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

The lancet. Diabetes & endocrinology Pub Date : 2022-08-01 Epub Date: 2022-07-01 DOI:10.1016/S2213-8587(22)00160-7
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
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引用次数: 8

摘要

背景:在垂体腺瘤和颅咽管瘤的治疗方法中,放疗是一种有价值的治疗方法。然而,放射治疗后发生第二次脑瘤的风险是一个主要问题。我们使用与对照组相同的原发病理和影像学监测的未照射患者来评估这种风险。方法:在这项多中心、回顾性队列研究中,从6个成人内分泌中心(伯明翰、牛津、利兹、莱斯特和布里斯托尔,英国和费拉拉,意大利)的部门登记中确定了4292例垂体腺瘤或颅咽管瘤患者。临床资料不足、研究开始前已知的遗传易感性或脑肿瘤病史的患者(n=532)以及接受质子束或立体定向放疗的患者(n=81)被排除在外。对接受二维放疗、三维适形放疗或调强放疗的996例患者进行数据分析,并与对照组2683例进行比较。结果:在45246例患者年中,有61例患者报告了第二脑肿瘤(恶性7例[放疗5例,对照组2例],良性54例[放疗25例,对照组29例])。放射治疗暴露和垂体瘤检测年龄较大与第二脑瘤的风险增加有关。结论:经放疗的成人垂体腺瘤或颅咽管瘤患者患第二脑瘤的风险增加,尽管这一风险远低于之前报道的使用无影像学监测的普通人群对照的研究。我们的数据阐明了一个重要的临床问题,并指导临床医生咨询垂体腺瘤或颅咽管瘤患者放疗的风险和益处。资金:辉瑞。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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.

Funding: Pfizer.

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