Primary gonadal failure in children with intracranial brain tumors treated with high dose alkylating agents and radiation sparing therapy: an institutional case series

Treatment of young children with brain tumors may require the use of high dose chemotherapy with alkylating agents to avoid craniospinal irradiation. The objective of this study is to describe the probability of primary gonadal failure (PGF) in children with a malignant intracranial tumor treated with high-dose alkylating agents in children diagnosed less than age 8 years who were treated with this radiation-sparing approach at our institution. Patient demographics, oncological and endocrine diagnoses, treatment modalities, and laboratory values were collected. Descriptive statistics, Kaplan Meier survival curves, regression analysis, and T-tests were used in data analysis. Eight of 18 (44%) developed PGF. The probability of developing PGF is 11% at 5 years, and 31% at 10 years. Cyclophosphamide equivalent dose (CED) was higher and duration of follow-up was longer in children with PGF. PGF is common in children who received CED without irradiation, but further studies are needed to correlate CED dose and time to onset of PGF.