title: Differential effects of radiotherapy on growth and endocrine function among acute leukemia survivors: a childhood cancer survivor study report.
abstract: BACKGROUND
  The differential effects of cranial radiotherapy (CRT), spinal radiotherapy (SRT), and total body irradiation (TBI) on growth and endocrine outcomes have rarely been examined in combination among childhood acute leukemia survivors.
  
  
  METHODS
  Self-reported height/weight, hypothyroidism, and pregnancy/live birth were determined among acute lymphoblastic and myeloid leukemia survivors (n = 3,467) participating in the Childhood Cancer Survivor Study, an ongoing cohort study of 5-year survivors of pediatric cancers diagnosed from 1970 to 1986.
  
  
  RESULTS
  Compared with no radiotherapy, risk estimates were consistent across outcomes (adult short stature, hypothyroidism, absence of pregnancy/live birth) with CRT treatment associated with 2-3-fold increased risks, TBI associated with 5-10 fold increased risks, and CRT + TBI associated with >10 fold increased risks. Exposure to any SRT further increased risk of these outcomes 2-3-fold. Changes in body composition were more nuanced as CRT only was associated with an increased risk of being overweight/obese (OR 1.6, 95% CI 1.3-1.9) whereas TBI only was associated with an increased risk of being underweight (OR 6.0, 95% CI 2.4-14.9).
  
  
  CONCLUSIONS
  Although patients treated with CRT + TBI were at greatest risk for short stature, hypothyroidism, and a reduced likelihood of pregnancy/live birth, those treated with either modality alone had significantly increased risks as well, including altered body composition. Any SRT exposure further increased risk in an independent fashion.
authors.affiliation: Department of Pediatrics, Seattle Children's Hospital and University of Washington, Seattle, WA, USA. ericchow@u.washington.edu
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Chow
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.forename: Kumar
authors.initials: K
authors.lastname: Srivastava
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Leisenring
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hayashi
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sklar
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: K Scott
authors.initials: KS
authors.lastname: Baker
mesh_terms: D000293:Adolescent; D000328:Adult; D001827:Body Height / Q000528:radiation effects; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation / Q000009:adverse effects; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000209:etiology*; D007223:Infant; D007231:Infant, Newborn; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000503:physiopathology / Q000532:radiotherapy*; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000401:mortality / Q000503:physiopathology / Q000532:radiotherapy*; D012098:Reproduction / Q000528:radiation effects*; D017741:Survivors; D014916:Whole-Body Irradiation / Q000009:adverse effects