Pituitary Dysfunction after Radiation for Anterior Skull Base Malignancies: Incidence and Screening

VanKoevering, Kyle K.; Sabetsarvestani, Katayoon; Sullivan, Stephen; Barkan, Ariel; McKean, Erin L.

doi:10.1055/s-0037-1600619

Cited by 3 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This aligns with our previously published institutional cohort hypopituitarism rate of 37%. 5 There were no significant differences between the non-hypopituitarism and hypopituitarism groups except for in length of follow-up and overall incidence of death as of the time of final analysis (January 2022). ►Table 2 shows the types of tumor pathologies included, with the most patients having either squamous cell carcinoma or esthesioneuroblastoma.…”

Section: Resultsmentioning

confidence: 81%

“…2,3 Higher radiation doses (greater than 50 Gy), as commonly seen for anterior skull base malignancies and nasopharyngeal carcinoma, are associated with higher incidence of HPA dysfunction. 1,[4][5][6] The estimated cumulative incidence of RIH after high-dose radiation is broad, with estimates ranging from 37% over 3 years among our own institutional cohort of sinonasal malignancies, 5 to 41% at 6 years among adult survivors of nonpituitary brain tumors with radiation exposure, 7 and 82 8 to 93% 9 for long-term survivors (greater than 10 years) of nasopharyngeal carcinoma. There is a well-characterized dose-dependent sequence of pituitary derangements, with the somatotrophs more likely to be affected first at even low radiation doses; gonadal, adrenal, and thyroid axes are more likely to become dysfunctional with higher radiation doses and with increased time out from radiation.…”

Section: Introductionmentioning

confidence: 93%

See 1 more Smart Citation

Assessing Quality of Life among Radiation-Induced Hypopituitary Patients

Ryder

Bellile

VanKoevering

et al. 2022

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

Introduction: Radiation-induced hypopituitarism (RIH) has long been recognized as one of the deleterious side effects of skull base radiation. This study aims to assess the quality of life (QoL) among patients with RIH compared to radiated patients who did not develop hypopituitarism using the validated Anterior Skull Base Questionnaire (ASBQ). Methods: This was a single institution retrospective cohort study. Included patients had a history of anterior skull base tumor, underwent at least one round of radiation to the skull base, and had filled out at least one ASBQ survey after their radiation treatment. Three statistical models were used to determine the effect of hypopituitarism and treatment on QoL scores. Results: 145 patients met inclusion criteria, and 330 ASBQ surveys were analyzed. 35 percent (51/145) had evidence of RIH at some point after their radiation treatment. Those with hypopituitarism had significantly lower overall ASBQ scores across all 3 models even after adjusting for potential confounders and intraperson correlation (average decrease of 0.24-0.45 on a 5-point Likert scale; p-values ranging from 0.0004 to 0.018). The increase in QoL with hormonal replacement was modulated by time out from radiation, with long-term survivors (5+ years out from radiation) gaining the most benefit from treatment (increase of 0.89 on a 5-point Likert scale, p 0.0412), especially in the vitality domain. Conclusion: This data demonstrate that hypopituitarism is an independent predictor of lower QOL. Early detection and appropriate treatment are essential to avoid the negative impact of hypopituitarism on QoL.

show abstract

Section: Resultsmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 93%

Assessing Quality of Life among Radiation-Induced Hypopituitary Patients

Ryder

Bellile

VanKoevering

et al. 2022

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

show abstract

“…This is important because these high-grade cancers are more aggressive than other types of SNECs, and smCC has consistently been found to have lower survival than other types of SNEC. 5,[14][15][16][17] For these tumors, surgical resection may not be the ideal treatment. Not only can margins be difficult to clear, as they often extend well beyond gross tumor margins.…”

Section: Discussionmentioning

confidence: 99%

Sinonasal Neuroendocrine Carcinoma: 15 Years of Experience at a Single Institution

Keilin

VanKoevering

McHugh

et al. 2022

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

Objectives Sinonasal neuroendocrine carcinomas (SNECs) are among the rarest paranasal sinus cancers. Consensus guidelines for therapy are difficult to develop due to limited data regarding the natural history and successful treatment of these tumors. This study presents 15 years of experience treating SNEC at a single institution and a review of the literature. Design Retrospective review. Setting Academic medical center in the United States. Participants Patients diagnosed with primary SNEC. Main Outcome Measures Overall survival. Results Thirteen patients were identified and included. Overall estimated survival was 74.6% at 5 years. Ten of 13 (76.9%) patients were diagnosed with high-grade neuroendocrine carcinoma and three (23.1%) with intermediate or low grade. All three patients with low- or intermediate-grade cancer survived more than 10 years from their initial diagnosis (median survival: 11.6 years) and are currently alive. The four patients who died had high-grade carcinoma, and estimated overall 5-year survival for all patients with high-grade carcinomas was 65.6%. Five patients, all with high-grade carcinoma, of seven who completed primary chemoradiation therapy (CRT) required salvage resection, and 60% are alive without disease. Conclusion This cohort has a higher overall rate of survival than many recent case series and reviews. There is consensus that multimodal therapy is preferred over monotherapy, but approaches to treatment vary widely. Our approach of surgical resection as primary therapy for low-grade tumors and primary CRT for high-grade SNEC has been successful, and could indicate hope for improved survival among these patients.

show abstract

“…Predictors and accelerators of such process include classic cardiovascular risk factors as well as age of radiation, radiation dose and post-RT duration [4]. Hypothyroidism and pituitary disfunction are frequent consequences after radiation for anterior skull base malignancies with involvement of up the 71% irradiated patients [8,9]. These endocrinopathies play a relevant role in inducing or aggravating dysmetabolism associated to blood cholesterol homeostasis, glucose intolerance or diabetes, or regulation of AP, relevant risk factors for atherosclerosis and stroke.…”

Section: Discussionmentioning

confidence: 99%

Juvenile Stroke in a Patient with Severe Large Vessel Atherosclerosis of the Neck Decades after Radiotherapy for Nasopharyngeal Carcinoma: Are Iatrogenic Endocrinopathies Additional Risk Factors?

Ruggiero¹,

Sergio²,

Stella³

et al. 2022

Int J Brain Disord Treat

View full text Add to dashboard Cite

Introduction: Juvenile Nasopharyngeal carcinoma (NPC) is a rare head and neck cancer in Western Countries. Neck radiotherapy (RT) is a routine procedure for treating or preventing the nodal metastasis in NPC patients. Ionizing radiation from RT has been associated with enhanced atherosclerotic process of large vessel arteries of the neck and brain which results in higher incidence of cerebrovascular events.Clinical presentation: Herein we describe a 43-yearold man who presented with acute hemiparesis due to partial infarct in the anterior circulation of the brain due to severe steno-occlusive atherosclerosis of the neck arteries decades after RT for NPC. Additional risk factors were high levels of Low-Density Lipoprotein (LDL) and low Arterial Pressure (AP) possibly associated to post-RT secondary hypothyroidism and reduced corticotropin. Conclusion:Iatrogenic or acquired endocrinopathies may represent additional triggers of the atherogenic process and should be kept into account when dealing with rare forms of juvenile strokes in patients who had undergone to RT for either brain or neck cancers decades before.

show abstract

Pituitary Dysfunction after Radiation for Anterior Skull Base Malignancies: Incidence and Screening

Cited by 3 publications

References 0 publications

Assessing Quality of Life among Radiation-Induced Hypopituitary Patients

Assessing Quality of Life among Radiation-Induced Hypopituitary Patients

Sinonasal Neuroendocrine Carcinoma: 15 Years of Experience at a Single Institution

Juvenile Stroke in a Patient with Severe Large Vessel Atherosclerosis of the Neck Decades after Radiotherapy for Nasopharyngeal Carcinoma: Are Iatrogenic Endocrinopathies Additional Risk Factors?

Contact Info

Product

Resources

About