Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Int J Radiat Oncol Biol Phys. 2013 Sep 1;87(1):53-9. doi: 10.1016/j.ijrobp.2013.05.006.
To assess and compare the incidence of stroke and stroke subtype in pituitary adenoma patients treated with postoperative radiation therapy (RT) and surgery alone.
A cohort of 462 pituitary adenoma patients treated between 1959 and 2008 at the University Medical Center Groningen in The Netherlands was studied. Radiation therapy was administered in 236 patients. The TOAST (Trial of ORG 10172 in Acute Stroke Treatment) and the Oxfordshire Community Stroke Project classification methods were used to determine causative mechanism and anatomic localization of stroke. Stroke incidences in patients treated with RT were compared with that observed after surgery alone. Risk factors for stroke incidence were studied by log-rank test, without and with stratification for other significant risk factors. In addition, the stroke incidence was compared with the incidence rate in the general Dutch population.
Thirteen RT patients were diagnosed with stroke, compared with 12 surgery-alone patients. The relative risk (RR) for stroke in patients treated with postoperative RT was not significantly different compared with surgery-alone patients (univariate RR 0.62, 95% confidence interval [CI] 0.28-1.35, P=.23). Stroke risk factors were coronary or peripheral artery disease (univariate and multivariate RR 10.4, 95% CI 4.7-22.8, P<.001) and hypertension (univariate RR 3.9, 95% CI 1.6-9.8, P=.002). There was no difference in TOAST and Oxfordshire classification of stroke. In this pituitary adenoma cohort 25 strokes were observed, compared with 16.91 expected (standard incidence ratio 1.48, 95% CI 1.00-1.96, P=.049).
In pituitary adenoma patients, an increased incidence of stroke was observed compared with the general population. However, postoperative RT was not associated with an increased incidence of stroke or differences in causative mechanism or anatomic localization of stroke compared with surgery alone. The primary stroke risk factor was pre-existent coronary or peripheral artery disease.
评估和比较接受术后放疗（RT）和单纯手术治疗的垂体腺瘤患者中风和中风亚型的发生率。
对荷兰格罗宁根大学医学中心 1959 年至 2008 年间治疗的 462 例垂体腺瘤患者进行了研究。对 236 例患者进行了放射治疗。采用 TOAST（急性中风治疗 ORG 10172 试验）和牛津郡社区中风项目分类方法确定中风的病因机制和解剖定位。比较接受 RT 治疗的患者的中风发生率与单纯手术治疗的患者的中风发生率。通过对数秩检验研究中风发生率的危险因素，不考虑和考虑其他显著危险因素的分层。此外，还将中风发生率与荷兰一般人群的发病率进行了比较。
在接受 RT 的 13 例患者中诊断出中风，而在单纯手术组中则有 12 例。与单纯手术组相比，接受术后 RT 治疗的患者中风的相对风险（RR）无显著差异（单变量 RR 0.62，95%置信区间[CI]0.28-1.35，P=.23）。中风危险因素为冠状动脉或外周动脉疾病（单变量和多变量 RR 10.4，95%CI4.7-22.8，P<.001）和高血压（单变量 RR 3.9，95%CI1.6-9.8，P=.002）。TOAST 和牛津郡中风分类无差异。在该垂体腺瘤队列中观察到 25 例中风，而预期为 16.91 例（标准发病率比 1.48，95%CI1.00-1.96，P=.049）。
与一般人群相比，垂体腺瘤患者中风的发生率增加。然而，与单纯手术相比，术后 RT 并不会增加中风的发生率，也不会改变中风的病因机制或解剖定位。主要的中风危险因素是先前存在的冠状动脉或外周动脉疾病。
