Radiotherapy for pituitary adenomas: Long-term efficacy and toxicity☆
Received 15 May 2009; received in revised form 17 September 2009; accepted 29 September 2009. published online 09 November 2009.
Abstract
Background
Radiotherapy for pituitary adenomas is an effective treatment but remains controversial due to toxicity concerns.
Materials and methods
A retrospective audit of patients referred for radiotherapy during 1974–2003 was conducted, the case records were examined and data linkage to cancer registry and hospital discharge records was performed to assess the overall survival (OS), progression-free survival (PFS) and late effects (hormone deficiency, reduced vision, second cancer and stroke).
Results
Three hundred and eighty-five patients had radiotherapy (median 45Gy). The OS was 74% and 49%, PFS was 97% and 96%, at 10 and 20years, respectively. No specific factors influenced local control. Additional hormone deficiencies occurred in 19% (ACTH) and 26% (TSH). Actuarial rate optic neuropathy at 10years was 0.8%. Seventy-eight patients had a stroke, a RR for a matched Scottish population of 1.45 (CI 1.05–1.18, p=0.03) men and 2.22 (1.56–3.08, p<0.01) women. Four intra-cranial tumours were identified; 20-year actuarial risk 1.9% (CI 0–2.6%), a RR of 5.65 (0.53–20.77, p=0.10) men and 9.94 (0.94–36.56, p=0.04) women.
Conclusions
This treatment is effective with good local control rates at 20years. A significant proportion developed hypo-pituitarism. The risk of optic neuropathy was low but risk of stroke increased, particularly in women who had slight increased risk of intra-cranial tumours.
eEdinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
Corresponding author. Address: Edinburgh Centre for Neuro-Oncology, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK.
☆Funding: Dr. Conkey was funded by The University of Edinburgh Brain Tumour Research Fund and The University of Edinburgh Cancer Research Centre funded the Cancer Registry data linkage.
ABSTRACT