Ischemic stroke after radiation therapy for pituitary adenomas: a systematic review

Westrhenen, Anouk van; Muskens, Ivo S.; Verhoeff, J.; Smith, Timothy R.; Broekman, M.L.D.

doi:10.1007/s11060-017-2530-9

Cited by 20 publications

(7 citation statements)

References 35 publications

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“…Radiation can cause apoptosis and subsequent endothelial loss. Local inflammatory response and upregulation of hypoxia-related genes can lead to vascular injury, atherosclerosis and thromboembolism [ 26 ]. These data emphasise the potential issues pertaining to normal tissue receiving excess radiation and the need for our analyses here.…”

Section: Discussionmentioning

confidence: 99%

Long-term safety of gamma knife radiosurgery (SRS) for acromegaly

et al. 2021

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Purpose Acromegaly has high morbidity and mortality when growth hormone secretion remains uncontrolled. Stereotactic radiosurgery (SRS) may be used when pituitary surgery is not suitable or unsuccessful, but there are few very long-term safety data available, especially for significant adverse events such as stroke. Methods 118 patients with acromegaly were treated with SRS between 1985 and 2015, at the National Centre for Stereotactic Radiosurgery, Sheffield, UK. Data were gathered from case notes, hospital databases, and patient questionnaires. Stroke incidence in comparison to the normal population was quantified using the standardised incidence ratio (SIR), and visual complications assessed. Results 88% (104/118) had complete morbidity follow up data for analysis. The mean follow-up was 134 months, and median SRS dose was 30 Gy. 81% of tumours had cavernous sinus invasion. There was no excess stroke rate relative to that seen in two age- and sex-matched large population studies (SIR = 1.36, 95% CI 0.27–3.96; SIR = 0.52, 95% CI 0.06–1.89). In 68/104 patients who had MRI-guided SRS with no further radiation treatment (SRS or fractionated radiotherapy) there was no loss of visual acuity and 3% developed ophthalmoplegia. There was a positive correlation between > 1 radiation treatment and both ophthalmoplegia and worsening visual acuity. Conclusion Stroke rate is not increased by SRS for acromegaly. Accurate MRI-based treatment planning and single SRS treatment allow the lowest complication rates. More than one radiation treatment (SRS or fractionated radiotherapy) was associated with increased visual complications.

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Section: Discussionmentioning

confidence: 99%

Long-term safety of gamma knife radiosurgery (SRS) for acromegaly

et al. 2021

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“…Temozolomide is an orally administered alkylating drug that is well-tolerated by glioma patients; however, its myelotoxic effect can be severe and long-lasting. A prospective study showed that grade III-IV lymphopenia (absolute lymphocyte count <500 cells/mm 3 ) and CD4 lymphopenia (CD4 lymphocyte count <200 cells/mm 3 ) occurred in 40% of patients with high-grade astrocytoma ( 3 ), and another study reported that lymphopenia remained throughout a 48-week observation period ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus Hemorrhagic Cystitis in a Malignant Glioma Patient Treated with Temozolomide

et al. 2018

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Temozolomide, a key drug in the treatment of malignant glioma, can cause profound lymphopenia and various opportunistic infectious diseases. A 79-year-old woman with anaplastic oligodendroglioma developed a fever and gross hematuria after 8 weeks of standard radiotherapy with concomitant temozolomide treatment. A cytomegalovirus (CMV) antigen test for pp65 antigenemia was positive (137 cells per 75,800 leukocytes), and the findings from a urine cytology test were consistent with CMV-induced hemorrhagic cystitis. She was treated with ganciclovir, and her condition improved. CMV monitoring is needed when patients develop symptoms related to opportunistic infections during temozolomide treatment for malignant glioma.

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“…The significant rate of cerebrovascular accidents (CVA) and mortality after CRT have been of great concern: CVA 4% at 5 years and up to 21% at 20 years was noted in 334 patients with various pituitary tumours irradiated with 3-field CRT in 1962 -1986 (19). More recently, other studies showed lower rates, varying between 0 -11.6% (20,21). Increased mortality has been also reported in patients with acromegaly or NFPAs treated with CRT: 1.6 -4.1 times higher compared to general population (22)(23)(24)(25)(26)(27), mainly due to cerebrovascular disease.…”

Section: Radiation Techniquesmentioning

confidence: 96%

“…Local tumour control has been achieved in 83 -100% of patients (median 94%), at a median followup (mFU) of 47.3 months (21.7 -95) using a median marginal dose of 16 Gy. Notably, doses delivered to the tumour margin are lower for NFPA (10 -20 Gy) than for secreting adenomas (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) (36). In a large study (512 patients), progression-free survival was 95% and 85% at 5, respectively 10 years FU (46).…”

Section: Nonfunctioning Pituitary Adenomasmentioning

confidence: 99%

Stereotactic Radiation Therapy in Pituitary Adenomas, is it Better than Conventional Radiation Therapy

Gheorghiu

Fleseriu

2017

Acta Endo (Buc)

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Pituitary radiotherapy (RT) has undergone important progress in the last decades due to the development of new stereotactic techniques which provide more precise tumour targeting with less overall radiation received by the adjacent brain structures. Pituitary surgery is usually firstline therapy in most patients with nonfunctioning (NFPA) and functioning adenomas (except for prolactinomas and large growth hormone (GH) secreting adenomas), while RT is used as second or third-line therapy. The benefits of RT (tumour volume control and, in functional tumours, decreased hormonal secretion) are hampered by the long latency of the effect and the potential side effects. This review presents the updates in the efficacy and safety of the new stereotactic radiation techniques in patients with NFPA, GH-, ACTH-or PRL-secreting pituitary adenomas. Methods. A systematic review was performed using PubMed and articles/abstracts and reviews detailing RT in pituitary adenomas from 2000 to 2017 were included. Results. Stereotactic radiosurgery (SRS) and fractionated stereotactic RT (FSRT) provide high rates of tumour control i.e. stable or decrease in tumour size, in all types of pituitary adenomas (median 92-98%) at 5 years. Endocrinological remission is however significantly lower: 44-52% in acromegaly, 54-64% in Cushing's disease and around 30% in prolactinomas at 5 years. The rate of new hypopituitarism varies from 10% to 50% at 5 years in all tumour types and as expected increases with the duration of follow-up (FU). The risk for other radiation-induced complications is usually low (0-5% for new visual deficits, cranial nerves damage or brain radionecrosis and extremely low for secondary brain tumours), however longer FU is needed to determine rates of secondary tumours. Notably, in acromegaly, there may be a higher risk for stroke with FSRT. Conclusion. Stereotactic radiotherapy can be an effective treatment option for patients with persistent or recurrent pituitary adenomas after unsuccessful surgery (especially if residual tumour is enlarging) and/or resistance or unavailability of medical therapy. Comparison with conventional radiation therapy (CRT) is rather difficult, due to the substantial heterogeneity of the studies. In order to evaluate the potential brain-sparing effect of the new stereotactic techniques, suggested by the current data, longterm studies evaluating secondary morbidity and mortality are needed.

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Ischemic stroke after radiation therapy for pituitary adenomas: a systematic review

Cited by 20 publications

References 35 publications

Long-term safety of gamma knife radiosurgery (SRS) for acromegaly

Long-term safety of gamma knife radiosurgery (SRS) for acromegaly

Cytomegalovirus Hemorrhagic Cystitis in a Malignant Glioma Patient Treated with Temozolomide

Stereotactic Radiation Therapy in Pituitary Adenomas, is it Better than Conventional Radiation Therapy

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