Factors affecting the final adult height in survivors of childhood brain tumors

Yun, Kyong-Ah; Lee, Young Ah; Shin, Choong Ho; Yang, Sei Won; Shin, Hee Young; Ahn, Hyo Seop; Kim, Il Han

Original Article

Korean Journal of Pediatrics 2007;50(1):65-73.
Published online January 15, 2007.

Factors affecting the final adult height in survivors of childhood brain tumors

Kyong-Ah Yun¹, Young Ah Lee¹, Choong Ho Shin¹, Sei Won Yang¹, Hee Young Shin¹, Hyo Seop Ahn¹, Il Han Kim²

¹Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
²Department of Therapeutic Radiology & Oncology, Seoul National University College of Medicine, Seoul, Korea

소아 뇌종양 환자의 최종 성인키에 영향을 미치는 인자

윤경아^¹^, 이영아^¹^, 신충호^¹^, 양세원^¹^, 신희영^¹^, 안효섭^¹^, 김일환^²

^¹서울대학교 의과대학 소아과학교실
^²서울대학교 의과대학 방사선종양학교실

Correspondence:
Choong Ho Shin, Email: chshinpd@sun.ac.kr

Abstract

Purpose
: Short stature is an important complication that impairs the quality of life in survivors of childhood brain tumors. We studied their final adult height (FAH) to evaluate risk factors for short stature.
Methods
: We reviewed the medical data of 95 survivors of childhood brain tumors (64 males and 31 females) who had been followed up from 1982 to 2006, reached FAH, and had a more than five year-disease-free survival.
Results
: Final adult height standard deviation score (FAHTSDS: mean켚D) of the patients was lower than those of general population (-1.15?.72), HTSDS at diagnosis (-0.13?.57), and target HTSDS (-0.49?.69). FAHTSDS of craniopharyngioma patients did not decrease (0.57?.17), but those of germ cell tumor and medulloblastoma patients were significantly reduced (-1.20?.45, -2.70?.46; P<0.05). The patients treated with craniospinal radiation or chemotherapy had lower FAHTSDS (-1.93?.58, -2.27?.44; P<0.01). In the spinal irradiation group, the younger the age at diagnosis was, the more the loss of FAH (r=0.442, P<0.01). Growth hormone replacement (GHR) didn't improve FAHTSDS, but starting GHR under 12 years was an independent factor for improving FAH once treatment methods were taken into account (P=0.01).
Conclusion
: The younger age at diagnosis, spinal radiation and chemotherapy were all important risk factors of height loss, and height gain was expected in patients who received GHR under the age of 12 years. Therefore, regular check-ups of growth and early intervention with growth hormones are needed for high risk groups to improve FAH.

Key Words: Brain tumor , Final adult height , Radiation therapy , Growth hormone therapy