Assessing Quality of Life among Radiation-Induced Hypopituitarism Patients

Introduction: Radiotherapy is a mainstay of definitive or adjuvant treatment for anterior skull base tumors. Among these patients who undergo skull base radiation, an estimated 37% go on to develop radiation-induced hypopituitarism. It has previously been shown that radiotherapy in general is a negative prognostic factor for quality of life (QoL) among skull base patients; however, to our knowledge, QoL has not yet been analyzed for the radiation-induced hypopituitarism population. The Anterior Skull Base Questionnaire (ASBQ; developed by Z. Gil) is a multidimensional quality of life assessment instrument with 35 questions (each on a 5-point Likert scale) that has been validated to estimate patients’ QoL after removal of anterior skull base tumors. This study aims to determine if there is a difference in QoL (measured by ASBQ) between radiated patients who developed hypopituitarism compared with radiated patients who did not develop hypopituitarism.

Methods: Patients prospectively enrolled in a skull base registry between the years 2011 and 2020 at a tertiary academic center were considered for review. Included patients had a history of anterior skull base tumor, underwent at least one round of external beam radiation to the primary site in the skull base, and had filled out at least one ASBQ survey after their radiation treatment. Excluded patients included those with pituitary adenomas. Hypopituitarism status was determined via routine pituitary screening laboratory values using manual chart review and Data Direct software.

Results: A total of 109 patients met inclusion criteria. 29.4% (32/109) had evidence of radiation-induced hypopituitarism at some point after their radiation treatment. ASBQ responses were summed per survey, with a range of possible values of 35 to 175; higher scores indicate better quality of life. For all ASBQ surveys completed and analyzed (n = 153), the average score for the non-hypopituitarism group was 115.9 (SD: 22.64) and for the hypopituitarism group 111.0 (SD: 21.94). This difference was not significant (p = 0.2087, 95% CI: −2.77 to 12.58) using an unpaired t-test with significance level set at 0.05. ASBQ surveys were then divided into three groups, depending on how far out the patient was from the completion of their radiation treatment (0–2 years, 2–5 years, 5+ years) at the time of filling out the survey. Results comparing the non-hypopituitary with hypopituitary patients per time group are shown in [Fig. 1].

Conclusion: This preliminary data demonstrates that while there is no significant difference overall, the patients who developed hypopituitarism on average were more likely to have lower QoL scores compared with the time-matched non-hypopituitarism patients for the 5+ years out from radiation group. This could reflect the phenomenon that the prevalence of radiation-induced hypopituitarism seems to increase with time out from radiation. Due to the limited ASBQ longitudinal data available per patient, we are presenting pooled averages that do not reflect an individual's trend over time. We plan to further characterize the QoL trend among radiation-induced hypopituitarism patients by analyzing the effect of hormone replacement status on QoL.

 

MissingLinkText

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
15 February 2022