title: Abnormal timing of menarche in survivors of central nervous system tumors: A report from the Childhood Cancer Survivor Study.
abstract: BACKGROUND
  Children who receive high-dose radiotherapy to the hypothalamic-pituitary (H-P) axis may be at risk for both early and late puberty. To the authors' knowledge, data regarding the risk of altered timing of menarche after higher dose radiotherapy (RT), as used in the treatment of central nervous system (CNS) tumors, are limited.
  
  
  METHODS
  The authors evaluated 235 female survivors of CNS tumors, diagnosed between 1970 and 1986, and >1000 sibling controls who were participants in the Childhood Cancer Survivor Study, and provided self-reported data concerning age at menarche.
  
  
  RESULTS
  Survivors of CNS tumors were more likely to have onset of menarche before age 10 years compared with their siblings (11.9% vs 1.0%) (odds ratio [OR], 14.1; 95% confidence interval [95% CI], 7.0-30.9). Of the 138 survivors who received RT to the H-P axis, 20 (14.5%) had onset of menarche before age 10 years, compared with 4.3% of those who did not receive RT (OR, 3.8; 95% CI, 1.2-16.5). Age <or=4 years at the time of diagnosis was associated with an increased risk (OR, 4.0; 95% CI, 1.7-10.0) of early menarche. In addition, survivors of CNS tumors were more likely than siblings to have onset of menarche after age 16 years (10.6% vs 1.9%) (OR, 6.6; 95% CI, 3.4-11.4). Doses of RT to the H-P axis >50 gray OR, 9.0; 95% CI, 2.3-59.5) and spinal RT conferred an increased risk of late menarche, as did older age (>10 years) at the time of diagnosis (OR, 3.0; 95% CI, 1.3-7.0).
  
  
  CONCLUSIONS
  Survivors of CNS tumors are at a significantly increased risk of both early and late menarche associated with RT exposure and age at treatment.
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA. greg.armstrong@stjude.org
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.forename: John A
authors.initials: JA
authors.lastname: Whitton
authors.forename: Amar
authors.initials: A
authors.lastname: Gajjar
authors.forename: Larry E
authors.initials: LE
authors.lastname: Kun
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Chow
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.forename: Wendy
authors.initials: W
authors.lastname: Leisenring
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sklar
mesh_terms: D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D016543:Central Nervous System Neoplasms / Q000503:physiopathology* / Q000532:radiotherapy*; D002648:Child; D002675:Child, Preschool; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008572:Menarche; D017063:Outcome Assessment, Health Care; D011829:Radiation Dosage; D012306:Risk; D035781:Siblings; D011795:Surveys and Questionnaires; D017741:Survivors