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Title: Incidence, Causative Mechanisms, and Anatomic Localization of Stroke in Pituitary Adenoma Patients Treated With Postoperative Radiation Therapy Versus Surgery Alone

Abstract

Purpose: To assess and compare the incidence of stroke and stroke subtype in pituitary adenoma patients treated with postoperative radiation therapy (RT) and surgery alone. Methods and Materials: A cohort of 462 pituitary adenoma patients treated between 1959 and 2008 at the University Medical Center Groningen in The Netherlands was studied. Radiation therapy was administered in 236 patients. The TOAST (Trial of ORG 10172 in Acute Stroke Treatment) and the Oxfordshire Community Stroke Project classification methods were used to determine causative mechanism and anatomic localization of stroke. Stroke incidences in patients treated with RT were compared with that observed after surgery alone. Risk factors for stroke incidence were studied by log–rank test, without and with stratification for other significant risk factors. In addition, the stroke incidence was compared with the incidence rate in the general Dutch population. Results: Thirteen RT patients were diagnosed with stroke, compared with 12 surgery-alone patients. The relative risk (RR) for stroke in patients treated with postoperative RT was not significantly different compared with surgery-alone patients (univariate RR 0.62, 95% confidence interval [CI] 0.28-1.35, P=.23). Stroke risk factors were coronary or peripheral artery disease (univariate and multivariate RR 10.4, 95% CI 4.7-22.8, P<.001) and hypertension (univariatemore » RR 3.9, 95% CI 1.6-9.8, P=.002). There was no difference in TOAST and Oxfordshire classification of stroke. In this pituitary adenoma cohort 25 strokes were observed, compared with 16.91 expected (standard incidence ratio 1.48, 95% CI 1.00-1.96, P=.049). Conclusions: In pituitary adenoma patients, an increased incidence of stroke was observed compared with the general population. However, postoperative RT was not associated with an increased incidence of stroke or differences in causative mechanism or anatomic localization of stroke compared with surgery alone. The primary stroke risk factor was pre-existent coronary or peripheral artery disease.« less

Authors:
 [1];  [2];  [3];  [2];  [4];  [2];  [2]
  1. Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands)
  2. Department of Endocrinology and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen (Netherlands)
  3. Department of Primary and Community Care, Radboud University Nijmegen Medical Centre (Netherlands)
  4. Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen (Netherlands)
Publication Date:
OSTI Identifier:
22267852
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 87; Journal Issue: 1; Other Information: Copyright (c) 2013 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ADENOMAS; COMPARATIVE EVALUATIONS; CORONARIES; HYPERTENSION; PATIENTS; RADIOTHERAPY; SURGERY

Citation Formats

Sattler, Margriet G.A., E-mail: g.a.sattler@umcg.nl, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Vroomen, Patrick C., Sluiter, Wim J., Schers, Henk J., Berg, Gerrit van den, Langendijk, Johannes A., Wolffenbuttel, Bruce H.R., Bergh, Alphons C.M. van den, and Beek, André P. van. Incidence, Causative Mechanisms, and Anatomic Localization of Stroke in Pituitary Adenoma Patients Treated With Postoperative Radiation Therapy Versus Surgery Alone. United States: N. p., 2013. Web. doi:10.1016/J.IJROBP.2013.05.006.
Sattler, Margriet G.A., E-mail: g.a.sattler@umcg.nl, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Vroomen, Patrick C., Sluiter, Wim J., Schers, Henk J., Berg, Gerrit van den, Langendijk, Johannes A., Wolffenbuttel, Bruce H.R., Bergh, Alphons C.M. van den, & Beek, André P. van. Incidence, Causative Mechanisms, and Anatomic Localization of Stroke in Pituitary Adenoma Patients Treated With Postoperative Radiation Therapy Versus Surgery Alone. United States. https://doi.org/10.1016/J.IJROBP.2013.05.006
Sattler, Margriet G.A., E-mail: g.a.sattler@umcg.nl, Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Vroomen, Patrick C., Sluiter, Wim J., Schers, Henk J., Berg, Gerrit van den, Langendijk, Johannes A., Wolffenbuttel, Bruce H.R., Bergh, Alphons C.M. van den, and Beek, André P. van. 2013. "Incidence, Causative Mechanisms, and Anatomic Localization of Stroke in Pituitary Adenoma Patients Treated With Postoperative Radiation Therapy Versus Surgery Alone". United States. https://doi.org/10.1016/J.IJROBP.2013.05.006.
@article{osti_22267852,
title = {Incidence, Causative Mechanisms, and Anatomic Localization of Stroke in Pituitary Adenoma Patients Treated With Postoperative Radiation Therapy Versus Surgery Alone},
author = {Sattler, Margriet G.A., E-mail: g.a.sattler@umcg.nl and Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON and Vroomen, Patrick C. and Sluiter, Wim J. and Schers, Henk J. and Berg, Gerrit van den and Langendijk, Johannes A. and Wolffenbuttel, Bruce H.R. and Bergh, Alphons C.M. van den and Beek, André P. van},
abstractNote = {Purpose: To assess and compare the incidence of stroke and stroke subtype in pituitary adenoma patients treated with postoperative radiation therapy (RT) and surgery alone. Methods and Materials: A cohort of 462 pituitary adenoma patients treated between 1959 and 2008 at the University Medical Center Groningen in The Netherlands was studied. Radiation therapy was administered in 236 patients. The TOAST (Trial of ORG 10172 in Acute Stroke Treatment) and the Oxfordshire Community Stroke Project classification methods were used to determine causative mechanism and anatomic localization of stroke. Stroke incidences in patients treated with RT were compared with that observed after surgery alone. Risk factors for stroke incidence were studied by log–rank test, without and with stratification for other significant risk factors. In addition, the stroke incidence was compared with the incidence rate in the general Dutch population. Results: Thirteen RT patients were diagnosed with stroke, compared with 12 surgery-alone patients. The relative risk (RR) for stroke in patients treated with postoperative RT was not significantly different compared with surgery-alone patients (univariate RR 0.62, 95% confidence interval [CI] 0.28-1.35, P=.23). Stroke risk factors were coronary or peripheral artery disease (univariate and multivariate RR 10.4, 95% CI 4.7-22.8, P<.001) and hypertension (univariate RR 3.9, 95% CI 1.6-9.8, P=.002). There was no difference in TOAST and Oxfordshire classification of stroke. In this pituitary adenoma cohort 25 strokes were observed, compared with 16.91 expected (standard incidence ratio 1.48, 95% CI 1.00-1.96, P=.049). Conclusions: In pituitary adenoma patients, an increased incidence of stroke was observed compared with the general population. However, postoperative RT was not associated with an increased incidence of stroke or differences in causative mechanism or anatomic localization of stroke compared with surgery alone. The primary stroke risk factor was pre-existent coronary or peripheral artery disease.},
doi = {10.1016/J.IJROBP.2013.05.006},
url = {https://www.osti.gov/biblio/22267852}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 1,
volume = 87,
place = {United States},
year = {Sun Sep 01 00:00:00 EDT 2013},
month = {Sun Sep 01 00:00:00 EDT 2013}
}