Abstract
BackgroundCranial irradiation represents one of the first line treatment proposed in skull base meningiomas. While cranial irradiation is associated with a high risk of secondary hypopituitarism, few studies focused on the specific location of skull base meningiomas.MethodsFifty-two adults receiving photon-beam therapy for skull base meningiomas between 2003 and 2014 in our Institution were included. Anterior pituitary (ACTH, FSH, GH, LH, TSH and prolactin) as well as corresponding peripheral hormones (8 am-Cortisol, IGF-1, fT3, fT4, 17βestradiol or testosterone) were biologically screened before radiotherapy (baseline), then yearly until March 2019. The pituitary gland (PG) was delineated on CT and the mean dose delivered to it was calculated.ResultsMean age at diagnosis was 56 +/− 14 years. Median follow-up was 7 years. Up to 60% of patients developed at least ≥2 pituitary deficiencies, 10 years after radiotherapy. Gonadotroph, thyrotroph, corticotroph and somatotroph deficiencies occurred in 37, 28, 18 and 15% of patients, respectively. Hyperprolactinemia was found in 13% of patients. None patient had only one pituitary deficiency. In the multivariate analysis, a delivered dose to the PG ≥ 50 Gy or a meningioma size ≥40 mm significantly increased the risk of developing hypopituitarism.ConclusionsOver a long-term follow-up, cranial radiation therapy used in skull base meningiomas led to a high prevalence of hypopituitarism, further pronounced in case of tumor ≥4 cm. These results advocate for an annual and prolonged follow-up of the pituitary functions in patients with irradiated skull base meningiomas.
Highlights
Cranial irradiation represents one of the first line treatment proposed in skull base meningiomas
We retrospectively reviewed the records of patients treated between 2003 and 2014 in our institution (Institut de Cancérologie de Lorraine) for skull base meningiomas, anterior or medial localization, by cerebral radiation therapy involving the pituitary gland within the radiation field
Endocrinology Before the first cranial irradiation session, patients underwent an initial hormonal analysis, which was not necessarily performed in our center. This hormonal check-up was considered as the baseline and comprised anterior pituitary hormones (ACTH, Follicle-Stimulating Hor‐ mone (FSH), Growth Hormone (GH), Luteinizing Hormone (LH), Thyroid Stimulating Hormone (TSH) and prolactin) as well as corresponding peripheral hormones (8 am-Cortisol, IGF-1, Free Tri-iodothyronine (fT3), Free Thyroxine (fT4), 17bestradiol or testosterone)
Summary
Cranial irradiation represents one of the first line treatment proposed in skull base meningiomas. While cranial irradiation is associated with a high risk of secondary hypopituitarism, few studies focused on the specific loca‐ tion of skull base meningiomas. Meningiomas are the most common benign intracranial tumors, with an incidence of 8.3 per 100.000 population between 2003 and 2014, representing 36.6% of primary cerebral tumors [1]. Raymond et al BMC Cancer (2021) 21:1346 deficiency [8, 9], and at-risk patients require a regular follow-up to both diagnose and treat the outcome of hormonal deficiency (ies).In our study, our aim was to retrospectively assess the rates of anterior pituitary deficiencies in a population of patients treated by cranial radiation therapy for a skull base meningioma
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