Factors Associated with and Temporal Trends in the Use of Radiation Therapy for the Treatment of Pituitary Adenoma in the National Cancer Database
29 March 2019
28 July 2019
04 October 2019 (online)
Purpose Radiation therapy represents an uncommon but important component of treatment plans for some pituitary adenomas (PAs). Although radiation therapy has been used to treat pituitary adenomas for over a century, general trends in the usage of radiation therapy for this purpose have not been reviewed. Additionally, there are few large studies evaluating how radiation therapy is used for the treatment of these benign tumors. Investigating these trends and identifying any variations in radiation therapy utilization would help to better inform treatment decisions and improve patient outcomes.
Design Present study is a retrospective analysis of cases using the National Cancer Database.
Setting The research was organized at a tertiary academic medical center.
Participants Patients were diagnosed with pituitary adenoma between 2004 and 2014 within the National Cancer Database (NCDB).
Methods Temporal trends in the usage of radiation therapy to treat pituitary adenoma were analyzed through a retrospective analysis of 77,142 pituitary adenoma cases from the NCDB between 2004 and 2014. Univariate and multivariate analyses were to examine the relationship between patient, tumor, and treatment factors, and the incorporation of radiation therapy into the treatment of pituitary adenomas. We adjusted for potential confounders such as age, sex, race, comorbidity score, facility type, and year of diagnosis.
Results A total of 77,142 patients met inclusion criteria. Inclusion of radiation therapy in pituitary adenoma treatment was 8.0% in 2004 and steadily declined to a low of 3.1% in 2014. Overall, patients were less likely to receive radiation for their pituitary adenoma over time (p < 0.001). Similarly, patients were found to be less likely to receive any type of treatment for PA over time (p < 0.001). Multivariable evaluation found patients who were female, between 54 and 64 years of age, or treated at either a Comprehensive Community Cancer Program or an Integrated Network Cancer Program were more likely to receive radiation as part of their pituitary adenoma treatment (p < 0.001, odds ratio [OR] = 2.01, confidence interval [CI]: 1.54–2.63; p < 0.001, OR = 1.84, CI: 1.38–2.44, respectively). Patients were less likely to receive radiation for their PA if they were African American (p < 0.001, OR = 0.81, CI: 0.72–0.91). Logistic regression also identified a progressive increase in the likelihood of receiving radiation after a PA diagnosis with increasing tumor size starting with microscopic tumors, peaking at 4 to 5 cm (p < 0.001; OR = 15.57; CI: 12.20–19.87).
Conclusion In this sample of pituitary adenoma patients treated at NCDB institutions between 2004 and 2014, we found a steady decline in the incorporation of radiation therapy in treatment, as well as in the use of any type of intervention for PA treatment, suggesting a rise in noninterventional observation of PA.
- 1 Laws Jr. ER, Ebersold MJ, Piepgras DG, Randall RV, Salassa RM. The results of transsphenoidal surgery in specific clinical entities. In: Management of Pituitary Adenomas and Related Lesions with Emphasis on Transsphenoidal Microsurgery. New York, NY: Appleton-Century-Crofts Inc.; 1982: 277-305
- 2 Laws Jr. ER, Vance ML. Radiosurgery for pituitary tumors and craniopharyngiomas. Neurosurg Clin N Am 1999; 10 (02) 327-336
- 3 Sheehan JP, Xu Z, Lobo MJ. External beam radiation therapy and stereotactic radiosurgery for pituitary adenomas. Neurosurg Clin N Am 2012; 23 (04) 571-586
- 4 Loeffler JS, Shih HA. Radiation therapy in the management of pituitary adenomas. J Clin Endocrinol Metab 2011; 96 (07) 1992-2003
- 5 Nilsson B, Gustavasson-Kadaka E, Bengtsson BA, Jonsson B. Pituitary adenomas in Sweden between 1958 and 1991: incidence, survival, and mortality. J Clin Endocrinol Metab 2000; 85 (04) 1420-1425
- 6 Shibui S. [The present status and trend of brain tumors based on the data of the Brain Tumor Registry of Japan]. Brain Nerve 2012; 64 (03) 286-290
- 7 Dolecek TA, Propp JM, Stroup NE, Kruchko C. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2005-2009. Neuro-oncol 2012; 14 (Suppl. 05) v1-v49
- 8 Aflorei ED, Korbonits M. Epidemiology and etiopathogenesis of pituitary adenomas. J Neurooncol 2014; 117 (03) 379-394
- 9 Davis FG, Kupelian V, Freels S, McCarthy B, Surawicz T. Prevalence estimates for primary brain tumors in the United States by behavior and major histology groups. Neuro-oncol 2001; 3 (03) 152-158
- 10 Ezzat S, Asa SL, Couldwell WT. , et al. The prevalence of pituitary adenomas: a systematic review. Cancer 2004; 101 (03) 613-619
- 11 Fernández-Balsells MM, Murad MH, Barwise A. , et al. Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis. J Clin Endocrinol Metab 2011; 96 (04) 905-912
- 12 Nammour GM, Ybarra J, Naheedy MH, Romeo JH, Aron DC. Incidental pituitary macroadenoma: a population-based study. Am J Med Sci 1997; 314 (05) 287-291
- 13 Yue NC, Longstreth Jr. WT, Elster AD, Jungreis CA, O'Leary DH, Poirier VC. Clinically serious abnormalities found incidentally at MR imaging of the brain: data from the Cardiovascular Health Study. Radiology 1997; 202 (01) 41-46
- 14 Hartwigsen G, Siebner HR, Deuschl G, Jansen O, Ulmer S. Incidental findings are frequent in young healthy individuals undergoing magnetic resonance imaging in brain research imaging studies: a prospective single-center study. J Comput Assist Tomogr 2010; 34 (04) 596-600
- 15 Vernooij MW, Ikram MA, Tanghe HL. , et al. Incidental findings on brain MRI in the general population. N Engl J Med 2007; 357 (18) 1821-1828
- 16 Ryu WH, Tam S, Rotenberg B. , et al. Conservative management of pituitary macroadenoma contacting the optic apparatus. Can J Neurol Sci 2010; 37 (06) 837-842
- 17 Iglesias P, Arcano K, Triviño V. , et al. Prevalence, clinical features, and natural history of incidental clinically non-functioning pituitary adenomas. Horm Metab Res 2017; 49 (09) 654-659
- 18 Powell JS, Wardlaw SL, Post KD, Freda PU. Outcome of radiotherapy for acromegaly using normalization of insulin-like growth factor I to define cure. J Clin Endocrinol Metab 2000; 85 (05) 2068-2071
- 19 Mitsumori M, Shrieve DC, Alexander III E. , et al. Initial clinical results of LINAC-based stereotactic radiosurgery and stereotactic radiotherapy for pituitary adenomas. Int J Radiat Oncol Biol Phys 1998; 42 (03) 573-580
- 20 Landolt AM, Haller D, Lomax N. , et al. Stereotactic radiosurgery for recurrent surgically treated acromegaly: comparison with fractionated radiotherapy. J Neurosurg 1998; 88 (06) 1002-1008
- 21 Brada M, Rajan B, Traish D. , et al. The long-term efficacy of conservative surgery and radiotherapy in the control of pituitary adenomas. Clin Endocrinol (Oxf) 1993; 38 (06) 571-578
- 22 Erridge SC, Conkey DS, Stockton D. , et al. Radiotherapy for pituitary adenomas: long-term efficacy and toxicity. Radiother Oncol 2009; 93 (03) 597-601
- 23 Tishler RB, Loeffler JS, Lunsford LD. , et al. Tolerance of cranial nerves of the cavernous sinus to radiosurgery. Int J Radiat Oncol Biol Phys 1993; 27 (02) 215-221
- 24 Mayo C, Martel MK, Marks LB, Flickinger J, Nam J, Kirkpatrick J. Radiation dose-volume effects of optic nerves and chiasm. Int J Radiat Oncol Biol Phys 2010; 76 (3, Suppl): S28-S35
- 25 Pollock BE, Cochran J, Natt N. , et al. Gamma knife radiosurgery for patients with nonfunctioning pituitary adenomas: results from a 15-year experience. Int J Radiat Oncol Biol Phys 2008; 70 (05) 1325-1329
- 26 Sheehan JP, Starke RM, Mathieu D. , et al. Gamma Knife radiosurgery for the management of nonfunctioning pituitary adenomas: a multicenter study. J Neurosurg 2013; 119 (02) 446-456
- 27 Park HS, Decker RH. Disparities in radiation therapy delivery: current evidence and future directions in head and neck cancer. Cancers Head Neck 2016; 1 (01) 5
- 28 Vinod SK, Simonella L, Goldsbury D, Delaney GP, Armstrong B, O'Connell DL. Underutilization of radiotherapy for lung cancer in New South Wales, Australia. Cancer 2010; 116 (03) 686-694
- 29 Goulart BHL, Reyes CM, Fedorenko CR. , et al. Referral and treatment patterns among patients with stages III and IV non-small-cell lung cancer. J Oncol Pract 2013; 9 (01) 42-50
- 30 Freeman HP, Chu KC. Determinants of cancer disparities: barriers to cancer screening, diagnosis, and treatment. Surg Oncol Clin N Am 2005; 14 (04) 655-669 , v
- 31 Gerend MA, Pai M. Social determinants of Black-White disparities in breast cancer mortality: a review. Cancer Epidemiol Biomarkers Prev 2008; 17 (11) 2913-2924
- 32 McClelland S, Deville C, Thomas CJr, Jaboin JJ. An overview of disparities research in access to radiation oncology care. J Radiat Oncol 2016; 5 (04) 437-444
- 33 Rieken S, Habermehl D, Welzel T. , et al. Long term toxicity and prognostic factors of radiation therapy for secreting and non-secreting pituitary adenomas. Radiat Oncol 2013; 8 (01) 18
- 34 Solda F, Fersht T. Radiotherapy for pituitary tumours. In: De Groot LJ, Chrousos G, Dungan K. , et al. Endotext [Internet]. South Dartmouth, MA: 2000