Fathy Ramie, Kuan Edward, Lee John Y K, Grady M Sean, Alonso-Basanta Michelle, Palmer James N, Adappa Nithin D, O'Malley Bert W, Brant Jason
University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States.
Department of Otolaryngology, University of California Irvine, Irvine, California, United States.
J Neurol Surg B Skull Base. 2021 Jun;82(3):285-294. doi: 10.1055/s-0039-1696724. Epub 2019 Oct 4.
Radiation therapy represents an uncommon but important component of treatment plans for some pituitary adenomas (PAs). Although radiation therapy has been used to treat pituitary adenomas for over a century, general trends in the usage of radiation therapy for this purpose have not been reviewed. Additionally, there are few large studies evaluating how radiation therapy is used for the treatment of these benign tumors. Investigating these trends and identifying any variations in radiation therapy utilization would help to better inform treatment decisions and improve patient outcomes. Present study is a retrospective analysis of cases using the National Cancer Database. The research was organized at a tertiary academic medical center. Patients were diagnosed with pituitary adenoma between 2004 and 2014 within the National Cancer Database (NCDB). Temporal trends in the usage of radiation therapy to treat pituitary adenoma were analyzed through a retrospective analysis of 77,142 pituitary adenoma cases from the NCDB between 2004 and 2014. Univariate and multivariate analyses were to examine the relationship between patient, tumor, and treatment factors, and the incorporation of radiation therapy into the treatment of pituitary adenomas. We adjusted for potential confounders such as age, sex, race, comorbidity score, facility type, and year of diagnosis. A total of 77,142 patients met inclusion criteria. Inclusion of radiation therapy in pituitary adenoma treatment was 8.0% in 2004 and steadily declined to a low of 3.1% in 2014. Overall, patients were less likely to receive radiation for their pituitary adenoma over time ( < 0.001). Similarly, patients were found to be less likely to receive any type of treatment for PA over time ( < 0.001). Multivariable evaluation found patients who were female, between 54 and 64 years of age, or treated at either a Comprehensive Community Cancer Program or an Integrated Network Cancer Program were more likely to receive radiation as part of their pituitary adenoma treatment ( < 0.001, odds ratio [OR] = 2.01, confidence interval [CI]: 1.54-2.63; < 0.001, OR = 1.84, CI: 1.38-2.44, respectively). Patients were less likely to receive radiation for their PA if they were African American ( < 0.001, OR = 0.81, CI: 0.72-0.91). Logistic regression also identified a progressive increase in the likelihood of receiving radiation after a PA diagnosis with increasing tumor size starting with microscopic tumors, peaking at 4 to 5 cm ( < 0.001; OR = 15.57; CI: 12.20-19.87). In this sample of pituitary adenoma patients treated at NCDB institutions between 2004 and 2014, we found a steady decline in the incorporation of radiation therapy in treatment, as well as in the use of any type of intervention for PA treatment, suggesting a rise in noninterventional observation of PA.
放射治疗是某些垂体腺瘤（PA）治疗方案中一个不常见但重要的组成部分。尽管放射治疗已用于治疗垂体腺瘤达一个多世纪，但尚未对其用于此目的的使用总体趋势进行综述。此外，很少有大型研究评估放射治疗如何用于治疗这些良性肿瘤。研究这些趋势并确定放射治疗使用中的任何差异将有助于更好地为治疗决策提供信息并改善患者预后。本研究是一项使用国家癌症数据库对病例进行的回顾性分析。该研究在一家三级学术医疗中心开展。患者于2004年至2014年期间在国家癌症数据库（NCDB）中被诊断为垂体腺瘤。通过对2004年至2014年NCDB中77142例垂体腺瘤病例进行回顾性分析，分析了放射治疗用于治疗垂体腺瘤的时间趋势。单因素和多因素分析旨在检验患者、肿瘤和治疗因素之间的关系，以及放射治疗纳入垂体腺瘤治疗的情况。我们对年龄、性别、种族、合并症评分、机构类型和诊断年份等潜在混杂因素进行了校正。共有77142例患者符合纳入标准。2004年垂体腺瘤治疗中放射治疗的纳入率为8.0%，并稳步下降至2014年的最低点3.1%。总体而言，随着时间的推移，患者垂体腺瘤接受放射治疗的可能性降低（P<0.001）。同样，随着时间的推移，患者接受PA任何类型治疗的可能性也降低（P<0.001）。多变量评估发现，女性、年龄在54至64岁之间、或在综合社区癌症项目或综合网络癌症项目接受治疗的患者，作为垂体腺瘤治疗的一部分更有可能接受放射治疗（P<0.001，比值比[OR]=2.01，置信区间[CI]：1.54 - 2.63；P<0.001，OR = 1.84，CI：1.38 - 2.44）。如果患者是非裔美国人，则其PA接受放射治疗的可能性较小（P<0.001，OR = 0.81，CI：0.72 - 0.91）。逻辑回归还发现，垂体腺瘤诊断后接受放射治疗的可能性随着肿瘤大小从微小肿瘤开始增加而逐渐增加，在4至5厘米时达到峰值（P<0.001；OR = 15.57；CI：12.20 - 19.87）。在2004年至2014年在NCDB机构接受治疗的该垂体腺瘤患者样本中，我们发现放射治疗在治疗中的纳入率以及PA治疗中任何类型干预措施的使用均稳步下降，这表明对PA的非干预性观察有所增加。
