2018 Volume 55 Issue 2 Pages 163-170
We retrospectively analyzed the frequency of and risk factor for endocrine dysfunction in 104 patients (61 males, 43 females) with pediatric cancer who were alive for at least one year after cancer treatment between 1983 and 2014. The median age at initial diagnosis and the last follow-up were 4 years (range, 0–16 years) and 15 years (range, 1–33 years), respectively. The disease subtypes were central nervous system (CNS) solid tumors without the involvement of the pituitary gland (n=22) and non-CNS solid tumors (n=82). Forty-eight (46.2%) of the 104 patients had at least one endocrine dysfunction. Gonadal dysfunction was observed in 33 (45.8%) of the 72 evaluable patients: high doses of cyclophosphamide (≥7.5 g/m2) or ifosfamide (≥60 g/m2) and age at diagnosis (≥10 years) were the independent risk factors. Thyroid dysfunction was observed in 18 (18.9%) of the 95 evaluable patients; head and neck irradiation was an independent risk factor. Growth disturbance/growth hormone deficiency was observed in 16 (19.3%) of the 83 evaluable patients; however, no independent risk factors were identified. None of the patients had adrenal gland dysfunction. A higher risk of gonadal dysfunction was found in patients with osteosarcoma or other sarcomas, and neuroblastoma, whereas multiple endocrine dysfunctions were detected in patients with medulloblastoma and intracranial germ cell tumor. Treatment should be improved to reduce the risk of late adverse effects for patients with bone and soft tissue tumors or brain tumors who were treated with high-dose alkylators and radiation therapy and thus have an increased risk of endocrine dysfunction.
