CEREBRAL IRRADIATION CAUSES BLUNTED PUBERTAL GROWTH IN GIRLS TREATED FOR ACUTE-LEUKEMIA

The improved treatment of childhood leukemia is a major achievement. T he late effects of the treatment need further investigation. Growth in hibition has been demonstrated in earlier studies. Growth and the timi ng of puberty were studied in 179 girls who had been treated for acute lymphoblastic leukemia (ALL) in Denmark, Finland, Norway, and Sweden. The patients were divided into two groups according to mode of CNS pr ophylaxis: with or without cerebral irradiation. Longitudinal analysis of 103 patients showed no difference in prepubertal growth in irradia ted and nonirradiated girls. Growth during puberty was normal in girls without irradiation and below normal in irradiated girls. There was n o difference in growth between girls after 24 Gy or 20 Gy of cerebral irradiation. Irradiated girls had a final height which was one SD less than expected before puberty and menarche occurred one year earlier t han in the nonirradiated girls. Prophylactic cerebral irradiation is t he most important factor for subnormal growth after treatment for ALL. There is no short-term influence on growth but the effects of irradia tion become apparent several years after therapy when girls enter pube rty somewhat early and have a subnormal pubertal growth. Growth and gr owth hormone (GH) levels should be evaluated several years after CNS i rradiation, and treatment with GH and/or luteinizing hormone releasing hormone (LHRH) analogues may be considered. (C) 1991 Wiley-Liss, Inc.