title: Long-term safety of growth hormone replacement after CNS irradiation.
abstract: BACKGROUND
  Radiotherapy is a central component in the treatment of many brain tumors, but long-term sequelae include GH deficiency and increased risk of secondary neoplasms. It is unclear whether replacement therapy with GH (GHRT) further increases this risk.
  
  
  OBJECTIVE
  The objective of the study was to assess the effect of GHRT on the incidence of secondary tumors and tumor recurrence after cranial irradiation.
  
  
  METHODS
  We conducted a retrospective matched-pairs analysis of previously irradiated patients, with and without GHRT, attending a tertiary center between 1994 and 2009.
  
  
  METHODS
  We reviewed the records for all patients undergoing GHRT at our institution over the study period. PATIENTS were included if they had received cranial irradiation, GHRT for at least 12 months, and records of serial magnetic resonance imaging data and data for dose and fractionation of irradiation were available. GH-naïve control patients were selected from a radiotherapy database of patients attending the same hospital. PATIENTS were matched for date of radiotherapy, age, site of primary diagnosis, radiation dose, and fractionation.
  
  
  METHODS
  The primary outcome measure was risk of tumor recurrence or secondary tumor.
  
  
  RESULTS
  Matched controls were identified for 110 GH-treated patients. Median follow-up was 14.5 yr. No significant differences were apparent in the number of tumor recurrences (six vs. eight, GHRT vs. control group) or secondary tumors (five vs. three, respectively) between groups.
  
  
  CONCLUSIONS
  Our study demonstrates no increased risk for recurrent or secondary neoplasms in patients receiving GHRT, thus supporting a high safety profile of GHRT after central nervous system irradiation.
authors.affiliation: Department of Endocrinology, The Christie, Manchester Academic Health Science Centre, Wilmslow Road, Manchester M20 4BX, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Mackenzie
authors.forename: T
authors.initials: T
authors.lastname: Craven
authors.forename: H R
authors.initials: HR
authors.lastname: Gattamaneni
authors.forename: R
authors.initials: R
authors.lastname: Swindell
authors.forename: S M
authors.initials: SM
authors.lastname: Shalet
authors.forename: G
authors.initials: G
authors.lastname: Brabant
mesh_terms: D000236:Adenoma / Q000532:radiotherapy*; D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000532:radiotherapy*; D016022:Case-Control Studies; D016371:Cranial Irradiation / Q000009:adverse effects*; D005260:Female; D020249:Hormone Replacement Therapy / Q000009:adverse effects*; D019382:Human Growth Hormone / Q000172:deficiency / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology*; D010911:Pituitary Neoplasms / Q000532:radiotherapy*; D012189:Retrospective Studies; D012306:Risk
chemical_list: D019382:Human Growth Hormone