Abstract
Background: We evaluated associations between radiation therapy (RT) and late side effects (long-term endocrine, cognitive and cerebrovascular complications) in pediatric patients with brain tumor in a nationwide population.
Methods: Data of pediatric patients with brain tumor were extracted from the National Health Insurance Research Database (NHIRD) of Taiwan. The RT cohort included 815 patients, randomly matched by age, gender, and index year with non-RT controls. Multivariable Cox proportional hazards regression was used to calculate adjusted hazard ratios (aHR) of developing late side effects in RT patients versus non-RT controls.
Results: The risk of late side effects in RT group was 1.173-fold (aHR =1.173, 95%CI 1.063-1.430) higher than did non-RT group. RT patients exhibited 1.172-fold and 1.796-fold higher risk of long-term endocrinopathies and late-delayed complications, respectively, than did non-RT patients. For long-term endocrinopathies, patients with RT had 1.602-fold and 1.120-fold higher risk for gonadotropin deficiency and hypothalamic pituitary dysfunction, respectively, than did non-RT patients. For late-delayed complications, patients with RT had 3.208-fold higher risk for necrosis of brain stem than did non-RT patients.
Conclusion: Gonadotropin deficiency, hypothalamic pituitary dysfunction and brainstem necrosis are dominant RT-related late side effects in pediatric patients. Frequency of these deficits increases with time, warranting long-term surveillance.