Incidence, Causative Mechanisms, and Anatomic Localization of Stroke in Pituitary Adenoma Patients Treated With Postoperative Radiation Therapy Versus Surgery Alone

Sattler, M.; Vroomen, Patrick; Sluiter, Wim J.; Schers, Henk; Berg, Gerrit van den; Langendijk, Johannes A.; Wolffenbuttel, Bruce H. R.; Bergh, Alphons C.M. van den; Beek, André P van

doi:10.1016/j.ijrobp.2013.05.006

Cited by 35 publications

(37 citation statements)

References 20 publications

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“…Coronary or peripheral artery disease was a significant risk factor for CVA on multivariate analysis from the Dutch study [20]. Other cardiovascular risk factors, hormonal substitution, and radiotherapy were not significant risk factors.…”

Section: Risk Factorsmentioning

confidence: 82%

“…Increased incidence of CVA among adult patients treated for pituitary adenoma has been reported [16][17][18][19][20]. The incidence of CVA post-fractionated radiotherapy has been estimated at 12-21 % at 20 years [17,19] (Table 1).…”

Section: Cerebrovascular Accident: Adultsmentioning

confidence: 99%

“…However, this data comes from single institution retrospective reviews using older radiotherapy techniques and a range of radiotherapy doses [17,19]. A more recent report, although still utilizing older radiotherapy techniques, found no increased incidence of CVA for patients receiving radiotherapy (13 of 236 patients) compared to those treated with surgery alone (12 of 226 patients) [20]. Nonetheless, in comparison with the general Dutch population, a significantly increased risk was observed (RR 1.5, 1.0-2.0, p = 0.049) for those with a pituitary adenoma.…”

Section: Cerebrovascular Accident: Adultsmentioning

confidence: 99%

“…From all studies reported above, radiotherapy dose was only significant in one on multivariate analysis as a risk factor for CVA. Only the Sattler et al [20] study used 3DCRT for treatment planning, and in this series, it was only used for the latter half of their patients. Therefore the interaction of modern fractionated radiotherapy and CVA in adults with pituitary adenoma remains unclear.…”

Section: Risk Factorsmentioning

confidence: 99%

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Review of cranial radiotherapy-induced vasculopathy

et al. 2015

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Cranial radiation can impact the cerebral vasculature in many ways, with a wide range of clinical manifestations. The incidence of these late effects including cerebrovascular accidents (CVAs), lacunar lesions, vascular occlusive disease including moyamoya syndrome, vascular malformations, and hemorrhage is not well known. This article reviews the preclinical findings regarding the pathophysiology of late radiation-induced vascular damage, and discusses the clinical incidence and risk factors for each type of vasculopathy. The pathophysiology is complex and dependent on the targeted blood vessels, and upregulation of pro-inflammatory and hypoxia-related genes. The risk factors for adult CVAs are similar to those for patients not exposed to cranial radiotherapy. For children, risks for late vascular complications include young age at radiotherapy, radiotherapy dose, NF1, tumor location, chemotherapy, and endocrine abnormalities. The incidence of late vascular complications of radiotherapy may be impacted by improved technology, therapeutic interventions, and appropriate follow up.

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Section: Risk Factorsmentioning

confidence: 82%

Section: Cerebrovascular Accident: Adultsmentioning

confidence: 99%

Section: Cerebrovascular Accident: Adultsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

See 2 more Smart Citations

Review of cranial radiotherapy-induced vasculopathy

et al. 2015

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“…Most prior reports of CVD after radiotherapy have either focused on the pediatric population [6][7][8][9] or on adults with head and neck cancers [10][11][12], and less is known about risks in the adult brain tumor population. Previous studies in adults have focused narrowly on the risk of CVD after irradiation of the pituitary, with mixed conclusions [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Radiotherapy and death from cerebrovascular disease in patients with primary brain tumors

Aizer

Wen

et al. 2015

J Neurooncol

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Radiotherapy is often used in the management of primary brain tumors, but late cerebrovascular risks remain incompletely characterized. We examined the relationship between radiotherapy and the risk of death from cerebrovascular disease (CVD) in this population. We used the Surveillance, Epidemiology, and End Results Program to identify 19,565 patients of any age diagnosed with a primary brain tumor between 1983-2002. Multivariable competing risks analysis and an interaction model were used to determine whether receipt of radiotherapy was associated with an increased risk of CVD-specific death, adjusting for tumor proximity to central arterial circulations of the brain. The median follow up in surviving patients was 12.75 years. Baseline characteristics were similar in patients who did and did not receive radiotherapy. Ten-year CVD-specific mortality in patients with tumors near central arterial circulations who did and did not receive radiotherapy were 0.64 % (95 % CI 0.42-0.93 %) versus 0.16 % (95 % CI 0.055-0.40 %), p = 0.01. After adjustment for demographic, tumor-related, and treatment-related covariates, patients with tumors near central arterial circulations were significantly more likely to experience CVD-specific mortality after radiotherapy (HR 2.81; 95 % CI 1.25-6.31; p = 0.01); no association was observed among patients with more distant tumors (HR 0.77; 95 % CI 0.50-1.16; p = 0.21). The interaction model showed that tumor location was a key predictor of the risk of radiotherapy-associated, CVD-specific mortality (p-interaction = 0.004). Patients receiving radiotherapy for tumors near but not distant from the central vasculature of the brain are at increased risk for death secondary to CVD, which should be considered when counseling patients.

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Review of Cerebral Radiotherapy‐Induced Vasculopathy in Pediatric and Adult Patients

Osouli

Guo

2023

Advanced Biology

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Radiation therapy (RT) causes radiation‐induced vasculopathy, which requires clinicians to identify and manage this side effect in pediatric and adult patients. This article reviews previous findings about the pathophysiology of RT‐induced vascular injury, including endothelial cell injury, oxidative stress, inflammatory cytokines, angiogenic pathways, and remodeling. The vasculopathy is categorized into ischemic vasculopathy, hemorrhagic vasculopathy, carotid artery injury, and other malformations (cavernous malformations and aneurysms) in populations of pediatric and adult patients separately. The prevention and management of this RT‐induced side effect are also discussed. The article summarizes the distribution and risk factors of different types of RT‐induced vasculopathy. This will help clinicians identify high‐risk patients with corresponding vasculopathy subtypes to deduce prevention and treatment strategies accordingly.

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Incidence, Causative Mechanisms, and Anatomic Localization of Stroke in Pituitary Adenoma Patients Treated With Postoperative Radiation Therapy Versus Surgery Alone

Cited by 35 publications

References 20 publications

Review of cranial radiotherapy-induced vasculopathy

Review of cranial radiotherapy-induced vasculopathy

Radiotherapy and death from cerebrovascular disease in patients with primary brain tumors

Review of Cerebral Radiotherapy‐Induced Vasculopathy in Pediatric and Adult Patients

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