Ross Hamblin, Ashley Vardon, Josephine Akpalu, Metaxia Tampourlou, Ioannis Spiliotis, Emilia Sbardella, Julie Lynch, Vani Shankaran, Akash Mavilakandy, Irene Gagliardi, Sara Meade, Claire Hobbs, Alison Cameron, Miles J Levy, John Ayuk, Ashley Grossman, Maria Rosaria Ambrosio, Maria Chiara Zatelli, Narendra Reddy, Karin Bradley, Robert D Murray, Aparna Pal, Niki Karavitaki
{"title":"垂体腺瘤或颅咽管瘤放疗后发生第二脑瘤的风险:一项对3679例长期影像学监测患者的回顾性、多中心、队列研究","authors":"Ross Hamblin, Ashley Vardon, Josephine Akpalu, Metaxia Tampourlou, Ioannis Spiliotis, Emilia Sbardella, Julie Lynch, Vani Shankaran, Akash Mavilakandy, Irene Gagliardi, Sara Meade, Claire Hobbs, Alison Cameron, Miles J Levy, John Ayuk, Ashley Grossman, Maria Rosaria Ambrosio, Maria Chiara Zatelli, Narendra Reddy, Karin Bradley, Robert D Murray, Aparna Pal, Niki Karavitaki","doi":"10.1016/S2213-8587(22)00160-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Radiotherapy is a valuable treatment in the management algorithm of pituitary adenomas and craniopharyngiomas. However, the risk of second brain tumour following radiotherapy is a major concern. We assessed this risk using non-irradiated patients with the same primary pathology and imaging surveillance as controls.</p><p><strong>Methods: </strong>In this multicentre, retrospective cohort study, 4292 patients with pituitary adenoma or craniopharyngioma were identified from departmental registries at six adult endocrine centres (Birmingham, Oxford, Leeds, Leicester, and Bristol, UK and Ferrara, Italy). Patients with insufficient clinical data, known genetic predisposition to or history of brain tumour before study entry (n=532), and recipients of proton beam or stereotactic radiotherapy (n=81) were excluded. Data were analysed for 996 patients exposed to 2-dimensional radiotherapy, 3-dimensional conformal radiotherapy, or intensity-modulated radiotherapy, and compared with 2683 controls.</p><p><strong>Findings: </strong>Over 45 246 patient-years, second brain tumours were reported in 61 patients (seven malignant [five radiotherapy, two controls], 54 benign [25 radiotherapy, 29 controls]). Radiotherapy exposure and older age at pituitary tumour detection were associated with increased risk of second brain tumour. Rate ratio for irradiated patients was 2·18 (95% CI 1·31-3·62, p<0·0001). Cumulative probability of second brain tumour was 4% for the irradiated and 2·1% for the controls at 20 years.</p><p><strong>Interpretation: </strong>Irradiated adults with pituitary adenoma or craniopharyngioma are at increased risk of second brain tumours, although this risk is considerably lower than previously reported in studies using general population controls with no imaging surveillance. Our data clarify an important clinical question and guide clinicians when counselling patients with pituitary adenoma or craniopharyngioma on the risks and benefits of radiotherapy.</p><p><strong>Funding: </strong>Pfizer.</p>","PeriodicalId":519532,"journal":{"name":"The lancet. Diabetes & endocrinology","volume":" ","pages":"581-588"},"PeriodicalIF":0.0000,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"8","resultStr":"{\"title\":\"Risk of second brain tumour after radiotherapy for pituitary adenoma or craniopharyngioma: a retrospective, multicentre, cohort study of 3679 patients with long-term imaging surveillance.\",\"authors\":\"Ross Hamblin, Ashley Vardon, Josephine Akpalu, Metaxia Tampourlou, Ioannis Spiliotis, Emilia Sbardella, Julie Lynch, Vani Shankaran, Akash Mavilakandy, Irene Gagliardi, Sara Meade, Claire Hobbs, Alison Cameron, Miles J Levy, John Ayuk, Ashley Grossman, Maria Rosaria Ambrosio, Maria Chiara Zatelli, Narendra Reddy, Karin Bradley, Robert D Murray, Aparna Pal, Niki Karavitaki\",\"doi\":\"10.1016/S2213-8587(22)00160-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Radiotherapy is a valuable treatment in the management algorithm of pituitary adenomas and craniopharyngiomas. However, the risk of second brain tumour following radiotherapy is a major concern. We assessed this risk using non-irradiated patients with the same primary pathology and imaging surveillance as controls.</p><p><strong>Methods: </strong>In this multicentre, retrospective cohort study, 4292 patients with pituitary adenoma or craniopharyngioma were identified from departmental registries at six adult endocrine centres (Birmingham, Oxford, Leeds, Leicester, and Bristol, UK and Ferrara, Italy). Patients with insufficient clinical data, known genetic predisposition to or history of brain tumour before study entry (n=532), and recipients of proton beam or stereotactic radiotherapy (n=81) were excluded. Data were analysed for 996 patients exposed to 2-dimensional radiotherapy, 3-dimensional conformal radiotherapy, or intensity-modulated radiotherapy, and compared with 2683 controls.</p><p><strong>Findings: </strong>Over 45 246 patient-years, second brain tumours were reported in 61 patients (seven malignant [five radiotherapy, two controls], 54 benign [25 radiotherapy, 29 controls]). Radiotherapy exposure and older age at pituitary tumour detection were associated with increased risk of second brain tumour. Rate ratio for irradiated patients was 2·18 (95% CI 1·31-3·62, p<0·0001). Cumulative probability of second brain tumour was 4% for the irradiated and 2·1% for the controls at 20 years.</p><p><strong>Interpretation: </strong>Irradiated adults with pituitary adenoma or craniopharyngioma are at increased risk of second brain tumours, although this risk is considerably lower than previously reported in studies using general population controls with no imaging surveillance. Our data clarify an important clinical question and guide clinicians when counselling patients with pituitary adenoma or craniopharyngioma on the risks and benefits of radiotherapy.</p><p><strong>Funding: </strong>Pfizer.</p>\",\"PeriodicalId\":519532,\"journal\":{\"name\":\"The lancet. Diabetes & endocrinology\",\"volume\":\" \",\"pages\":\"581-588\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"8\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The lancet. 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Risk of second brain tumour after radiotherapy for pituitary adenoma or craniopharyngioma: a retrospective, multicentre, cohort study of 3679 patients with long-term imaging surveillance.
Background: Radiotherapy is a valuable treatment in the management algorithm of pituitary adenomas and craniopharyngiomas. However, the risk of second brain tumour following radiotherapy is a major concern. We assessed this risk using non-irradiated patients with the same primary pathology and imaging surveillance as controls.
Methods: In this multicentre, retrospective cohort study, 4292 patients with pituitary adenoma or craniopharyngioma were identified from departmental registries at six adult endocrine centres (Birmingham, Oxford, Leeds, Leicester, and Bristol, UK and Ferrara, Italy). Patients with insufficient clinical data, known genetic predisposition to or history of brain tumour before study entry (n=532), and recipients of proton beam or stereotactic radiotherapy (n=81) were excluded. Data were analysed for 996 patients exposed to 2-dimensional radiotherapy, 3-dimensional conformal radiotherapy, or intensity-modulated radiotherapy, and compared with 2683 controls.
Findings: Over 45 246 patient-years, second brain tumours were reported in 61 patients (seven malignant [five radiotherapy, two controls], 54 benign [25 radiotherapy, 29 controls]). Radiotherapy exposure and older age at pituitary tumour detection were associated with increased risk of second brain tumour. Rate ratio for irradiated patients was 2·18 (95% CI 1·31-3·62, p<0·0001). Cumulative probability of second brain tumour was 4% for the irradiated and 2·1% for the controls at 20 years.
Interpretation: Irradiated adults with pituitary adenoma or craniopharyngioma are at increased risk of second brain tumours, although this risk is considerably lower than previously reported in studies using general population controls with no imaging surveillance. Our data clarify an important clinical question and guide clinicians when counselling patients with pituitary adenoma or craniopharyngioma on the risks and benefits of radiotherapy.