Toxicity Profiles of Fractionated Radiotherapy, Contemporary Stereotactic Radiosurgery, and Transsphenoidal Surgery in Nonfunctioning Pituitary Macroadenomas
Abstract
:1. Introduction
2. Patients and Methods
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
Abbreviations
aHR | adjusted hazard ratio |
FRT | fractionated radiotherapy |
HR | hazard ratio |
ICD-9-CM | International Classification of Diseases, Ninth Revision, Clinical Modification |
LR | local recurrence |
References
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Variables | Fractionated Radiotherapy (n = 133) | Stereotactic Radiosurgery (n = 53) | Transsphenoidal Surgery (n = 62) | p Value |
---|---|---|---|---|
n (%) | n (%) | n (%) | ||
Sex | 0.877 | |||
Male | 79 (59.4) | 32 (60.4) | 208 (57.5) | |
Female | 54 (40.6) | 21 (39.6) | 154 (42.5) | |
Age (y) | 0.024 | |||
1–17 | 22 (16.5) | 9 (17.0) | 96 (26.5) | |
18–29 30–39 40–49 50–59 60–69 ≥70 | 11 (8.3) 26 (19.5) 24 (18.0) 17 (12.8) 19 (14.3) 14 (10.5) | 7 (13.2) 12 (22.6) 8 (15.1) 6 (11.3) 3 (5.7) 8 (15.1) | 48 (13.3) 46 (12.7) 67 (18.5) 50 (13.8) 35 (9.7) 20 (5.5) | |
Hypertension | 0.111 | |||
No | 30 (22.6) | 19 (35.8) | 84 (23.2) | |
Yes | 17 (12.8) | 6 (11.3) | 69 (19.1) | |
Diabetes | 0.583 | |||
No | 23 (17.3) | 10 (18.9) | 84 (23.2) | |
DSCI = 1 | 59 (44.4) | 26 (49.1) | 153 (42.3) | |
DSCI > 1 | 51 (38.3) | 17 (32.1) | 125 (34.5) | |
Hyperlipidemia | 0.029 | |||
No | 93 (69.9) | 38 (71.7) | 286 (79.0) | |
Yes | 34 (25.6) | 9 (17.0) | 51 (14.1) | |
Atrial fibrillation | 0.868 | |||
No | 84 (63.2) | 32 (60.4) | 232 (64.1) | |
Yes | 49 (36.8) | 21 (39.6) | 130 (35.9) | |
Radiation dose (median, Gy) | 50.4 | 18 | 0 | <0.001 |
Variables | Fractionated Radiotherapy (n = 133) | Stereotactic Radiosurgery (n = 53) | Transsphenoidal Surgery (n = 62) | p Value |
---|---|---|---|---|
n (%) | n (%) | n (%) | ||
Second primary brain or head and neck cancer | 26 (19.5) | 7 (13.2) | 64 (17.7) | 0.593 |
Stroke | 33 (24.8) | 5 (9.4) | 48 (13.3) | 0.003 |
Hypopituitarism | 14 (10.5) | 5 (9.4) | 37 (10.2) | 0.976 |
Optic nerve pathway injury | 47 (35.3) | 12 (22.6) | 95 (26.2) | 0.089 |
Variables | Crude HR (95% CI) | Adjusted HR * (95% CI) | p Value | ||
---|---|---|---|---|---|
Therapeutic modality (reference, fractionated radiotherapy) | |||||
Stereotactic radiosurgery | 0.839 | (0.30, 2.34) | 0.780 | (0.27, 2.25) | 0.6457 |
Transsphenoidal surgery | 0.915 | (0.49, 1.70) | 0.863 | (0.45, 1.66) | 0.6579 |
Age (y; reference, 1–17 y) | |||||
18–29 | 1.591 | (0.77, 3.31) | 1.751 | (0.82, 3.75) | 0.1499 |
30–39 | 1.466 | (0.73, 2.97) | 1.543 | (0.74, 3.23) | 0.2485 |
40–49 | 0.609 | (0.24, 1.56) | 0.500 | (0.19, 1.31) | 0.1569 |
50–59 | 0.922 | (0.34, 2.53) | 0.664 | (0.23, 1.95) | 0.4572 |
60–69 | 0.198 | (0.03, 1.49) | 0.191 | (0.11, 0.74) | 0.0247 |
≥70 | 0.177 | (0.41, 1.87) | 0.169 | (0.12, 0.60) | 0.0296 |
Sex (reference, female) | |||||
Male | 1.026 | (0.46, 2.27) | 1.263 | (0.52, 3.04) | 0.6030 |
Diabetes (reference, no diabetes) | |||||
DSCI = 1 | 1.645 | (0.71, 3.82) | 1.744 | (0.73, 4.19) | 0.2135 |
DSCI > 1 | 2.069 | (0.89, 4.79) | 2.765 | (0.73, 6.75) | 0.1256 |
Hyperlipidemia (reference, no hyperlipidemia) | |||||
Yes | 1.245 | (0.54, 2.88) | 1.529 | (0.64, 3.64) | 0.3377 |
Hypertension (reference, no hypertension) | |||||
Yes | 1.697 | (0.55, 5.29) | 2.597 | (0.79, 8.53) | 0.1157 |
Atrial fibrillation (reference, no atrial fibrillation) | |||||
Yes | 2.13 | (1.94, 3.35) | 2.113 | (0.95, 3.25) | 0.4361 |
Variables | Crude HR (95% CI) | Adjusted HR * (95% CI) | p Value | ||
---|---|---|---|---|---|
Therapeutic modality (reference, fractionated radiotherapy) | |||||
Stereotactic radiosurgery | 0.637 | (0.34, 1.21) | 0.580 | (0.29, 1.15) | 0.1176 |
Transsphenoidal surgery | 0.956 | (0.67, 1.36) | 0.987 | (0.68, 1.43) | 0.9432 |
Age (y; reference, 1–17 y) | |||||
18–29 | 0.615 | (0.34, 1.11) | 0.552 | (0.30, 1.01) | 0.3081 |
30–39 | 0.696 | (0.43, 1.12) | 0.666 | (0.40, 1.12) | 0.1153 |
40–49 | 0.726 | (0.44, 1.20) | 0.604 | (0.35, 1.03) | 0.1034 |
50–59 | 1.007 | (0.58, 1.76) | 1.014 | (0.56, 1.82) | 0.1824 |
60–69 | 1.987 | (1.15, 3.42) | 1.561 | (0.83, 2.93) | 0.2928 |
≥70 | 0.877 | (0.41, 1.87) | 0.669 | (0.28, 1.60) | 0.1596 |
Sex (reference, female) | |||||
Male | 1.276 | (0.79, 2.07) | 1.003 | (0.59, 1.7) | 0.9924 |
Diabetes (reference, no diabetes) | |||||
DSCI = 1 | 1.152 | (0.76, 1.75) | 1.744 | (0.73, 4.19) | 0.2135 |
DSCI > 1 | 1.311 | (0.61, 2.83) | 1.321 | (0.56, 3.14) | 0.5284 |
Hyperlipidemia (reference, no hyperlipidemia) | |||||
Yes | 1.043 | (0.62, 1.77) | 0.883 | (0.51, 1.52) | 0.6536 |
Hypertension (reference, no hypertension) | |||||
Yes | 1.359 | (0.70, 2.62) | 1.180 | (0.60, 2.33) | 0.6322 |
Atrial fibrillation (reference, no atrial fibrillation) | |||||
Yes | 1.244 | (0.89, 1.74) | 1.181 | (0.76, 1.83) | 0.4558 |
Variables | Crude HR (95% CI) | Adjusted HR * (95% CI) | p Value | ||
---|---|---|---|---|---|
Therapeutic modality (reference, fractionated radiotherapy) | |||||
Stereotactic radiosurgery | 0.57 | (0.25, 1.32) | 0.532 | (0.23, 1.26) | 0.1495 |
Transsphenoidal surgery | 0.971 | (0.62, 1.53) | 0.909 | (0.56, 1.48) | 0.7005 |
Age (y; reference, 1–17 y) | |||||
18–29 | 0.745 | (0.22, 0.91) | 0.658 | (0.17, 0.76) | 0.0074 |
30–39 | 0.746 | (0.24, 0.84) | 0.518 | (0.22, 0.81) | 0.0101 |
40–49 | 0.663 | (0.24, 0.88) | 0.511 | (0.21, 0.80) | 0.0085 |
50–59 | 0.562 | (0.47, 1.59) | 0.479 | (0.40, 1.50) | 0.0461 |
60–69 | 0.434 | (0.18, 1.04) | 0.304 | (0.07, 0.58) | 0.0028 |
≥70 | 0.375 | (0.24, 1.38) | 0.211 | (0.11, 0.86) | 0.0238 |
Sex (reference, female) | |||||
Male | 1.087 | (0.6, 1.96) | 1.292 | (0.66, 2.53) | 0.4547 |
Diabetes (reference, no diabetes) | |||||
DSCI = 1 | 1.318 | (0.79, 2.20) | 1.304 | (0.76, 2.23) | 0.3315 |
DSCI > 1 | 1.661 | (0.49, 1.72) | 1.512 | (0.50, 1.66) | 0.7633 |
Hyperlipidemia (reference, no hyperlipidemia) | |||||
Yes | 1.047 | (0.54, 2.03) | 1.009 | (0.51, 2.00) | 0.9796 |
Hypertension (reference, no hypertension) | |||||
Yes | 1.088 | (0.58, 4.05) | 1.961 | (0.41, 6.28) | 0.2047 |
Atrial fibrillation (reference, no atrial fibrillation) | |||||
Yes | 1.104 | (0.73, 1.68) | 1.300 | (0.76, 2.22) | 0.3382 |
Variables | Crude HR (95% CI) | Adjusted HR * (95% CI) | p Value | ||
---|---|---|---|---|---|
Therapeutic modality (reference, fractionated radiotherapy) | |||||
Stereotactic radiosurgery | 0.388 | (0.15, 1) | 0.371 | (0.14, 0.89) | 0.0387 |
Transsphenoidal surgery | 0.530 | (0.34, 0.83) | 0.509 | (0.31, 0.83) | 0.0072 |
Age (y; reference, 1–17 y) | |||||
18–29 | 1.359 | (0.54, 3.45) | 1.574 | (0.61, 4.05) | 0.3470 |
30–39 | 1.304 | (0.54, 3.14) | 1.267 | (0.51, 3.13) | 0.6077 |
40–49 | 1.523 | (1.14, 3.57) | 1.419 | (1.08, 2.42) | 0.0318 |
50–59 | 1.673 | (1.13, 4.26) | 1.906 | (1.57, 3.57) | <0.0001 |
60–69 | 2.907 | (1.71, 6.93) | 2.686 | (1.05, 5.88) | 0.0395 |
≥70 | 5.546 | (2.79, 7.34) | 4.721 | (1.74, 6.81) | 0.0023 |
Sex (reference, female) | |||||
Male | 2.047 | (1.19, 3.51) | 1.312 | (0.72, 2.41) | 0.3796 |
Diabetes (reference, no diabetes) | |||||
DSCI = 1 | 1.360 | (0.69, 2.67) | 1.554 | (0.77, 3.13) | 0.2181 |
DSCI > 1 | 1.942 | (0.92, 4.12) | 1.971 | (0.91, 4.29) | 0.0877 |
Hyperlipidemia (reference, no hyperlipidemia) | |||||
Yes | 2.707 | (1.16, 6.30) | 2.369 | (0.96, 5.87) | 0.0626 |
Hypertension (reference, no hypertension) | |||||
Yes | 2.197 | (1.43, 3.38) | 1.261 | (0.72, 2.20) | 0.4146 |
Atrial fibrillation (reference, no atrial fibrillation) | |||||
Yes | 1.300 | (0.73, 2.31) | 1.189 | (0.64, 2.20) | 0.5820 |
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Chang, C.-L.; Yuan, K.S.-P.; Wu, A.T.H.; Wu, S.-Y. Toxicity Profiles of Fractionated Radiotherapy, Contemporary Stereotactic Radiosurgery, and Transsphenoidal Surgery in Nonfunctioning Pituitary Macroadenomas. Cancers 2019, 11, 1658. https://doi.org/10.3390/cancers11111658
Chang C-L, Yuan KS-P, Wu ATH, Wu S-Y. Toxicity Profiles of Fractionated Radiotherapy, Contemporary Stereotactic Radiosurgery, and Transsphenoidal Surgery in Nonfunctioning Pituitary Macroadenomas. Cancers. 2019; 11(11):1658. https://doi.org/10.3390/cancers11111658
Chicago/Turabian StyleChang, Chia-Lun, Kevin Sheng-Po Yuan, Alexander T.H. Wu, and Szu-Yuan Wu. 2019. "Toxicity Profiles of Fractionated Radiotherapy, Contemporary Stereotactic Radiosurgery, and Transsphenoidal Surgery in Nonfunctioning Pituitary Macroadenomas" Cancers 11, no. 11: 1658. https://doi.org/10.3390/cancers11111658