Department of Endocrinology, The Christie, Manchester Academic Health Science Centre, Wilmslow Road, Manchester M20 4BX, United Kingdom.
J Clin Endocrinol Metab. 2011 Sep;96(9):2756-61. doi: 10.1210/jc.2011-0112. Epub 2011 Jun 29.
Radiotherapy is a central component in the treatment of many brain tumors, but long-term sequelae include GH deficiency and increased risk of secondary neoplasms. It is unclear whether replacement therapy with GH (GHRT) further increases this risk.
The objective of the study was to assess the effect of GHRT on the incidence of secondary tumors and tumor recurrence after cranial irradiation.
We conducted a retrospective matched-pairs analysis of previously irradiated patients, with and without GHRT, attending a tertiary center between 1994 and 2009.
We reviewed the records for all patients undergoing GHRT at our institution over the study period. PATIENTS were included if they had received cranial irradiation, GHRT for at least 12 months, and records of serial magnetic resonance imaging data and data for dose and fractionation of irradiation were available. GH-naïve control patients were selected from a radiotherapy database of patients attending the same hospital. PATIENTS were matched for date of radiotherapy, age, site of primary diagnosis, radiation dose, and fractionation.
The primary outcome measure was risk of tumor recurrence or secondary tumor.
Matched controls were identified for 110 GH-treated patients. Median follow-up was 14.5 yr. No significant differences were apparent in the number of tumor recurrences (six vs. eight, GHRT vs. control group) or secondary tumors (five vs. three, respectively) between groups.
Our study demonstrates no increased risk for recurrent or secondary neoplasms in patients receiving GHRT, thus supporting a high safety profile of GHRT after central nervous system irradiation.
放射疗法是治疗许多脑肿瘤的核心手段，但长期的后遗症包括生长激素缺乏症和继发肿瘤风险增加。目前尚不清楚生长激素替代疗法（GHRT）是否会进一步增加这种风险。
本研究旨在评估 GHRT 对颅脑放疗后继发肿瘤和肿瘤复发的影响。
我们对 1994 年至 2009 年期间在一家三级中心接受 GHRT 和未接受 GHRT 的既往放疗患者进行了回顾性配对分析。
我们查阅了研究期间在我院接受 GHRT 的所有患者的记录。如果患者接受过颅脑放疗、至少接受了 12 个月的 GHRT，且有连续磁共振成像数据记录和放疗剂量及分割记录，则纳入研究。GH 初治对照患者从同一医院的放疗数据库中选择。对放疗日期、年龄、原发诊断部位、放射剂量和分割进行匹配。
主要观察指标是肿瘤复发或继发肿瘤的风险。
为 110 例接受 GH 治疗的患者匹配了对照。中位随访时间为 14.5 年。两组间肿瘤复发（6 例 vs. 8 例，GHRT 组 vs. 对照组）或继发肿瘤（5 例 vs. 3 例）的数量无显著差异。
我们的研究表明，接受 GHRT 的患者不存在复发或继发肿瘤风险增加的情况，因此支持 GHRT 在中枢神经系统照射后的安全性。
