Radiation-associated secondary brain tumors after conventional radiotherapy and radiosurgery

Ecemiş, Gülçin Cengiz; Atmaca, Ayşegül; Meydan, Deniz

doi:10.1586/ern.13.37

Cited by 11 publications

(14 citation statements)

References 58 publications

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“…The mean latency period between CRT and secondary tumor development was 19.6 years for meningioma, 11 years for glioma, and 9 years for astrocytoma. In these patients there was a slight but significant 1.3-2.7% increase in actuarial risk of secondary brain tumor (390). The incidence and the actuarial risk of secondary brain tumors are not clear in patients with CD.…”

Section: Safety Of Radiotherapymentioning

confidence: 85%

The Treatment of Cushing's Disease

et al. 2015

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Cushing's disease (CD), or pituitary-dependent Cushing's syndrome, is a severe endocrine disease caused by a corticotroph pituitary tumor and associated with increased morbidity and mortality. The first-line treatment for CD is pituitary surgery, which is followed by disease remission in around 78% and relapse in around 13% of patients during the 10-year period after surgery, so that nearly one third of patients experience in the long-term a failure of surgery and require an additional second-line treatment. Patients with persistent or recurrent CD require additional treatments, including pituitary radiotherapy, adrenal surgery, and/or medical therapy. Pituitary radiotherapy is effective in controlling cortisol excess in a large percentage of patients, but it is associated with a considerable risk of hypopituitarism. Adrenal surgery is followed by a rapid and definitive control of cortisol excess in nearly all patients, but it induces adrenal insufficiency. Medical therapy has recently acquired a more important role compared to the past, due to the recent employment of novel compounds able to control cortisol secretion or action. Currently, medical therapy is used as a presurgical treatment, particularly for severe disease; or as postsurgical treatment, in cases of failure or incomplete surgical tumor resection; or as bridging therapy before, during, and after radiotherapy while waiting for disease control; or, in selected cases, as primary therapy, mainly when surgery is not an option. The adrenal-directed drug ketoconazole is the most commonly used drug, mainly because of its rapid action, whereas the glucocorticoid receptor antagonist, mifepristone, is highly effective in controlling clinical comorbidities, mainly glucose intolerance, thus being a useful treatment for CD when it is associated with diabetes mellitus. Pituitary-directed drugs have the advantage of acting at the site responsible for CD, the pituitary tumor. Among this group of drugs, the dopamine agonist cabergoline and the somatostatin analog pasireotide result in disease remission in a consistent subgroup of patients with CD. Recently, pasireotide has been approved for the treatment of CD when surgery has failed or when surgery is not an option, and mifepristone has been approved for the treatment of Cushing's syndrome when associated with impairment of glucose metabolism in case of the lack of a surgical indication. Recent experience suggests that the combination of different drugs may be able to control cortisol excess in a great majority of patients with CD.

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Section: Safety Of Radiotherapymentioning

confidence: 85%

The Treatment of Cushing's Disease

et al. 2015

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“…Irradiation was the standard treatment for patients with PAs until the late 1980s, when it was found that irradiation can be harmful to patients and result in an increased risk of vascular and cognitive impairment and the development of secondary tumours (21). This together with improved neurosurgical techniques may explain the low frequency of irradiation treatment in this cohort of patients.…”

Section: Discussionmentioning

confidence: 99%

“…The mean number (range) of patients diagnosed with PAs per year was 54 (42-69); 26 (17-36) in men and 28 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) in women. The age-SIRs per 100 000 people per year are presented in Fig.…”

Section: Time Trends Of Incidencementioning

confidence: 99%

The incidence rate of pituitary adenomas in western Sweden for the period 2001–2011

Tjörnstrand

Gunnarsson

Evert

et al. 2014

European Journal of Endocrinology

236

156

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Objective: The number of studies on the incidence of pituitary adenomas (PAs) is limited. The aim of this study was to evaluate the standardised incidence rate (SIR) of PAs in western Sweden. Design, subjects and methods: Data from adult patients diagnosed with PAs in 2001-2011, living in the Vä stra Gö taland County, were collected from the Swedish Pituitary Registry (SPR). In addition, medical records on all patients diagnosed with PAs at the six hospitals in the region were reviewed. In total, 592 patients were included in the study. Age-SIR, given as rate/100 000 inhabitants (95% CI), was calculated using the WHO 2000 standard population as a reference. Results: The total SIR for PAs was 3.9/100 000 (3.6-4.3); 3.3/100 000 (2.9-3.7) for men and 4.7/100 000 (4.1-5.3) for women. In men, SIR increased with age, while in women SIR peaked at 25-34 years, mainly due to prolactinomas. Non-functioning PA (NFPA) was the most common PA (54%, 1.8/100 000 (1.6-2.0)) followed by prolactinomas (32%, 1.6/100 000 (1.3-1.9)), acromegaly (9%, 0.35/100 000 (0.25-0.45)), Cushing's disease (4%, 0.18/100 000 (0.11-0.25)) and TSH-producing PA (0.7%, 0.03/100 000 (0.00-0.05)). The proportion of macroadenomas for NFPA was 82%, prolactinomas 37%, GH-producing PA 77%, ACTH-producing PA 28% and TSH-producing PA 100%. The lifetime risk for PAs was 0.27% (0.24-0.31) in men and 0.29% (0.26-0.33) in women. Conclusion: This study provides a reliable estimate on the overall incidence of PAs and confirms an increased incidence of PAs compared with studies conducted in the pre-magnetic resonance imaging era. The lower proportion of prolactinomas compared with previous studies is probably explained by the different criteria used.

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“…Debus et al [64] reported late grade 3 radiation morbidity symptoms, such as reduced vision, visual-field defect and trigeminal neuropathy, in 2.1% patients, whereas Milker-Zabel et al [20] did not report any significant acute or late grade 3 symptoms. Concerning the risk of secondary malignancies, to the best of our knowledge no case has been reported after FRT of meningiomas, however limited series have reported a long follow-up of 15-20 years, thus possibly missing radio-induced secondary cancers occurring during the long-term [72]. Long-term follow-up of IMRT patients is also required to assess whether this historic data remain comparable in view of the larger volumes of normal tissue receiving low-dose radiation with IMRT [73].…”

Section: Side Effects and Long-term Risksmentioning

confidence: 88%