Age at Onset of Puberty Following High-Dose Central Nervous System Radiation Therapy
Sharon E. Oberfield, MD;
Dorothy Soranno, MD;
Anita Nirenberg, RN, PNP;
Glenn Heller, PhD;
Jeffrey C. Allen, MD;
Raphael David, MD;
Lenore S. Levine, MD;
Charles A. Sklar, MD
Arch Pediatr Adolesc Med. 1996;150(6):589-592.
Abstract
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Objective
To determine if a relationship exists between age at irradiation, sex of the patient, and age at onset of puberty and pubarche in children treated with high-dose radiation to the central nervous system.
Design
Case series.
Setting
Tertiary care institutional practices and clinics.
Patients
Thirty-six children treated with high-dose irradiation (hypothalamic pituitary dose, 30-72 Gy) by conventional (n=29) or hyperfractionated (n=7) schedules. Girls were treated before age 8 years and boys before age 9 years. Twenty-six of the 36 children also received chemotherapy. All tumors were distant from the hypothalamic-pituitary region.
Main Outcome Measure
Age at onset of puberty and pubarche.
Results
In girls, the median age at onset of puberty was 9.3 years vs 10.9 years for controls (P<.01); pubarche occurred at 9.4 years vs 11.2 years for controls (P<.01). In boys, the median age at onset of puberty—genital II—was 11.0 years vs 11.5 years for controls (P=.30); pubarche occurred at a median age of 10.5 years vs 12 years for controls (P=.25). A censored-data normal linear regression model was used to account for children (n=6) who had not reached puberty. Age at diagnosis (P<.01) and sex (P=.01) were significant predictors of age at onset of puberty. Body mass index SD score (z score) was inversely related to age at onset of puberty (r=–0.77) and was greater at onset of puberty in girls than in boys.
Conclusion
In children who have received high-dose cranial radiation therapy, a significant positive correlation exists between age at diagnosis and age at onset of puberty in boys and girls.
(Arch Pediatr Adolesc Med. 1996;150:589-592)
Author Affiliations
From the Departments of Pediatrics (Drs Oberfield, Soranno, and David) and Neurology (Ms Nirenberg and Dr Allen), New York (NY) University Medical Center; the Department of Pediatrics, St Luke's/Roosevelt Hospital Center (Dr Levine), and the Departments of Epidemiology and Biostatistics (Dr Heller) and Pediatrics (Dr Sklar), Memorial Sloan Kettering Cancer Center, New York.
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