{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T22:35:02Z","timestamp":1768516502646,"version":"3.49.0"},"reference-count":25,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2022,7,16]],"date-time":"2022-07-16T00:00:00Z","timestamp":1657929600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Pituitary insufficiency is a common toxicity of cranial radiotherapy received in childhood for central nervous system, head and neck, and hematological malignancies. There is a recognized deficiency pattern and correlation with prescribed radiotherapy dose; however, correlation with measured pituitary dose (which can be minimized with modern radiotherapy techniques) has not previously been assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>Retrospective analysis was carried out of measured pituitary dose and endocrine outcomes of patients receiving cranial, total body, or head and neck photon beam radiotherapy at a tertiary center from July 2008 to October 2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Complete data for 102 patients were available. Median (IQR) age at radiotherapy was 9.0 (6.0\u201012.0) and follow\u2010up 5.7 years (3.5\u20109.1). Most patients received focal brain radiotherapy (36.3%) or total body irradiation (32.4%); most frequent diagnoses were acute lymphoblastic leukemia (25.5%) and medulloblastoma (17.6%). The majority developed pituitary insufficiency (64; 62.7%); 41% had one and 38% had two hormone deficiencies. Growth hormone deficiency (GHD) (58; 56.9%) and thyroid\u2010stimulating hormone deficiency (TSHD) (32; 31.4%) were most common. Patients who developed pituitary insufficiency received higher maximum pituitary dose\u2014median (IQR) Gy, 44.0 (20.4\u201054.0) vs 18.2 (14.4\u201052.6); <jats:italic>P<\/jats:italic> = 0.008. Doses of 40\u201049 Gy or &gt;50 Gy led to a higher cumulative incident rate than &lt;20 Gy (HR 4.07, <jats:italic>P<\/jats:italic> &lt; 0.001 and HR 3.04, <jats:italic>P<\/jats:italic> &lt; 0.001, respectively). However, even at lower dose bands, levels of pituitary insufficiency were significant with a five\u2010year cumulative incidence of GHD for &lt;20 Gy and TSHD for 20\u201029 Gy reaching &gt;30%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings confirm a correlation between measured pituitary dose and risk of insufficiency even at lower doses, despite modern radiotherapy techniques. These data highlight the importance of minimizing pituitary dose and early specialist endocrine follow\u2010up.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.29847","type":"journal-article","created":{"date-parts":[[2022,6,17]],"date-time":"2022-06-17T10:24:17Z","timestamp":1655461457000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Correlating measured radiotherapy dose with patterns of endocrinopathy: The importance of minimizing pituitary dose"],"prefix":"10.1002","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1558-7572","authenticated-orcid":false,"given":"Olivia","family":"Fraser","sequence":"first","affiliation":[{"name":"Olivia Newton\u2010John Cancer Centre  Heidelberg Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Crowne","sequence":"additional","affiliation":[{"name":"Bristol Royal Hospital for Children University Hospitals Bristol and Weston NHS Foundation Trust  Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Tacey","sequence":"additional","affiliation":[{"name":"The Northern Hospital  Epping Victoria Australia"},{"name":"Melbourne School of Population and Global Health University of Melbourne  Carlton Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Cramer","sequence":"additional","affiliation":[{"name":"The Children's Hospital at Westmead  Westmead New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison","family":"Cameron","sequence":"additional","affiliation":[{"name":"Bristol Haematology and Oncology Centre University Hospitals Bristol and Weston NHS Foundation Trust  Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,7,16]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2019-00834"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.56.7933"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(15)00008-X"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-17-0054"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-12-1043"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11864-016-0426-0"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2012.07.008"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.66.6545"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2014.04.024"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2015.01.016"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers12092578"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.67.9.1107"},{"key":"e_1_2_8_14_1","unstructured":"Children's Oncology Group.Guidelines for survivors of childhood adolescent and young adult cancer long\u2010term follow\u2010up Version 4.0.2013:1\u2010241."},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199301143280203"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.24458"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2018.09.015"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1667\/RR14888.1"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.2000.01079.x"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2018.78.1492"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2019.01.002"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-021-03847-y"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12964"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27631"},{"key":"e_1_2_8_25_1","volume-title":"Long\u2010term Follow\u2010up of Survivors of Childhood Cancer: A National Clinical Guideline","author":"SIGN","year":"2013"},{"key":"e_1_2_8_26_1","volume-title":"Improving Outcomes in Children and Young People with Cancer","author":"NICE","year":"2005"}],"container-title":["Pediatric Blood &amp; 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