In an analysis from the French Childhood Cancer Survivors (CCS) Study reported in the Journal of Clinical Oncology, Demoor-Goldschmidt et al found that receipt of pituitary irradiation, busulfan, and higher doses of lomustine were risk factors for small adult height in survivors of childhood cancer.
"[Childhood cancer survivors] treated with radiotherapy, busulfan, or lomustine should be closely monitored for growth, puberty onset, and potential pituitary deficiency.”— Demoor-Goldschmidt et al
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The investigators noted that between 10% and 20% of childhood cancer survivors experience impaired growth, resulting in small adult height.
Study Details
The study involved analysis of self-administered questionnaires completed by 2,965 5-year survivors from the French CCS Study population who received cancer treatment prior to 2001. Small adult height was defined as adult height ≤ 2 standard deviation scores of control values obtained from a French population health study.
Key Findings
After exclusion of 189 survivors who had been treated with growth hormone, a total of 254 (9.2%) of 2,776 had a small adult height. On multivariate analysis, the following factors were independently associated with risk for small adult height:
- Younger age at time of cancer treatment (relative risk [RR] = 0.92 per year of age, P < .0001).
- Small height at diagnosis (≤ 2 standard deviation scores; RR = 6.74, P < .0001)
- Receipt of pituitary irradiation vs no radiotherapy, with relative risks of 4.24 (95% confidence interval [CI] = 1.98–9.06) for 5 to 20 Gy, 10.16 (95% CI = 5.18–19.94) for 20 to 40 Gy, and 19.48 (95% CI = 8.73–43.48) for ≥ 40 Gy
- Receipt of busulfan vs no busulfan (RR = 4.42, P = .0002).
- Receipt of lomustine at 300 to 600 mg/m2 (RR = 4.15, P = .003) or at ≥ 600 mg/m2 (RR = 8.47, P = .0004) vs no lomustine.
Irradiation of seven or more vertebrae at ≥ 15 Gy on ≥ 90% of volume vs no radiotherapy increased the relative risk of small adult height by 4.62 (95% CI = 2.77–7.72) in patients not receiving pituitary irradiation and by an additional factor of 1.3 to 2.4 in those receiving pituitary irradiation.
The investigators concluded, “[Childhood cancer survivors] are at a high risk of [small adult height]. [Childhood cancer survivors] treated with radiotherapy, busulfan, or lomustine should be closely monitored for growth, puberty onset, and potential pituitary deficiency.”
Charlotte Demoor-Goldschmidt, MD, of the Cancer and Radiation Team, Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the French Society of Childhood Cancer, the PAIR Research Program, Pfizer Foundation for Childhood and Adolescent Health, the Ligue Nationale Contre le Cancer, and others. For full disclosures of the study authors, visit ascopubs.org.
