Suprasellar CNS germ cell tumors and endocrine sequelae: early growth hormone therapy as a contributor to height gain: a single institute analysis.
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BACKGROUND: Although the prognosis of patients with pediatric intracranial germ cell tumors (ICGCTs) has improved, late effects in long-term survivors remains an important issue. Here, we evaluated endocrine complications and quality of life in ICGCT patients treated with proton beam therapy (PBT) or photon radiotherapy (RT). METHODS: We retrospectively evaluated 18 patients aged 15 years or younger at the time of ICGCT diagnosis at University of Tsukuba Hospital from January 2010 to December 2016. RESULTS: Eleven had tumors in the suprasellar region and seven in other parts of the brain (non-suprasellar ICGCT). Ten were treated with proton beam therapy only in combination with chemotherapy. All but 2 patients were alive without disease. The number of cases receiving hormone replacement therapy (HRT) were significantly higher in the suprasellar tumor group (p < 0.001), and longer time to diagnosis (TTD) from onset was associated with the number of hormones being replaced at the last visit (correlation coefficient 0.77, p < 0.001). All the patients who received appropriate growth hormone therapy increased in height without relapse of the tumor. With regard to the modality of radiation therapy for ICGCTs, PBT was equivalent to photon RT in terms of recurrence, survival, number of hormones being replaced, and quality of life. CONCLUSIONS: HRT was more frequently administered to patients with suprasellar ICGCT than to those with non-suprasellar ICGCT, and was more likely to be required in patients with a longer TTD. Parameters such as radiotherapy and chemotherapy were not associated with HRT in survivors of ICGCTs.