title: Radiotherapy, Especially at Young Age, Increases the Risk for De Novo Brain Tumors in Patients Treated for Pituitary/Sellar Lesions.
abstract: BACKGROUND
  De novo brain tumors developing after treatment of pituitary/sellar lesions have been reported, but it is unknown whether this is linked to any of the treatment modalities.
  
  
  OBJECTIVE
  To study the occurrence of malignant brain tumors and meningiomas in a large cohort of patients treated for pituitary/sellar lesions, with special emphasis on the role of radiotherapy (RT).
  
  
  METHODS
  Patients (n = 8917) who were hypopituitary due to pituitary adenomas, craniopharyngiomas, and other sellar tumors followed in KIMS (Pfizer International Metabolic Database) from 1994 to 2012 were included. Treatment consisted of surgery and/or medical therapy in 4927 patients, RT alone, or with surgery in 3236 patients; data were missing in 754. Incidence rate ratios (RRs) were analyzed through Poisson regression methods with internal comparisons.
  
  
  RESULTS
  During 53,786 patient-years, 17 cases of malignant brain tumors (13 exposed to RT) and 27 meningiomas (22 exposed to RT) were reported. RR for RT vs no RT was 3.34 [95% confidence interval (CI), 1.06 to 10.6] for malignant brain tumors, and 4.06 (95% CI, 1.51 to 10.9) for meningiomas. The risk of developing a malignant brain tumor increased by 2.4-fold (P = 0.005) and meningioma by 1.6-fold with every 10 years of younger age at RT (P = 0.05). Incidence rates were similar in patients treated with conventional RT compared with stereotactic RT.
  
  
  CONCLUSIONS
  RT of pituitary tumors is associated with increased risk of developing malignant brain tumors and meningiomas, especially when given at younger ages. In balancing risks and benefits of RT, our findings emphasize that special consideration should be given to the age of the patient.
authors.affiliation: Department of Endocrinology, Skånes University Hospital, University of Lund, 20502 Malmö, Sweden.
authors.forename: Pia
authors.initials: P
authors.lastname: Burman
authors.affiliation: Department of Endocrinology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands.
authors.forename: André P
authors.initials: AP
authors.lastname: van Beek
authors.affiliation: Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts 02114.
authors.forename: Beverly M K
authors.initials: BM
authors.lastname: Biller
authors.affiliation: Pfizer Endocrine Care, Pfizer Inc., New York, New York 10017; and.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Camacho-Hübner
authors.affiliation: Pfizer Endocrine Care, Pfizer Health AB, 19091 Sollentuna, Sweden.
authors.forename: Anders F
authors.initials: AF
authors.lastname: Mattsson
mesh_terms: D000236:Adenoma / Q000150:complications / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001254:Astrocytoma / Q000453:epidemiology; D001932:Brain Neoplasms / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation; D003397:Craniopharyngioma / Q000150:complications / Q000628:therapy*; D005260:Female; D005909:Glioblastoma / Q000453:epidemiology; D005910:Glioma / Q000453:epidemiology*; D013006:Growth Hormone / Q000627:therapeutic use; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology / Q000628:therapy; D015994:Incidence; D008297:Male; D008577:Meningeal Neoplasms / Q000453:epidemiology*; D008579:Meningioma / Q000453:epidemiology*; D008875:Middle Aged; D009447:Neuroblastoma / Q000453:epidemiology*; D019635:Neurosurgical Procedures; D009837:Oligodendroglioma / Q000453:epidemiology; D010911:Pituitary Neoplasms / Q000150:complications / Q000628:therapy*; D016012:Poisson Distribution; D016634:Radiosurgery; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D013006:Growth Hormone