Radiotherapy, Especially at Young Age, Increases the Risk for De Novo Brain Tumors in Patients Treated for Pituitary/Sellar Lesions

Pia Burman*, Andre P. van Beek, Beverly M.K. Biller, Cecilia Camacho-Hubner, Anders F. Mattsson

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    36 Citations (Scopus)

    Abstract

    Context: De novo brain tumors developing after treatment of pituitary/sellar lesions have been reported, but it is unknown whether this is linked to any of the treatment modalities.

    Objective: To study the occurrence of malignant brain tumors and meningiomas in a large cohort of patients treated for pituitary/sellar lesions, with special emphasis on the role of radiotherapy (RT).

    Patients and Methods: Patients (n = 8917) who were hypopituitary due to pituitary adenomas, craniopharyngiomas, and other sellar tumors followed in KIMS (Pfizer International Metabolic Database) from 1994 to 2012 were included. Treatment consisted of surgery and/or medical therapy in 4927 patients, RT alone, or with surgery in 3236 patients; data were missing in 754. Incidence rate ratios (RRs) were analyzed through Poisson regression methods with internal comparisons.

    Results: During 53,786 patient-years, 17 cases of malignant brain tumors (13 exposed to RT) and 27 meningiomas (22 exposed to RT) were reported. RR for RT vs no RT was 3.34 [95% confidence interval (CI), 1.06 to 10.6] for malignant brain tumors, and 4.06 (95% CI, 1.51 to 10.9) for meningiomas. The risk of developing a malignant brain tumor increased by 2.4-fold (P = 0.005) and meningioma by 1.6-fold with every 10 years of younger age at RT (P = 0.05). Incidence rates were similar in patients treated with conventional RT compared with stereotactic RT.

    Conclusion: RT of pituitary tumors is associated with increased risk of developing malignant brain tumors and meningiomas, especially when given at younger ages. In balancing risks and benefits of RT, our findings emphasize that special consideration should be given to the age of the patient.

    Original languageEnglish
    Pages (from-to)1051-1058
    Number of pages8
    JournalJournal of Clinical Endocrinology and Metabolism
    Volume102
    Issue number3
    DOIs
    Publication statusPublished - 1-Mar-2017

    Keywords

    • CONSERVATIVE SURGERY
    • INTRACRANIAL TUMORS
    • RADIATION-THERAPY
    • 2ND TUMORS
    • ADENOMA
    • CHILDHOOD
    • GLIOBLASTOMA
    • MORTALITY
    • RADIOSURGERY
    • MENINGIOMA

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