Ann Pediatr Endocrinol Metab.  2018 Jun;23(2):88-93. 10.6065/apem.2018.23.2.88.

Thyroid dysfunction in patients with childhood-onset medulloblastoma or primitive neuroectodermal tumor

• Jin SY
• Choi JY
• Park KD
• Kang HJ
• Shin HY
• Phi JH
• Kim SK
• Wang KC
• Kim IH
• Lee YA
• Shin CH
• Yang SW

• KMID: 2417765
• DOI: http://doi.org/10.6065/apem.2018.23.2.88

Abstract

PURPOSE
We investigated the clinical characteristics of patients who developed thyroid dysfunction and evaluated the risk factors for hypothyroidism following radiotherapy and chemotherapy in pediatric patients with medulloblastoma or primitive neuroectodermal tumor (PNET).
METHODS
The medical records of 66 patients (42 males) treated for medulloblastoma (n=56) or PNET (n=10) in childhood between January 2000 and December 2014 at Seoul National University Children's Hospital were retrospectively reviewed. A total of 21 patients (18 high-risk medulloblastoma and 3 PNET) underwent high-dose chemotherapy and autologous stem cell rescue (HDCT/ASCR)
RESULTS
During the median 7.6 years of follow-up, 49 patients (74%) developed transient (n=12) or permanent (n=37) hypothyroidism at a median 3.8 years of follow-up (2.9-4.6 years). Younger age ( < 5 years) at radiation exposure (P=0.014 vs. ≥9 years) and HDCT (P=0.042) were significantly predictive for hypothyroidism based on log-rank test. However, sex, type of tumor, and dose of craniospinal irradiation (less vs. more than 23.4 Gy) were not significant predictors. Cox proportional hazard model showed that both younger age (< 5 years) at radiation exposure (hazard ratio [HR], 3.1; vs. ≥9 years; P=0.004) and HDCT (HR, 2.4; P=0.010) were significant predictors of hypothyroidism.
CONCLUSIONS
Three-quarters of patients with pediatric medulloblastoma or PNET showed thyroid dysfunction, and over half had permanent thyroid dysfunction. Thus, frequent monitoring of thyroid function is mandatory in all patients treated for medulloblastoma or PNET, especially, in very young patients and/or high-risk patients recommended for HDCT/ASCR.

Keyword

Thyroid hormones; Medulloblastoma; Primitive neuroectodermal tumors; Craniospinal irradiation; Chemotherapy; Adjuvant; Pediatrics

MeSH Terms

Craniospinal Irradiation
Drug Therapy
Follow-Up Studies
Humans
Hypothyroidism
Medical Records
Medulloblastoma*
Neuroectodermal Tumors, Primitive*
Pediatrics
Proportional Hazards Models
Radiation Exposure
Radiotherapy
Retrospective Studies
Risk Factors
Seoul
Stem Cells
Thyroid Gland*
Thyroid Hormones
Thyroid Hormones

Figure

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  Fig. 1. Inclusion criteria of patients treated for medulloblastoma or primitive neuroectodermal tumor (PNET). TFT, thyroid function test; AML, acute myeloid leukemia.

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  Fig. 2. (A) Time to period to thyroid dysfunction was a median 3.8 years (95% confidence interval [CI], 2.9–4.6). Younger age (<5 years) at radiation exposure (B) and high-dose chemotherapy (HDCT) (C) and autologous stem cell rescue were predictors for the development of hypothyroidism during follow-up. HR, hazard ratio.

Reference

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