The incidence of cerebrovascular accidents and second brain tumors in patients with pituitary adenoma: A population-based study

Paul D. Brown, Miran Blanchard, Krishan Jethwa, Kelly Flemming, Cerise A. Brown, Robert W. Kline, Debra J. Jacobson, Jennifer St. Sauver, Bruce E. Pollock, Yolanda Isabel Garces, Scott L. Stafford, Michael J. Link, Dana Erickson, Robert L. Foote, Nadia N Laack

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background. To assess the risk of cerebrovascular accidents (CVAs) and second brain tumors (SBTs) in patients with pituitary adenoma after surgery or radiotherapy. Methods. A cohort of 143 people from Olmsted County, who were diagnosed with pituitary adenoma between 1933 and 2000, was studied. Only patients from Olmsted County were included because of the unique nature of medical care in Olmsted County, which allows the ascertainment of virtually all cases of pituitary adenoma for this community's residents and comparisons to the general population in the county. Surgical resection was performed in 76 patients, 29 patients underwent radiotherapy (with 21 undergoing both surgery and radiotherapy), 5 patients were reirradiated, and 59 patients were managed conservatively and observed. Results. Median follow-up was 15.5 years. There was no difference in CVA-free survival between treatment groups. On univariate analysis age >60 years (hazard ratio [HR], 11.93; 95% CI, 6.26-23.03; P<.001); male sex (HR, 3.67; 95% CI, 2.03-6.84; P<.001), and reirradiation (HR, 3.41; 95% CI, 1.05-9.68; P =.04) were associated with worse CVA-free survival. In multivariate analysis, only age >60 years was associated with worse CVA-free survival. Compared with the general population, there was a 4-fold increase in the rate of CVAs in pituitary adenoma patients (HR, 4.2; 95% CI, 2.8-6.1). Two patients developed SBT (an irradiated patient and a surgically managed patient). Conclusion. CVA is a significant risk for patients with pituitary tumors, but treatment does not seem to impact the risk. Even with longterm follow-up, SBTs are a rare event regardless of treatment modality.

Original languageEnglish (US)
Pages (from-to)22-28
Number of pages7
JournalNeuro-Oncology Practice
Volume1
Issue number1
DOIs
StatePublished - Mar 1 2014

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Pituitary Neoplasms
Brain Neoplasms
Stroke
Incidence
Population
Radiotherapy
Survival
Therapeutics

Keywords

  • Pituitary adenoma
  • Radiotherapy
  • Secondary malignancy
  • Stroke
  • Surgery

ASJC Scopus subject areas

  • Medicine (miscellaneous)

Cite this

The incidence of cerebrovascular accidents and second brain tumors in patients with pituitary adenoma : A population-based study. / Brown, Paul D.; Blanchard, Miran; Jethwa, Krishan; Flemming, Kelly; Brown, Cerise A.; Kline, Robert W.; Jacobson, Debra J.; St. Sauver, Jennifer; Pollock, Bruce E.; Garces, Yolanda Isabel; Stafford, Scott L.; Link, Michael J.; Erickson, Dana; Foote, Robert L.; Laack, Nadia N.

In: Neuro-Oncology Practice, Vol. 1, No. 1, 01.03.2014, p. 22-28.

Research output: Contribution to journalArticle

Brown, PD, Blanchard, M, Jethwa, K, Flemming, K, Brown, CA, Kline, RW, Jacobson, DJ, St. Sauver, J, Pollock, BE, Garces, YI, Stafford, SL, Link, MJ, Erickson, D, Foote, RL & Laack, NN 2014, 'The incidence of cerebrovascular accidents and second brain tumors in patients with pituitary adenoma: A population-based study', Neuro-Oncology Practice, vol. 1, no. 1, pp. 22-28. https://doi.org/10.1093/nop/npt001
Brown, Paul D. ; Blanchard, Miran ; Jethwa, Krishan ; Flemming, Kelly ; Brown, Cerise A. ; Kline, Robert W. ; Jacobson, Debra J. ; St. Sauver, Jennifer ; Pollock, Bruce E. ; Garces, Yolanda Isabel ; Stafford, Scott L. ; Link, Michael J. ; Erickson, Dana ; Foote, Robert L. ; Laack, Nadia N. / The incidence of cerebrovascular accidents and second brain tumors in patients with pituitary adenoma : A population-based study. In: Neuro-Oncology Practice. 2014 ; Vol. 1, No. 1. pp. 22-28.
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abstract = "Background. To assess the risk of cerebrovascular accidents (CVAs) and second brain tumors (SBTs) in patients with pituitary adenoma after surgery or radiotherapy. Methods. A cohort of 143 people from Olmsted County, who were diagnosed with pituitary adenoma between 1933 and 2000, was studied. Only patients from Olmsted County were included because of the unique nature of medical care in Olmsted County, which allows the ascertainment of virtually all cases of pituitary adenoma for this community's residents and comparisons to the general population in the county. Surgical resection was performed in 76 patients, 29 patients underwent radiotherapy (with 21 undergoing both surgery and radiotherapy), 5 patients were reirradiated, and 59 patients were managed conservatively and observed. Results. Median follow-up was 15.5 years. There was no difference in CVA-free survival between treatment groups. On univariate analysis age >60 years (hazard ratio [HR], 11.93; 95{\%} CI, 6.26-23.03; P<.001); male sex (HR, 3.67; 95{\%} CI, 2.03-6.84; P<.001), and reirradiation (HR, 3.41; 95{\%} CI, 1.05-9.68; P =.04) were associated with worse CVA-free survival. In multivariate analysis, only age >60 years was associated with worse CVA-free survival. Compared with the general population, there was a 4-fold increase in the rate of CVAs in pituitary adenoma patients (HR, 4.2; 95{\%} CI, 2.8-6.1). Two patients developed SBT (an irradiated patient and a surgically managed patient). Conclusion. CVA is a significant risk for patients with pituitary tumors, but treatment does not seem to impact the risk. Even with longterm follow-up, SBTs are a rare event regardless of treatment modality.",
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T1 - The incidence of cerebrovascular accidents and second brain tumors in patients with pituitary adenoma

T2 - A population-based study

AU - Brown, Paul D.

AU - Blanchard, Miran

AU - Jethwa, Krishan

AU - Flemming, Kelly

AU - Brown, Cerise A.

AU - Kline, Robert W.

AU - Jacobson, Debra J.

AU - St. Sauver, Jennifer

AU - Pollock, Bruce E.

AU - Garces, Yolanda Isabel

AU - Stafford, Scott L.

AU - Link, Michael J.

AU - Erickson, Dana

AU - Foote, Robert L.

AU - Laack, Nadia N

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N2 - Background. To assess the risk of cerebrovascular accidents (CVAs) and second brain tumors (SBTs) in patients with pituitary adenoma after surgery or radiotherapy. Methods. A cohort of 143 people from Olmsted County, who were diagnosed with pituitary adenoma between 1933 and 2000, was studied. Only patients from Olmsted County were included because of the unique nature of medical care in Olmsted County, which allows the ascertainment of virtually all cases of pituitary adenoma for this community's residents and comparisons to the general population in the county. Surgical resection was performed in 76 patients, 29 patients underwent radiotherapy (with 21 undergoing both surgery and radiotherapy), 5 patients were reirradiated, and 59 patients were managed conservatively and observed. Results. Median follow-up was 15.5 years. There was no difference in CVA-free survival between treatment groups. On univariate analysis age >60 years (hazard ratio [HR], 11.93; 95% CI, 6.26-23.03; P<.001); male sex (HR, 3.67; 95% CI, 2.03-6.84; P<.001), and reirradiation (HR, 3.41; 95% CI, 1.05-9.68; P =.04) were associated with worse CVA-free survival. In multivariate analysis, only age >60 years was associated with worse CVA-free survival. Compared with the general population, there was a 4-fold increase in the rate of CVAs in pituitary adenoma patients (HR, 4.2; 95% CI, 2.8-6.1). Two patients developed SBT (an irradiated patient and a surgically managed patient). Conclusion. CVA is a significant risk for patients with pituitary tumors, but treatment does not seem to impact the risk. Even with longterm follow-up, SBTs are a rare event regardless of treatment modality.

AB - Background. To assess the risk of cerebrovascular accidents (CVAs) and second brain tumors (SBTs) in patients with pituitary adenoma after surgery or radiotherapy. Methods. A cohort of 143 people from Olmsted County, who were diagnosed with pituitary adenoma between 1933 and 2000, was studied. Only patients from Olmsted County were included because of the unique nature of medical care in Olmsted County, which allows the ascertainment of virtually all cases of pituitary adenoma for this community's residents and comparisons to the general population in the county. Surgical resection was performed in 76 patients, 29 patients underwent radiotherapy (with 21 undergoing both surgery and radiotherapy), 5 patients were reirradiated, and 59 patients were managed conservatively and observed. Results. Median follow-up was 15.5 years. There was no difference in CVA-free survival between treatment groups. On univariate analysis age >60 years (hazard ratio [HR], 11.93; 95% CI, 6.26-23.03; P<.001); male sex (HR, 3.67; 95% CI, 2.03-6.84; P<.001), and reirradiation (HR, 3.41; 95% CI, 1.05-9.68; P =.04) were associated with worse CVA-free survival. In multivariate analysis, only age >60 years was associated with worse CVA-free survival. Compared with the general population, there was a 4-fold increase in the rate of CVAs in pituitary adenoma patients (HR, 4.2; 95% CI, 2.8-6.1). Two patients developed SBT (an irradiated patient and a surgically managed patient). Conclusion. CVA is a significant risk for patients with pituitary tumors, but treatment does not seem to impact the risk. Even with longterm follow-up, SBTs are a rare event regardless of treatment modality.

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KW - Radiotherapy

KW - Secondary malignancy

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KW - Surgery

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