Endocrine Abstracts (2012) 29 OC10.6

Second neoplasms in childhood cancer survivors with growth hormone deficiency treated or not treated with GH

F. Felicetti1, D. Di Cuonzo1, R. Manicone2, F. Lazzarato1, E. Biasin2, P. Chiabotto2, G. Boccuzzi1 & E. Brignardello3

1University of Turin, Turin, Italy; 2Regina Margherita Children’s Hospital, Turin, Italy; 3San Giovanni Battista Hospital, Turin, Italy.

Introduction: The relation between GH treatment and cancer is still matter of debate. Childhood cancer survivors (CCS) have a high risk to develop second benign and malignant neoplasms (SNs), mainly as a consequence of radiation therapy. Thus, in patients with GH deficiency it is difficult to discriminate the oncological risk due to GH treatment from that caused by anticancer therapy and by individual susceptibility.

Methods: We studied the prevalence of SNs in 49 CCS who developed GDH during childhood, after cancer therapy. 32 patient had a previous diagnosis of central nervous system tumor, 17 were cured for hematologic malignancies. 44 patients (90%) received radiation therapy involving the head, at doses ranging between 12 and 70 Gy. Patients were divided in two groups: GHD-treated patients (n=25, 18 males, 7 females) who received GH therapy during childhood for at least 12 month (mean±S.D.=3.9±1.9 years), and GHD not-treated patients (n=24, 12 males, 12 females) who did not receive any GH replacement. Statistical analysis was performed using Chi-square and Student’s t tests.

Results: Mean age at the time of the study was similar in the two groups (25.5±4.9; 28.3±6.7 years). Mean follow-up time was 16.7±7.0 years. In GHD-treated group, 8 patients (32%) developed 10 SNs (Table 1). In GHD not-treated group 6 patients (25%) developed 8 SNs (Table 1). None of the 5 GHD patients who did not received radiotherapy developed a second malignancy.

Conclusions: Data show that CCS with GHD are at high risk to develop SNs, mainly meningiomas. It is likely due to the very high percentage of GHD patients previously treated with radiation therapy, which is a risk factor for both GHD and SNs. Also if the difference between SNs in treated and not-trated patients is not statistically significant, these data should be considered when prescribing GH to CCS, especially in adulthood.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Table 1 SNs in cancer survivors with GHD
GDH treated (n = 25) GDH not-treated (n = 24)
Meningioma 54
Non Melanoma Skin Cancer 33
Thyroid Cancer 1
Neurinoma 1
Melanoma 1

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