Age at onset of puberty following high-dose central nervous system radiation therapy.
OBJECTIVE
To determine if a relationship exists between age at irradiation, sex of the patient, and age at onset of puberty and pubarche in children treated with high-dose radiation to the central nervous system.


METHODS
Case series.


METHODS
Tertiary care institutional practices and clinics.


METHODS
Thirty-six children treated with high-dose irradiation (hypothalamic pituitary dose, 30-72 Gy) by conventional (n = 29) or hyperfractionated (n = 7) schedules. Girls were treated before age 8 years and boys before age 9 years. Twenty-six of the 36 children also received chemotherapy. All tumors were distant from the hypothalamic-pituitary region.


METHODS
Age at onset of puberty and pubarche.


RESULTS
In girls, the median age at onset of puberty was 9.3 years vs 10.9 years for controls (P < .01); pubarche occurred at 9.4 years vs 11.2 years for controls (P < .01). In boys, the median age at onset of puberty--genital II--was 11.0 years vs 11.5 years for controls (P = .30); pubarche occurred at a median age of 10.5 years vs 12 years for controls (P = .25). A censored-data normal linear regression model was used to account for children (n = 6) who had not reached puberty. Age at diagnosis (P < .01) and sex (P = .01) were significant predictors of age at onset of puberty. Body mass index SD score (z score) was inversely related to age at onset of puberty (r = -0.77) and was greater at onset of puberty in girls than in boys.


CONCLUSIONS
In children who have received high-dose cranial radiation therapy, a significant positive correlation exists between age at diagnosis and age at onset of puberty in boys and girls.
Oberfield
S E
SE
Department of Pediatrics, New York University Medical Center, New York, USA.
Soranno
D
D
Nirenberg
A
A
Heller
G
G
Allen
J C
JC
David
R
R
Levine
L S
LS
Sklar
C A
CA
D000293:Adolescent; D000367:Age Factors; D017668:Age of Onset; D015992:Body Mass Index; D016543:Central Nervous System Neoplasms / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D011336:Probability; D011627:Puberty / Q000528:radiation effects*; D011879:Radiotherapy Dosage; D012737:Sex Factors