Burman Pia, van Beek André P, Biller Beverly M K, Camacho-Hübner Cecilia, Mattsson Anders F
Department of Endocrinology, Skånes University Hospital, University of Lund, 20502 Malmö, Sweden.
Department of Endocrinology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands.
J Clin Endocrinol Metab. 2017 Mar 1;102(3):1051-1058. doi: 10.1210/jc.2016-3402.
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.
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 (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.
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.
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.
已有垂体/鞍区病变治疗后新发脑肿瘤的报道，但尚不清楚这是否与任何治疗方式有关。
研究一大群接受垂体/鞍区病变治疗的患者中恶性脑肿瘤和脑膜瘤的发生情况，特别强调放射治疗（RT）的作用。
纳入1994年至2012年在KIMS（辉瑞国际代谢数据库）中随访的因垂体腺瘤、颅咽管瘤和其他鞍区肿瘤导致垂体功能减退的患者（n = 8917）。4927例患者接受手术和/或药物治疗，3236例患者单独接受放疗或放疗联合手术治疗；754例数据缺失。通过Poisson回归方法进行内部比较分析发病率比（RRs）。
在53786患者年期间，报告了17例恶性脑肿瘤（13例接受放疗）和27例脑膜瘤（22例接受放疗）。接受放疗与未接受放疗相比，恶性脑肿瘤的RR为3.34 [95%置信区间（CI），1.06至10.6]，脑膜瘤的RR为4.06（95%CI，1.51至10.9）。每早10年接受放疗，发生恶性脑肿瘤的风险增加2.4倍（P = 0.005），发生脑膜瘤的风险增加1.6倍（P = 0.05）。与立体定向放疗相比，接受传统放疗的患者发病率相似。
垂体肿瘤放疗与发生恶性脑肿瘤和脑膜瘤的风险增加有关，尤其是在年轻时进行放疗。在权衡放疗的风险和益处时，我们的研究结果强调应特别考虑患者的年龄。
