title: Growth hormone exposure as a risk factor for the development of subsequent neoplasms of the central nervous system: a report from the childhood cancer survivor study.
abstract: BACKGROUND
  Cranial radiation therapy (CRT) predisposes to GH deficiency and subsequent neoplasms (SNs) of the central nervous system (CNS). Increased rates of SNs have been reported in GH-treated survivors.
  
  
  OBJECTIVE
  The objective of the study was to evaluate the association between GH treatment and the development of CNS-SNs.
  
  
  METHODS
  The study was designed with a retrospective cohort with longitudinal follow-up.
  
  
  METHODS
  The setting of the study was multiinstitutional.
  
  
  METHODS
  A total of 12 098 5-year pediatric cancer survivors from the Childhood Cancer Survivor Study, diagnosed with cancer prior to age 21 years, of whom 338 self-reported GH treatment, which was verified through medical record review.
  
  
  METHODS
  INTERVENTIONS included subject surveys, medical records abstraction, and pathological review.
  
  
  METHODS
  Incidence of meningioma, glioma, and other CNS-SNs was measured.
  
  
  RESULTS
  Among GH-treated survivors, 16 (4.7%) developed CNS-SN, including 10 with meningioma and six with glioma. Two hundred three survivors without GH treatment (1.7%) developed CNS-SN, including 138 with meningioma, 49 with glioma, and 16 with other CNS-SNs. The adjusted rate ratio in GH-treated compared with untreated survivors for development of any CNS-SN was 1.0 [95% confidence interval (CI) 0.6-1.8, P = .94], for meningiomas, 0.8 (95% CI 0.4-1.7, P = .61), and for gliomas, 1.9 (95% CI 0.7-4.8, P = .21). Factors associated with meningioma development included female gender (P = .001), younger age at primary cancer diagnosis (P < .001), and CRT/longer time since CRT (P < .001). Glioma was associated with CRT/shorter time since CRT (P < .001).
  
  
  CONCLUSIONS
  There was no statistically significant increased overall risk of the occurrence of a CNS-SN associated with GH exposure. Specifically, occurrence of meningiomas and gliomas were not associated with GH treatment.
authors.affiliation: Department of Pediatrics (B.C.P., A.Mer., L.R.M.) Emory University/Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, Georgia 30322; Department of Public Health Sciences (Y.C., Y.Y.), University of Alberta, Edmonton, Alberta, Canada T6G 1C9; Department of Pediatrics (C.A.S.), Memorial Sloan-Kettering Cancer Center, New York, New York 10065; Department of Pediatrics (J.N.), University of Minnesota Medical School, Minneapolis, Minnesota 55454; Department of Epidemiology and Cancer Control (G.T.A., L.L.R.), St Jude Children's Research Hospital, Memphis, Tennessee 38105; Division of Oncology (A.Mea.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104; and Department of Radiation Physics (M.S.), The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030.
authors.forename: Briana C
authors.initials: BC
authors.lastname: Patterson
authors.forename: Yan
authors.initials: Y
authors.lastname: Chen
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sklar
authors.forename: Joseph
authors.initials: J
authors.lastname: Neglia
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.forename: Ann
authors.initials: A
authors.lastname: Mertens
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.forename: Anna
authors.initials: A
authors.lastname: Meadows
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Lillian R
authors.initials: LR
authors.lastname: Meacham
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D016543:Central Nervous System Neoplasms / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D005910:Glioma / Q000453:epidemiology / Q000209:etiology; D019382:Human Growth Hormone / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007018:Hypopituitarism / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008579:Meningioma / Q000453:epidemiology / Q000209:etiology; D016609:Neoplasms, Second Primary / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D019382:Human Growth Hormone