SFEBES2021 Oral Communications Reproductive and Neuroendocrinology (6 abstracts)
Is radiotherapy for pituitary adenoma or craniopharyngioma associated with increased risk of second brain tumour? A long-term multi-centre study of 3,679 patients
Ross Hamblin 1,2,3 , Ashley Vardon 1,2,3 , Josephine Akpalu 1,2,3 , Metaxia Tampourlou 1,2,3 , Ioannis Spiliotis 4 , Emilia Sbardella 4 , Julie Lynch 5 , Vani Shankaran 5 , Akash Mavilakandy 6 , Irene Gagliardi 7 , Sara Meade 8 , Claire Hobbs 9 , Miles J Levy 6 , Alison Cameron 10 , Ashley Grossman 4 , Maria Rosaria Ambrosio 7 , Maria Chiara Zatelli 7 , Narendra Reddy 6 , Karin Bradley 11 , Robert D Murray 5 , Aparna Pal 4 & Niki Karavitaki 1,2,3
1Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; 2Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, United Kingdom; 3Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; 4Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom; 5Department of Diabetes and Endocrinology, Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, United Kingdom; 6Department of Diabetes and Endocrinology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, United Kingdom; 7Section of Endocrinology & Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy; 8Department of Oncology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; 9Department of Clinical Oncology, Oxford University Hospitals NHS Trust, Oxford, United Kingdom; 10Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom; 11Department of Endocrinology, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
Background: Current conclusions on risk of second brain tumour following radiotherapy for pituitary adenoma or craniopharyngioma are challenged methodologically by small patient sample size, selection biases or lack of appropriate controls.
Objective: To ascertain whether radiotherapy for pituitary adenoma or craniopharyngioma is associated with increased second brain tumour risk, through use of appropriate methodology.
Design: Multi-centre, retrospective cohort study (6 centres; 5 within UK, 1 from Italy).
Methods: 4,292 patients with pituitary adenoma or craniopharyngioma detected until 31/12/2013 were identified from departmental registries. Patients with one image, unknown radiotherapy exposure status, genetic predisposition, or history of brain tumour prior to study entry were excluded (n = 532). Recipients of proton or stereotactic radiotherapy (n = 81) were excluded from statistical analyses and data were explored for 996 patients exposed to conventional, 3D-CRT or IMRT and 2,683 controls.
Results: During 45,246 patient-years, second brain tumours were reported in 61 patients (30 radiotherapy, 31 controls); 7 malignant (5 radiotherapy, 2 controls), 2 atypical (1 radiotherapy, 1 control) and 52 benign (24 radiotherapy, 28 controls). Age at pituitary tumour diagnosis and radiotherapy were associated with increased risk of second brain tumour (HR 1.031, 95%CI 1.014-1.049, P < 0.0001, and HR 1.731, 95%CI 1.046-2.864, p = 0.034, respectively), but tumour type and gender were not. After adjusting for age, radiotherapy exposure was associated with increased risk of second brain tumour (HR 1.824, 95%CI 1.100-3.020, p = 0.020). Relative risk ratio of irradiated to controls was 2.18 (95%CI 1.31-3.62). Median latency after radiotherapy was 8.3 (7.5-27.3) for malignant and 17.7 years (3-50.8) for atypical or benign tumours, respectively.
Conclusions: This is the first study assessing the risk of second brain tumour in a cohort of non-selected irradiated patients and appropriate controls with confirmed long-term imaging surveillance. Risk is increased in irradiated patients, although much less than previously reported and these data can inform clinical practice.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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