(Pediatrics in Review. 1997;18:442-444.)
© 1997 American Academy of Pediatrics
Consultation with the Specialist: Poor Growth After Cranial Irradiation
Stephen Burstein, MD, PhD*
*
Associate Professor of Pediatrics, Division of Endocrinology
and Metabolism, University of Tennessee; Consultant in Endocrinology, St. Jude
Children's Research Hospital,
Memphis, TN
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Introduction
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We are indeed fortunate that survival after cancer therapy is
now common among growing children. Although the overriding concern is to
maintain these children in remission, an increasing proportion of them are
being referred to growth specialists because of the effects of their
treatment on subsequent growth and maturation. Some of this early growth
failure is due to antineo-plastic therapy, anorexia, vomiting, and chronic
illness, but later many of these patients have diagnosable endocrinopathies
as the major or sole explanation for poor growth. The pediatrician needs to
be aware of these problems and monitor growth as more of these children
appear in his or her practice for ongoing pediatric care.
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Case Report
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BPS was an 11-year-old, early pubertal male referred for poor growth after therapy
for T-cell acute lymphoblastic leukemia (ALL) with central nervous system
(CNS) involvement. He had been diagnosed at 7 years of age, and his remission
was induced with a standard systemic induction regimen (prednisone,
vincristine, L-asparaginase, teniposide, cytarabine, and daunomycin),
followed by continuation therapy consisting of a cyclic rotation of
antileukemic drug pairs for another 2.5 years. Initial CNS treatment
consisted of triple intrathecal chemotherapy (methotrexate, hydrocortisone,
and cytarabine) and cranial irradiation of 18 Gy (1 Gy = 100 rad) at 1 year
after remission. He suffered a CNS relapse at 9 years and was treated
further with systemic chemotherapy and craniospinal irradiation (24 Gy
cranial, 15 Gy spinal). In all, he received 42 Gy of cranial irradiation and
15 Gy of spinal irradiation.
At the time of the patient's ALL diagnosis,
his height was +2.0 SD at the 95th percentile above mean height for age, but
over the intervening 4 years until endocrine evaluation, he had slowly
decreased in height for age to +0.1 SD. At the time of his first growth
evaluation, at 11 years . . . [Full Text of this Article]
Copyright © 1997 by the American Academy of Pediatrics.
