Background: Radiotherapy is part of the complex treatment of pituitary tumors; it is an effective treatment for residual postoperative tumors or recurrent tumors, but cerebrovascular events and secondary intracranial tumors may occur during long term follow-up.
Aim: To assess prevalence of cerebrovascular events, secondary intracranial tumors and other neoplasia in patients with non-acromegaly pituitary tumors and craniopharyngiomas submitted to radiotherapy.
Patients and methods: 320 patients (156 M/164 F) with non-acromegaly pituitary tumors and craniopharyngiomas (246 prolactinomas, 70 nonfunctioning pituitary adenomas, 2 corticotropinomas, and 2 craniopharyngiomas), aged 46.8±16.7 years at diagnosis, from a tertiary endocrine centre were retrospectively reviewed. Pituitary imaging was performed by computed tomography scan or MRI.
Results: The vast majority of patients had macroadenomas (313 patients, 97.8%). 79 patients were submitted to radiotherapy: 67 patients to 3D-conformal high voltage radiotherapy, median dose 50 Gy, 12 patients to gamma knife radiosurgery 1417 Gy on 50% isodose. Radiotherapy was adjuvant therapy after surgery in cases with tumor regrowth or in patients with significant residual postoperative tumor in 76 patients (96.2%); in 3 patients who initially refused surgery, radiotherapy was the primary treatment. In non-irradiated patients (n=241), we found 3 cystic lesions (2 arachnoid cysts, one porencephalic cyst), 2 cavernomas, 5 meningiomas, carotid or basilar arteries ectasia (n=5), ischemic brain lesion or stroke (n=7), malignant tumors (n=4: one colorectal cancer, one renal cancer and two papillary thyroid carcinomas). In irradiated patients (n=79), we found a similar prevalence of cystic lesions (n=2: one arachnoid cyst, one pineal cyst), ischemic brain lesions (n=2), internal carotid arteria ectasia (n=4), and malignant tumors (n=3: one colorectal, one breast cancer, one malignant nonHodgkin lymphoma with B cells, stage III B), respectively. Neither glioma or sarcoma were diagnosed in patients following radiotherapy.
Conclusion: Similar prevalence of cerebral arteries ectasia, ischemic brain lesions and stroke, secondary intracranial tumors and other neoplasia was found in our series following radiotherapy for non-acromegaly pituitary tumors and craniopharyngiomas. However, long term follow-up is mandatory.
18 - 21 May 2019
European Society of Endocrinology