Pavlova

mgpavlova68@rambler.ru
I.M. Sechenov First Moscow State Medical University
Russian Federation

Ph.D., M.D.endocrinologist, Chair of endocrinology

Alexey V. Zilov

avzilov@hotmail.com
I.M. Sechenov First Moscow State Medical University
Russian Federation

P.h.d., M.D.endocrinologist, Chair of endocrinology

Nadezhda A. Mazerkina

nmazer@nsi.ru
Burdenko Neurosurgery Institute
Russian Federation

P.h.d., M.D.endocrinologist,

Olga G. Zheludkova

clelud@mail.ru
Russian Scientific Center of Roentgenoradiology
Russian Federation

P.h.d., M.D. oncologist

Irina A. Arefyeva

iarefyeva@nsi.ru
ORCID iD: 0000-0001-7136-9540
Burdenko Neurosurgery Institute
Russian Federation

Ph.D., M.D. Clinical Laboratory Diagnostics

Andrey N. Gerasimov

andr-gerasim@yandex.ru
I.M. Sechenov First Moscow State Medical University
Russian Federation

PhD, DSc., Head of the department of Medical Statistics and Informatics

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Copyright (c) 2016 Tselovalnikova T.Y., Yudina A.E., Pavlova M.G., Zilov A.V., Mazerkina N.A., Zheludkova O.G., Arefyeva I.A., Gerasimov A.N.

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