Abstract 540 Poster Session I, Saturday, 5/1 (poster 310)

Obesity is a relatively common sequel after treatment for certain types of childhood cancers. However, the causes of obesity in this at-risk population are unclear. Environmental changes, such as parental attitudes, quality of life, self-image, exercise, and nutrition after cancer therapy all may play a role. In some cases, the tumor itself may play a role, especially in the CNS (e.g. craniopharyngiomas). Other biochemical factors have also been proposed, such as treatment with glucocorticoids, other chemotherapies, and cranial irradiation. We undertook a review of the weight and height data of 1703 patients, diagnosed between ages 0-14 yr, and treated for either malignant or non-malignant disease at St. Jude Children's Research Hospital between 1962 and 1993, and who were followed into adulthood (i.e. beyond age 18). Patients were stratified into four groups: 1) non-malignant disease (e.g. Sickle Cell, Aplastic Anemia); 2) solid tumors (e.g. Ewing's Sarcoma, neuroblastoma; but excluding retinoblastoma and nasopharyngeal rhabdomyosarcoma); 3) Acute Lymphocytic Leukemia (ALL) without prophylactic cranial irradiation (CrXRT); and 4) ALL with CrXRT. Obesity was identified by the current American Heart Association definition of Body Mass Index (BMI) greater than 25. (Table) These data demonstrate that adults who had malignant disease as children have similar BMI and obesity incidence as adults with non-malignant disease. In adults previously treated for ALL, those who received CrXRT had a higher mean BMI than those who did not (despite similar chemotherapeutic regimens); although this does not rule out steroid exposure as an etiologic factor. We conclude that cranial irradiation is a risk factor for the development of adult obesity in patients treated for cancer in childhood.

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