title: GH replacement therapy and second neoplasms in adult survivors of childhood cancer: a retrospective study from a single institution.
abstract: OBJECTIVE
  Growth hormone deficiency (GHD) is the most common endocrine late effect observed in childhood cancer survivors (CCS) previously submitted to cranial irradiation. Radiation therapy can also increase the risk of second neoplasms (SNs). Since in previous studies GH replacement therapy was associated with increased incidence of neoplasia, we explored the association between SNs and GH replacement therapy in a cohort of CCS with GHD.
  
  
  METHODS
  Within the clinical cohort of CCS referred to the Transition Unit for Childhood Cancer Survivors of Turin between November 2001 and December 2012, we considered all patients who developed GHD as a consequence of cancer therapies. GHD was always diagnosed in childhood. To evaluate the quality of data, our cohort was linked to the Childhood Cancer Registry of Piedmont.
  
  
  RESULTS
  GHD was diagnosed in 49 out of 310 CCS included in our clinical cohort. At least one SN was diagnosed in 14 patients, meningioma and basal cell carcinoma being the most common SNs. The cumulative incidence of SNs was similar in GH-treated and -untreated patients (8 SNs out of 26 GH-treated and 6 out of 23 GH-untreated patients; p = 0.331). Age, sex and paediatric cancer type had no impact on SNs development.
  
  
  CONCLUSIONS
  In our CCS, GH replacement therapy does not seem to increase the risk of SNs. Anyway, independently from replacement therapy, in these patients we observed an elevated risk of SNs, possibly related to previous radiation therapy, which suggests the need of a close long-term follow-up.
authors.affiliation: Transition Unit for Childhood Cancer Survivors, Department of Oncology, AOU Città della Salute e della Scienza Hospital, Via Cherasco, 15, 10126, Turin, Italy. ebrignardello@cittadellasalute.to.it.
authors.forename: E
authors.initials: E
authors.lastname: Brignardello
authors.affiliation: Transition Unit for Childhood Cancer Survivors, Department of Oncology, AOU Città della Salute e della Scienza Hospital, Via Cherasco, 15, 10126, Turin, Italy.|Oncological Endocrinology Unit, Department of Oncology, University of Torino, Turin, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Felicetti
authors.affiliation: Unit of Clinical Epidemiology, University of Torino and Centre for Cancer Epidemiology and Prevention (CPO Piemonte), Turin, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Castiglione
authors.affiliation: Transition Unit for Childhood Cancer Survivors, Department of Oncology, AOU Città della Salute e della Scienza Hospital, Via Cherasco, 15, 10126, Turin, Italy.|Oncological Endocrinology Unit, Department of Oncology, University of Torino, Turin, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Fortunati
authors.affiliation: Paediatric Endocrinology Unit, Department of Paediatric Sciences, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Matarazzo
authors.affiliation: Paediatric Hematology/Oncology Unit, Department of Paediatric Sciences, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Biasin
authors.affiliation: Unit of Clinical Epidemiology, University of Torino and Centre for Cancer Epidemiology and Prevention (CPO Piemonte), Turin, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Sacerdote
authors.affiliation: Radiation Oncology Unit, Department of Oncology, University of Torino, Turin, Italy.
authors.forename: U
authors.initials: U
authors.lastname: Ricardi
authors.affiliation: Paediatric Hematology/Oncology Unit, Department of Paediatric Sciences, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Fagioli
authors.affiliation: Paediatric Endocrinology Unit, Department of Paediatric Sciences, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Corrias
authors.affiliation: Oncological Endocrinology Unit, Department of Oncology, University of Torino, Turin, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Arvat
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000097:blood / Q000175:diagnosis / Q000532:radiotherapy; D015331:Cohort Studies; D005260:Female; D020249:Hormone Replacement Therapy / Q000639:trends; D019382:Human Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000097:blood / Q000175:diagnosis / Q000532:radiotherapy; D016609:Neoplasms, Second Primary / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology; D012189:Retrospective Studies
chemical_list: D019382:Human Growth Hormone
keywords: Childhood cancer; Growth hormone; Radiotherapy; Second neoplasm