垂体腺瘤或颅咽管瘤放疗后第二脑肿瘤风险：3679 例长期影像学随访患者的回顾性、多中心队列研究。
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.
机构信息
Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK; Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
出版信息
Lancet Diabetes Endocrinol. 2022 Aug;10(8):581-588. doi: 10.1016/S2213-8587(22)00160-7. Epub 2022 Jul 1.
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.
背景
放射治疗是管理垂体腺瘤和颅咽管瘤的重要治疗方法。然而，放射治疗后发生第二脑肿瘤的风险是一个主要关注点。我们使用具有相同原发病理和影像学监测的未接受放疗的患者作为对照来评估这种风险。
方法
在这项多中心、回顾性队列研究中，从六个成人内分泌中心（英国伯明翰、牛津、利兹、莱斯特和布里斯托尔和意大利费拉拉）的科室登记处确定了 4292 名垂体腺瘤或颅咽管瘤患者。排除了临床数据不足、研究入组前已知有脑肿瘤遗传易感性或病史（n=532）以及接受质子束或立体定向放射治疗的患者（n=81）。分析了 996 名接受二维放射治疗、三维适形放射治疗或调强放射治疗的患者的数据，并与 2683 名对照进行了比较。
结果
在超过 45246 患者年中，61 名患者（7 名恶性肿瘤[5 例放疗，2 例对照]，54 名良性肿瘤[25 例放疗，29 例对照]）报告了第二脑肿瘤。放疗暴露和垂体瘤检测时年龄较大与第二脑肿瘤风险增加相关。照射患者的比率比为 2.18（95%CI 1.31-3.62，p<0.0001）。照射组 20 年的第二脑肿瘤累积概率为 4%，对照组为 2.1%。
结论
接受过放疗的垂体腺瘤或颅咽管瘤成年患者发生第二脑肿瘤的风险增加，尽管与使用无影像学监测的一般人群对照的既往研究相比，这种风险要低得多。我们的数据阐明了一个重要的临床问题，并指导临床医生在向垂体腺瘤或颅咽管瘤患者提供放射治疗的风险和获益时进行咨询。
资助
辉瑞。
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