Risk of new tumor, carotid stenosis, and stroke after Stereotactic Radiosurgery for Pituitary Tumor: A multicenter study of 2254 patients with imaging follow-up

Chloe Dumot; Georgios Mantziaris; Sam Dayawansa; Carson Brantley; Cheng-Chia Lee; Huai-Che Yang; Selcuk Peker; Yavuz Samanci; David Mathieu; Jean-Nicolas Tourigny; Nuria Martinez Moreno; Roberto Martinez Alvarez; Thomas Chytka; Roman Liscak; Herwin Speckter; Erwin Lazo; Anderson Brito; Piero Picozzi; Andrea Franzini; Juan Alzate; Elad Mashiach; Kenneth Bernstein; Douglas Kondziolka; Manjul Tripathi; Greg N Bowden; Ronald E Warnick; Darrah Sheehan; Kimball Sheehan; Angelica Fuentes; John A Jane Jr; Mary Lee Vance; Jason P Sheehan

doi:10.1093/neuonc/noae133

Risk of new tumor, carotid stenosis, and stroke after Stereotactic Radiosurgery for Pituitary Tumor: A multicenter study of 2254 patients with imaging follow-up

Neuro Oncol. 2024 Jul 19:noae133. doi: 10.1093/neuonc/noae133. Online ahead of print.

Authors

Chloe Dumot^{1

2}, Georgios Mantziaris¹, Sam Dayawansa¹, Carson Brantley¹, Cheng-Chia Lee^{3

4}, Huai-Che Yang^{3

4}, Selcuk Peker⁵, Yavuz Samanci⁵, David Mathieu⁶, Jean-Nicolas Tourigny⁶, Nuria Martinez Moreno⁷, Roberto Martinez Alvarez⁷, Thomas Chytka⁸, Roman Liscak⁸, Herwin Speckter⁹, Erwin Lazo⁹, Anderson Brito⁹, Piero Picozzi¹⁰, Andrea Franzini¹⁰, Juan Alzate¹¹, Elad Mashiach¹¹, Kenneth Bernstein, Douglas Kondziolka¹¹, Manjul Tripathi¹², Greg N Bowden¹³, Ronald E Warnick¹⁴, Darrah Sheehan¹, Kimball Sheehan¹, Angelica Fuentes¹, John A Jane Jr¹⁵, Mary Lee Vance¹⁶, Jason P Sheehan¹

Affiliations

¹ Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
² Department of Neurological Surgery, Hospices civils de Lyon, Lyon, France.
³ Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipai, Taiwan.
⁴ School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁵ Department of Neurosurgery, Koc university Hospital School of Medicine, Turkey.
⁶ Division of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada.
⁷ Radiosurgery Unit, Hospital Ruber Internacional Madrid, Spain.
⁸ Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic.
⁹ Dominican Gamma Knife Center and Radiology department, CEDIMAT, Santo Domingo, Dominican Republic.
¹⁰ Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy.
¹¹ Department of Neurosurgery and 12Radiation Oncology, NYU Langone, New York City, New York, USA.
¹² Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
¹³ Department of Neurosurgery, University of Alberta, Canada.
¹⁴ Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio, USA.
¹⁵ Departement of Neurosurgery, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
¹⁶ Department of Medicine, University of Virginia, Charlottesville, Virginia, USA.

PMID: 39028740
DOI: 10.1093/neuonc/noae133

Abstract

Background: Higher risk of secondary brain tumor, carotid stenosis and stroke has been reported after conventional sella irradiation for pituitary neuroendocrine tumors (PitNET). Stereotactic radiosurgery (SRS), which is a more focused approach, is now increasingly used instead. The aim was to assess the risk of secondary brain tumor, carotid stenosis/occlusion and stroke after SRS.

Methods: In this multicentric retrospective study, 2,254 patients with PitNET were studied, 1,377 in the exposed group and 877 in the control group.

Results: There were 9,840.1 patient-years at risk for the SRS and 5,266.5 for the control group. The 15-year cumulative probability of secondary intracranial tumor was 2.3% (95%CI:0.5%, 4.1%) for SRS and 3.7% (95%CI:0%, 8.7%) for the control group (p=0.6), with an incidence rate of 1.32 per 1,000 and 0.95 per 1,000, respectively. SRS was not associated with increased risk of tumorigenesis when stratified by age (HR: 1.59 [95%CI: 0.57, 4.47], p=0.38). The 15-year probability of new carotid stenosis/occlusion was 0.9% (95%CI: 0.2, 1.6) in the SRS and 2% (95%CI: 0, 4.4) in the control group (p=0.8). The 15-year probability of stroke was 2.6% (95%CI: 0.6%, 4.6%) in the SRS and 11.1% (95%CI: 6%, 15.9%) in the control group (p<0.001). In cox multivariate analysis stratified by age, SRS (HR 1.85[95%CI:0.64, 5.35], p=0.26) was not associated with risk of new stroke.

Conclusion: No increased risk of long-term secondary brain tumor, new stenosis or occlusion and stroke was demonstrated in SRS group compared to control in this study with imaging surveillance.

Keywords: Pituitary neuro-endocrine tumor; carotid stenosis; radiosurgery; secondary tumor; stroke.

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