title: Neurocognitive long-term impact of two-field conventional radiotherapy in adult patients with operated pituitary adenomas.
abstract: OBJECTIVE
  To assess the long-term impact of postoperative two-field-conventional radiotherapy (RT) on neurocognitive functions of adult patients with operated pituitary adenomas (PA).
  
  
  METHODS
  We selected 124 adult patients with operated PA-56 of whom had also received RT-recorded their main clinical data and performed a neuropsychological assessment in all of them that included 15 standardized tests, and a cerebral SPECT in eight patients. Comparative analyses were carried out on major clinical and neurocognitive domains between irradiated and not irradiated patients, and on cerebral SPECT source.
  
  
  RESULTS
  Compared with non-irradiated patients, irradiated patients performed significantly worse on Barcelona's story recall test (P < 0.001) and arithmetic problems (P < 0.03) and on five categories of the Wisconsin card sorting test, especially on perseverative answers and errors (P < 0.001) without differences in other examined functional domains. RT was the only factor associated with worse results in these tests regardless other clinical and treatment-related variables. Kaplan-Meier analysis suggested that the probability of achieving poorer results with time was related to RT total dose and field-size, type of PA and age at the time of RT. Four of the five SPECTS performed in irradiated patients revealed a similar altered perfusion in the left temporal lobe cortical region.
  
  
  CONCLUSIONS
  In adult patients with operated PA, RT was independently associated with an impairment on verbal memory and executive function, when compared to non-irradiated patients. Our data suggest that diagnosis of acromegaly or Cushing's disease, and age at the time of RT were able to modulate this long-term radio-induced neurocognitive sequelae.
authors.affiliation: Endocrinology and Nutrition Department, La Paz University Hospital, Castellana 261, 28046, Madrid, Spain. lecum74@hotmail.com.|Endocrinology and Nutrition Department, Puerta de Hierro University Hospital, Madrid, Spain. lecum74@hotmail.com.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Lecumberri
authors.affiliation: Endocrinology and Nutrition Department, Puerta de Hierro University Hospital, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Estrada
authors.affiliation: Neurosurgery Department, Puerta de Hierro University Hospital, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: García-Uría
authors.affiliation: Statistics Department, Puerta de Hierro University Hospital, Madrid, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Millán
authors.affiliation: Endocrinology and Nutrition Department, La Paz University Hospital, Castellana 261, 28046, Madrid, Spain.
authors.forename: Luis Felipe
authors.initials: LF
authors.lastname: Pallardo
authors.affiliation: Psychiatry Department, Puerta de Hierro University Hospital, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Caballero
authors.affiliation: Endocrinology and Nutrition Department, Puerta de Hierro University Hospital, Madrid, Spain.|Sanchinarro University Hospital, Madrid, Spain.
authors.forename: Tomás
authors.initials: T
authors.lastname: Lucas
mesh_terms: D000172:Acromegaly / Q000150:complications; D000328:Adult; D000367:Age Factors; D003071:Cognition / Q000528:radiation effects; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D047748:Pituitary ACTH Hypersecretion / Q000150:complications; D010911:Pituitary Neoplasms / Q000503:physiopathology* / Q000532:radiotherapy* / Q000601:surgery; D011878:Radiotherapy / Q000009:adverse effects*
keywords: Neurocognitive; Pituitary adenomas; Radiotherapy; Transsphenoidal surgery
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