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Excess mortality in radiotherapy-treated pituitary adenoma patients: 50-year follow-up.

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Τίτλος: Excess mortality in radiotherapy-treated pituitary adenoma patients: 50-year follow-up.
Συγγραφείς: Fitzgerald A; UCD School of Medicine, University College Dublin, Dublin D04 W6W8, Ireland., de Boisanger J; Neuro-oncology Unit, The Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK.; The Institute of Cancer Research, London SW7 3RP, UK., Cooke R; The Institute of Cancer Research, London SW7 3RP, UK., Traish D; The Institute of Cancer Research, London SW7 3RP, UK., Swerdlow A; The Institute of Cancer Research, London SW7 3RP, UK., Rosenfelder N; Neuro-oncology Unit, The Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK.; The Institute of Cancer Research, London SW7 3RP, UK., Solda F; Neuro-oncology Unit, The Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK.; The Institute of Cancer Research, London SW7 3RP, UK., Brada M; The Institute of Cancer Research, London SW7 3RP, UK.; Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool L69 7BE, UK.
Πηγή: Journal of the Endocrine Society [J Endocr Soc] 2026 May 14; Vol. 10 (11), pp. bvag115. Date of Electronic Publication: 2026 May 14 (Print Publication: 2026).
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Endocrine Society Country of Publication: United States NLM ID: 101697997 Publication Model: eCollection Cited Medium: Internet ISSN: 2472-1972 (Electronic) Linking ISSN: 24721972 NLM ISO Abbreviation: J Endocr Soc Subsets: PubMed not MEDLINE
Imprint Name(s): Original Publication: Washington, DC : Endocrine Society, [2017]-
Περίληψη: Context: We report the long-term survival and the causes of excess mortality in a cohort of pituitary adenoma (PA) patients treated with radiotherapy, with or without prior surgery at up to 50 years of follow-up.
Objective: To evaluate long-term survival and causes of excess mortality in patients with PAs treated with radiotherapy, with or without prior surgery, and to examine the relationship between treatment factors, particularly radiotherapy dose and mortality outcomes over extended follow-up.
Methods: 426 patients treated with radiotherapy at the Royal Marsden Hospital during 1962 and 1994 with or without prior surgery were followed up via the NHS Central Register to identify deaths and emigrations. Standardized mortality ratios (SMRs) and absolute excess risks (AERs) were calculated by comparing observed deaths with expected rates based on national age, sex, year, and period-specific mortality rates for England and Wales.
Results: 260 deaths were recorded compared to 144 expected (SMR 1.8; AER 140.7). The main contributors to excess mortality were cerebrovascular disease (SMR 4.9; AER 61.4), endocrine/metabolic disease (SMR 5.6), and mental and behavioral disorders (SMR 5.0). Both all-cause and cerebrovascular-specific mortality were associated with increasing radiotherapy dose and with the use of surgery.
Conclusion: Patients with PAs treated with surgery and radiotherapy have an increased mortality compared to the general population, with the principal contributor cerebrovascular accident mortality. The observed dose-response suggests a potential relationship between radiotherapy and vascular morbidity. The findings highlight the need for long-term surveillance and proactive management of vascular risk factors and in patients requiring radiotherapy and avoiding excessive radiotherapy doses. Whether modern high-precision fractionated radiotherapy techniques reduce the risk of cerebrovascular morbidity and mortality requires long-term studies.
(© The Author(s) 2026. Published by Oxford University Press on behalf of the Endocrine Society.)
References: Front Endocrinol (Lausanne). 2022 Dec 13;13:1064216. (PMID: 36578965)
Int J Radiat Oncol Biol Phys. 1991 Aug;21(3):607-14. (PMID: 1907958)
Radiother Oncol. 2009 Dec;93(3):597-601. (PMID: 19900729)
Cancers (Basel). 2017 Aug 08;9(8):. (PMID: 28786923)
Am Fam Physician. 2013 Sep 1;88(5):319-27. (PMID: 24010395)
Pituitary. 2021 Feb;24(1):38-47. (PMID: 32949324)
Endocrinol Metab (Seoul). 2015 Dec;30(4):443-55. (PMID: 26790380)
Lancet. 2016 Aug 20;388(10046):761-75. (PMID: 27431356)
Endocr Rev. 2022 Nov 25;43(6):1003-1037. (PMID: 35395078)
Clin Endocrinol (Oxf). 2002 Dec;57(6):713-7. (PMID: 12460319)
Eur J Endocrinol. 2015 Oct;173(4):M133-57. (PMID: 26060052)
Lancet. 2001 Feb 10;357(9254):425-31. (PMID: 11273062)
Endocrine. 2025 Feb;87(2):782-787. (PMID: 39425840)
Therapie. 1999 May-Jun;54(3):381-5. (PMID: 10500455)
J Neurooncol. 2014 May;117(3):379-94. (PMID: 24481996)
Ther Adv Endocrinol Metab. 2017 Mar;8(3):33-48. (PMID: 28377801)
J Neurooncol. 2015 Sep;124(2):291-7. (PMID: 26080799)
J Clin Endocrinol Metab. 2015 Mar;100(3):1104-12. (PMID: 25574793)
J Clin Endocrinol Metab. 2017 Mar 01;102(3):1051-1058. (PMID: 28359095)
Eur J Endocrinol. 2018 May;178(5):459-469. (PMID: 29483205)
Endocr Rev. 2010 Jun;31(3):301-42. (PMID: 20086217)
J Neurooncol. 2017 Oct;135(1):1-11. (PMID: 28660317)
J Clin Endocrinol Metab. 2005 Feb;90(2):800-4. (PMID: 15562021)
Int J Radiat Oncol Biol Phys. 1999 Oct 1;45(3):693-8. (PMID: 10524424)
J Neurol Neurosurg Psychiatry. 2009 Aug;80(8):910-5. (PMID: 18653549)
J Cancer Surviv. 2024 Feb;18(1):59-67. (PMID: 37142871)
Sci Rep. 2021 Jul 26;11(1):15155. (PMID: 34312470)
Clin Endocrinol (Oxf). 2006 Jul;65(1):51-8. (PMID: 16817819)
Radiat Oncol J. 2016 Jun;34(2):121-7. (PMID: 27306775)
Neurosurg Clin N Am. 2019 Oct;30(4):391-400. (PMID: 31471046)
Lancet. 2005 Nov 5;366(9497):1640-9. (PMID: 16271645)
Clin Endocrinol (Oxf). 1993 Jun;38(6):571-8. (PMID: 8334743)
Lancet Diabetes Endocrinol. 2022 Aug;10(8):581-588. (PMID: 35780804)
Clin Endocrinol (Oxf). 2016 Nov;85(5):748-756. (PMID: 27327840)
Int J Radiat Oncol Biol Phys. 2024 Jun 1;119(2):417-430. (PMID: 36057476)
J Clin Endocrinol Metab. 2013 Apr;98(4):1466-75. (PMID: 23457412)
J Clin Endocrinol Metab. 2015 Jul;100(7):2651-8. (PMID: 25946030)
Neurosurgery. 2011 Jul;69(1):72-8; discussion 78-9. (PMID: 21346660)
N Engl J Med. 1999 Jun 10;340(23):1801-11. (PMID: 10362825)
Int J Radiat Oncol Biol Phys. 2000 Jul 15;47(5):1337-45. (PMID: 10889388)
Pituitary. 2017 Apr;20(2):218-224. (PMID: 27743172)
Int J Radiat Oncol Biol Phys. 2008 Jul 15;71(4):994-8. (PMID: 18403133)
Contributed Indexing: Keywords: cerebrovascular accidents; late toxicity; pituitary adenoma; radiotherapy
Entry Date(s): Date Created: 20261009 Date Completed: 20261009 Latest Revision: 20261010
Update Code: 20261010
PubMed Central ID: PMC13647088
DOI: 10.1210/jendso/bvag115
PMID: 42851721
Βάση Δεδομένων: MEDLINE
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  Data: Excess mortality in radiotherapy-treated pituitary adenoma patients: 50-year follow-up.
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  Data: <searchLink fieldCode="AU" term="%22Fitzgerald+A%22">Fitzgerald A</searchLink>; UCD School of Medicine, University College Dublin, Dublin D04 W6W8, Ireland.<br /><searchLink fieldCode="AU" term="%22de+Boisanger+J%22">de Boisanger J</searchLink>; Neuro-oncology Unit, The Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK.; The Institute of Cancer Research, London SW7 3RP, UK.<br /><searchLink fieldCode="AU" term="%22Cooke+R%22">Cooke R</searchLink>; The Institute of Cancer Research, London SW7 3RP, UK.<br /><searchLink fieldCode="AU" term="%22Traish+D%22">Traish D</searchLink>; The Institute of Cancer Research, London SW7 3RP, UK.<br /><searchLink fieldCode="AU" term="%22Swerdlow+A%22">Swerdlow A</searchLink>; The Institute of Cancer Research, London SW7 3RP, UK.<br /><searchLink fieldCode="AU" term="%22Rosenfelder+N%22">Rosenfelder N</searchLink>; Neuro-oncology Unit, The Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK.; The Institute of Cancer Research, London SW7 3RP, UK.<br /><searchLink fieldCode="AU" term="%22Solda+F%22">Solda F</searchLink>; Neuro-oncology Unit, The Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK.; The Institute of Cancer Research, London SW7 3RP, UK.<br /><searchLink fieldCode="AU" term="%22Brada+M%22">Brada M</searchLink>; The Institute of Cancer Research, London SW7 3RP, UK.; Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool L69 7BE, UK.
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  Data: Context: We report the long-term survival and the causes of excess mortality in a cohort of pituitary adenoma (PA) patients treated with radiotherapy, with or without prior surgery at up to 50 years of follow-up.<br />Objective: To evaluate long-term survival and causes of excess mortality in patients with PAs treated with radiotherapy, with or without prior surgery, and to examine the relationship between treatment factors, particularly radiotherapy dose and mortality outcomes over extended follow-up.<br />Methods: 426 patients treated with radiotherapy at the Royal Marsden Hospital during 1962 and 1994 with or without prior surgery were followed up via the NHS Central Register to identify deaths and emigrations. Standardized mortality ratios (SMRs) and absolute excess risks (AERs) were calculated by comparing observed deaths with expected rates based on national age, sex, year, and period-specific mortality rates for England and Wales.<br />Results: 260 deaths were recorded compared to 144 expected (SMR 1.8; AER 140.7). The main contributors to excess mortality were cerebrovascular disease (SMR 4.9; AER 61.4), endocrine/metabolic disease (SMR 5.6), and mental and behavioral disorders (SMR 5.0). Both all-cause and cerebrovascular-specific mortality were associated with increasing radiotherapy dose and with the use of surgery.<br />Conclusion: Patients with PAs treated with surgery and radiotherapy have an increased mortality compared to the general population, with the principal contributor cerebrovascular accident mortality. The observed dose-response suggests a potential relationship between radiotherapy and vascular morbidity. The findings highlight the need for long-term surveillance and proactive management of vascular risk factors and in patients requiring radiotherapy and avoiding excessive radiotherapy doses. Whether modern high-precision fractionated radiotherapy techniques reduce the risk of cerebrovascular morbidity and mortality requires long-term studies.<br /> (© The Author(s) 2026. Published by Oxford University Press on behalf of the Endocrine Society.)
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  Data: Front Endocrinol (Lausanne). 2022 Dec 13;13:1064216. (PMID: <searchLink fieldCode="PM" term="%2236578965%22">36578965)</searchLink><br />Int J Radiat Oncol Biol Phys. 1991 Aug;21(3):607-14. (PMID: <searchLink fieldCode="PM" term="%221907958%22">1907958)</searchLink><br />Radiother Oncol. 2009 Dec;93(3):597-601. (PMID: <searchLink fieldCode="PM" term="%2219900729%22">19900729)</searchLink><br />Cancers (Basel). 2017 Aug 08;9(8):. (PMID: <searchLink fieldCode="PM" term="%2228786923%22">28786923)</searchLink><br />Am Fam Physician. 2013 Sep 1;88(5):319-27. (PMID: <searchLink fieldCode="PM" term="%2224010395%22">24010395)</searchLink><br />Pituitary. 2021 Feb;24(1):38-47. (PMID: <searchLink fieldCode="PM" term="%2232949324%22">32949324)</searchLink><br />Endocrinol Metab (Seoul). 2015 Dec;30(4):443-55. (PMID: <searchLink fieldCode="PM" term="%2226790380%22">26790380)</searchLink><br />Lancet. 2016 Aug 20;388(10046):761-75. (PMID: <searchLink fieldCode="PM" term="%2227431356%22">27431356)</searchLink><br />Endocr Rev. 2022 Nov 25;43(6):1003-1037. (PMID: <searchLink fieldCode="PM" term="%2235395078%22">35395078)</searchLink><br />Clin Endocrinol (Oxf). 2002 Dec;57(6):713-7. (PMID: <searchLink fieldCode="PM" term="%2212460319%22">12460319)</searchLink><br />Eur J Endocrinol. 2015 Oct;173(4):M133-57. (PMID: <searchLink fieldCode="PM" term="%2226060052%22">26060052)</searchLink><br />Lancet. 2001 Feb 10;357(9254):425-31. (PMID: <searchLink fieldCode="PM" term="%2211273062%22">11273062)</searchLink><br />Endocrine. 2025 Feb;87(2):782-787. (PMID: <searchLink fieldCode="PM" term="%2239425840%22">39425840)</searchLink><br />Therapie. 1999 May-Jun;54(3):381-5. (PMID: <searchLink fieldCode="PM" term="%2210500455%22">10500455)</searchLink><br />J Neurooncol. 2014 May;117(3):379-94. (PMID: <searchLink fieldCode="PM" term="%2224481996%22">24481996)</searchLink><br />Ther Adv Endocrinol Metab. 2017 Mar;8(3):33-48. (PMID: <searchLink fieldCode="PM" term="%2228377801%22">28377801)</searchLink><br />J Neurooncol. 2015 Sep;124(2):291-7. (PMID: <searchLink fieldCode="PM" term="%2226080799%22">26080799)</searchLink><br />J Clin Endocrinol Metab. 2015 Mar;100(3):1104-12. (PMID: <searchLink fieldCode="PM" term="%2225574793%22">25574793)</searchLink><br />J Clin Endocrinol Metab. 2017 Mar 01;102(3):1051-1058. (PMID: <searchLink fieldCode="PM" term="%2228359095%22">28359095)</searchLink><br />Eur J Endocrinol. 2018 May;178(5):459-469. (PMID: <searchLink fieldCode="PM" term="%2229483205%22">29483205)</searchLink><br />Endocr Rev. 2010 Jun;31(3):301-42. (PMID: <searchLink fieldCode="PM" term="%2220086217%22">20086217)</searchLink><br />J Neurooncol. 2017 Oct;135(1):1-11. (PMID: <searchLink fieldCode="PM" term="%2228660317%22">28660317)</searchLink><br />J Clin Endocrinol Metab. 2005 Feb;90(2):800-4. (PMID: <searchLink fieldCode="PM" term="%2215562021%22">15562021)</searchLink><br />Int J Radiat Oncol Biol Phys. 1999 Oct 1;45(3):693-8. (PMID: <searchLink fieldCode="PM" term="%2210524424%22">10524424)</searchLink><br />J Neurol Neurosurg Psychiatry. 2009 Aug;80(8):910-5. (PMID: <searchLink fieldCode="PM" term="%2218653549%22">18653549)</searchLink><br />J Cancer Surviv. 2024 Feb;18(1):59-67. (PMID: <searchLink fieldCode="PM" term="%2237142871%22">37142871)</searchLink><br />Sci Rep. 2021 Jul 26;11(1):15155. (PMID: <searchLink fieldCode="PM" term="%2234312470%22">34312470)</searchLink><br />Clin Endocrinol (Oxf). 2006 Jul;65(1):51-8. (PMID: <searchLink fieldCode="PM" term="%2216817819%22">16817819)</searchLink><br />Radiat Oncol J. 2016 Jun;34(2):121-7. (PMID: <searchLink fieldCode="PM" term="%2227306775%22">27306775)</searchLink><br />Neurosurg Clin N Am. 2019 Oct;30(4):391-400. (PMID: <searchLink fieldCode="PM" term="%2231471046%22">31471046)</searchLink><br />Lancet. 2005 Nov 5;366(9497):1640-9. (PMID: <searchLink fieldCode="PM" term="%2216271645%22">16271645)</searchLink><br />Clin Endocrinol (Oxf). 1993 Jun;38(6):571-8. (PMID: <searchLink fieldCode="PM" term="%228334743%22">8334743)</searchLink><br />Lancet Diabetes Endocrinol. 2022 Aug;10(8):581-588. (PMID: <searchLink fieldCode="PM" term="%2235780804%22">35780804)</searchLink><br />Clin Endocrinol (Oxf). 2016 Nov;85(5):748-756. (PMID: <searchLink fieldCode="PM" term="%2227327840%22">27327840)</searchLink><br />Int J Radiat Oncol Biol Phys. 2024 Jun 1;119(2):417-430. (PMID: <searchLink fieldCode="PM" term="%2236057476%22">36057476)</searchLink><br />J Clin Endocrinol Metab. 2013 Apr;98(4):1466-75. (PMID: <searchLink fieldCode="PM" term="%2223457412%22">23457412)</searchLink><br />J Clin Endocrinol Metab. 2015 Jul;100(7):2651-8. (PMID: <searchLink fieldCode="PM" term="%2225946030%22">25946030)</searchLink><br />Neurosurgery. 2011 Jul;69(1):72-8; discussion 78-9. (PMID: <searchLink fieldCode="PM" term="%2221346660%22">21346660)</searchLink><br />N Engl J Med. 1999 Jun 10;340(23):1801-11. (PMID: <searchLink fieldCode="PM" term="%2210362825%22">10362825)</searchLink><br />Int J Radiat Oncol Biol Phys. 2000 Jul 15;47(5):1337-45. (PMID: <searchLink fieldCode="PM" term="%2210889388%22">10889388)</searchLink><br />Pituitary. 2017 Apr;20(2):218-224. (PMID: <searchLink fieldCode="PM" term="%2227743172%22">27743172)</searchLink><br />Int J Radiat Oncol Biol Phys. 2008 Jul 15;71(4):994-8. (PMID: <searchLink fieldCode="PM" term="%2218403133%22">18403133)</searchLink>
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