Adult growth hormone replacement therapy and neuroimaging surveillance in brain tumour survivors.
OBJECTIVE
Systematic collections of neuroimaging data are nonexistent in brain tumour survivors treated with adult growth hormone replacement therapy (AGHRT). We present our surveillance data.


METHODS
In 1993, our unit implemented a policy of performing brain scans on every brain tumour survivor before starting AGHRT, with repeat neuroimaging at least once after 12-18 months' treatment. Reports for baseline scans and most recent scans were analysed for this retrospective study.


METHODS
All brain tumour survivors who received AGHRT (60 patients) were included in the analysis.


METHODS
Evidence and extent of residual tumour, tumour progression, tumour recurrence, and secondary neoplasms (SN) on baseline scan and latest follow-up scan.


RESULTS
All patients had baseline scans performed. Follow-up scans were available in 41/45 (91%) patients who received AGHRT for more than 1 year (mean duration +/- SD of GHRT was 6.7 +/- 3.6 years). Sixteen patients had residual tumours, and SNs (all meningiomas) were demonstrated in three patients on baseline scans. Appearances remained stable in 34 (83%) patients during follow-up (extending to 17.4 +/- 8.3 years after tumour diagnosis). Of the 16 residual primary tumours, an incurable ependymoma continued to grow, and one meningioma progressed slightly in size over 7.7 years. Follow-up scans also revealed continued growth of the SNs detected at baseline, and five additional meningiomas (two in patients with a previous SN, confirming an excess risk in this subgroup, P = 0.02). All SNs occurred on average 22.8 (range 17-37) years after radiotherapy.


CONCLUSIONS
Our data do not suggest an increased rate of recurrence or progression of childhood brain tumours during AGHRT. Nonetheless, vigilance and long-term surveillance are needed in these patients in order to detect and monitor SNs, in particular in patients with a previous history of a SN. We endorse a proactive neuroimaging policy, preferably as part of a larger, controlled trial in the future.
Jostel
Andreas
A
Department of Endocrinology, Christie Hospital, Wilmslow Road, Manchester, M20 4BX, UK.
Mukherjee
Annice
A
Hulse
Paul A
PA
Shalet
Stephen M
SM
D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D013006:Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use*; D020249:Hormone Replacement Therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000175:diagnosis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D018365:Neoplasm, Residual / Q000175:diagnosis; D016609:Neoplasms, Second Primary / Q000175:diagnosis; D014057:Tomography, X-Ray Computed
D013006:Growth Hormone