Endocrine factors influencing radiation injury to central nervous tissue

Aristizabal, Silvio A.; Boone, Max L. M.; Laguna, Jose F.

doi:10.1016/0360-3016(79)91215-x

Cited by 23 publications

(8 citation statements)

References 28 publications

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“…Although we have not seen optic nerve damage or delayed brain necrosis with the higher doses that we have used for the treatment of other types of pituitary adenoma (Littley et al, 1989a, b), these complications have been reported from other centres (Harris & Levine, 1976;Aristizabal et al, 1977;Sheline et al, 1980). This may be of greater importance where Cushing's disease is treated with conventional-dose radiotherapy, because of the postulated greater susceptibility of these patients compared to those with other histological tumour types, to unwanted radiation damage to neural tissue (Aristizabal et al, 1979). A shorter, more convenient course of irradiation is a further advantage of a lower-dose radiotherapy schedule.…”

Section: Discussionmentioning

confidence: 73%

Long‐term Follow‐up of Low‐dose External Pituitary Irradiation for Cushing's Disease

Littley

Shalet

Beardwell

et al. 1990

Clinical Endocrinology

102

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Twenty-four patients (three male) with Cushing's disease, aged between 11 and 67 years, were treated with low-dose external pituitary irradiation (20 Gy in eight fractions over 10-12 days) and followed for between 13 and 171 months (median 93 months). Eleven patients (46%) went into remission 4-36 months after irradiation, but five subsequently relapsed. Two of these received no further active treatment, one underwent successful pituitary surgery, one underwent a second course of low-dose external irradiation (as yet unsuccessful) and one has been treated with metyrapone for a total of 75 months. One of the 13 patients who did not respond received a further course of low-dose pituitary irradiation with prompt remission and two have received metyrapone for 41 months and 15 years without ill effect. One patient died from cerebrovascular disease. The remaining nine patients underwent bilateral adrenalectomy (one after unsuccessful pituitary surgery) with rapid resolution of hypercortisolism. Five of these patients have developed hyperpigmentation and elevated ACTH levels (range 505-1150 ng/l). A pituitary microadenoma has been demonstrated on CT scan in three and successfully removed by microadenomectomy. In the present series, the low incidence of radiation-induced hypopituitarism and absence of other complications attributable to radiotherapy suggest that low-dose pituitary irradiation may be a useful treatment option in selected patients. However, long-term follow-up has demonstrated a high relapse rate and failure to prevent Nelson's syndrome in adrenalectomized patients, indicating that it should not be used as primary treatment in preference to selective adenomectomy.

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Section: Discussionmentioning

confidence: 73%

Long‐term Follow‐up of Low‐dose External Pituitary Irradiation for Cushing's Disease

Littley

Shalet

Beardwell

et al. 1990

Clinical Endocrinology

102

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“…Patients with hypercortisolemia are predisposed to radiation-induced nervous tissue damage 17. The higher incidence of radiation sequelae in patients with hypercortisolemia may be explained by increased capillary permeability and capillary thrombosis caused by hypercortisolemia 18…”

Section: Discussionmentioning

confidence: 99%

Unusual cause of paraparesis in a patient with Cushing's syndrome

et al. 2016

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Paraparesis is a rare manifestation in patients with Cushing's syndrome and the causes include vertebral compression fracture, hypokalaemia, spinal epidural lipomatosis, paraneoplastic syndrome and metastasis to the vertebrae and spinal cord. We report an unusual cause of paraparesis due to radiation-induced myelomalacia in a patient with adrenocortical carcinoma-associated Cushing's syndrome, who are predisposed to radiation-induced injury.

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“…Among the delayed sequelae, hypopituitarism is the most common (50%); other sequelae are fewer but devastating 1,2,5 . The severity of RIBD is influenced by age of the patient (greater in the younger age group), total radiation dose (> 50 Gy) delivered, dose per fraction (> 2 Gy), field of radiation, duration of treatment and associated hormone secretory disorders 6−11 . The first instance of RIBD was reported by O’Connell and Brunshwig in 1937 following radiation of a brain tumour 12 .…”

Section: Introductionmentioning

confidence: 91%

“…The first instance of RIBD was reported by O’Connell and Brunshwig in 1937 following radiation of a brain tumour 12 . Since then, case studies have been reported highlighting cerebral radionecrosis 3,4,9 , visual abnormalities 10,11 , hypopituitarism 2,5,8 and second neo‐plasm as sequelae of pituitary tumour irradiation 13,14 . The present retrospective analysis provides the spectrum of clinical, radiological and hormonal abnormalities in 11 patients with pituitary macroadenoma who received conventional megavoltage radiotherapy post‐surgery at a tertiary care hospital in North India.…”

Section: Introductionmentioning

confidence: 99%

Radiation‐induced brain disorders in patients with pituitary tumours

Bhansali¹,

Ak²,

Chanda³

et al. 2004

Australasian Radiology

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Radiation-induced brain disorders (RIBD) are uncommon and they are grave sequelae of conventional radiotherapy. In the present report, we describe the clinical spectrum of RIBD in 11 patients who received post-surgery conventional megavoltage irradiation for residual pituitary tumours. Of these 11 patients (nine men, two women), seven had been treated for non-functioning pituitary tumours and four for somatotropinomas. At the time of irradiation the age of these patients ranged from 30 to 59 years (mean, 39.4 +/- 8.3; median, 36) with a follow-up period of 6-96 months (mean, 18.3 +/- 26.4; median, 11). The dose of radiation ranged from 45 to 90 Gy (mean, 51.3 +/- 13.4; median, 45), which was given in 15-30 fractions (mean, 18.6 +/- 5.0; median, 15) with 2.8 +/- 0.3 Gy (median, 3) per fraction. The biological effective dose calculated for late complications in these patients ranged from 78.7 to 180 Gy (mean, 99.1 +/- 27.5; median, 90). The lag time between tumour irradiation and the onset of symptoms ranged from 6 to 168 months (mean, 46.3 +/- 57.0; median, 57). The clinical spectrum of RIBD included new-onset visual abnormalities in five, cerebral radionecrosis in the form of altered sensorium in four, generalized seizures in four, cognitive dysfunction in five, dementia in three and motor deficits in two patients. Magnetic resonance imaging (MRI)/CT of the brain was suggestive of radionecrosis in eight, cerebral oedema in three, cerebral atrophy in two and second neoplasia in one patient. Associated hormone deficiencies at presentation were hypogonadism in eight, hypoadrenalism in six, hypothyroidism in four and diabetes insipidus in one patient. Autopsy in two patients showed primitive neuroectodermal tumour (PNET) and brainstem radionecrosis in one, and a cystic lesion in the left frontal lobe following radionecrosis in the other. We conclude that RIBD have distinctive but varying clinical and radiological presentations. Diabetes insipidus and PNET as a second neoplastic disorder in adults following pituitary irradiation have not been reported previously.

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Endocrine factors influencing radiation injury to central nervous tissue

Cited by 23 publications

References 28 publications

Long‐term Follow‐up of Low‐dose External Pituitary Irradiation for Cushing's Disease

Long‐term Follow‐up of Low‐dose External Pituitary Irradiation for Cushing's Disease

Unusual cause of paraparesis in a patient with Cushing's syndrome

Radiation‐induced brain disorders in patients with pituitary tumours

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