Thyroid diseases in patients treated during pre-puberty for medulloblastoma with different radiotherapic protocols.
We evaluated thyroid disease in 32 patients treated, during pre-puberty, for medulloblastoma, followed for at least 4 years and without relapse during observation. After surgery the patients underwent chemotherapy (CT) and radiotherapy (RT). The protocols were as follows: 20 patients (group A) SNC 76 and SNC 85 protocols which included conventional fractionated RT (36-40 Gy to the craniospinal axis and a 14-18 Gy boost to the posterior fossa, administered as 1.5-1.8 Gy per fraction per day) and a junction between the cranial and the spinal fields at C2-C3 level; 12 patients (group B) SNC 91 protocol which included hyperfractionated RT (36 Gy to the craniospinal axis and a 30 Gy boost to the posterior fossa; this was administred as 1 Gy per fraction twice per day) and a junction at levels C5-C6 or C6-C7 level. The mean age at diagnosis was 7.4+/-3.2 years for group A and 8.4+/-2.6 years for group B. Thyroid function was evaluated yearly and ultrasonographic characteristics every 2 years. The patients were followed for a mean of 10.8+/-3.8 for group A and 6+/-1.4 years for group B. Primary hypothyroidism was diagnosed in 16 group A patients and 4 group B patients, and central hypothyroidism was diagnosed in 2 group A patients (difference in risk of developing hypothyroidism evaluated with a Wilcoxon-test: p=0.048). Ultrasonography showed reduced thyroid volume in 7 group A cases, and structural changes in 21 patients (17 group A, 4 group B); 9 L-thyroxine-treated patients were confirmed hypothyroid after having stopped therapy. A thyroid nodule was detected in two cases (one from each group). In conclusion, our data indicate that thyroid injury may be diminished by the use of hyperfractionation and low-junction radiotherapy in the treatment of medulloblastoma.
Corrias
A
A
Division of Pediatric Endocrinology, Regina Margherita Hospital, Turin, Italy. endop50@hotmail.com
Einaudi
S
S
Ricardi
U
U
Sandri
A
A
Besenzon
L
L
Altare
F
F
Artesani
L
L
Genitori
L
L
Andreo
M
M
De Sanctis
C
C
D000293:Adolescent; D001707:Biopsy, Needle; D002528:Cerebellar Neoplasms / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008527:Medulloblastoma / Q000532:radiotherapy*; D011627:Puberty; D011878:Radiotherapy / Q000009:adverse effects*; D012307:Risk Factors; D013959:Thyroid Diseases / Q000209:etiology*; D013972:Thyrotropin / Q000097:blood; D013973:Thyrotropin-Releasing Hormone; D013974:Thyroxine / Q000627:therapeutic use; D013997:Time Factors; D014463:Ultrasonography
D013973:Thyrotropin-Releasing Hormone; D013972:Thyrotropin; D013974:Thyroxine