Hypofyse-uitval na hoofd-halsbestraling

Objective

To systematically evaluate the reported prevalence of hypopituitarism following radiotherapy of the head and neck for cerebral or nasopharyngeal tumours, and following total body radiation.

Design

Systematic review and meta-analysis

Methods

PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for articles about the prevalence of hypopituitarism in adults following cranial radiotherapy. The reference lists of key articles were searched to identify other relevant studies. A meta-analysis was performed with the aid of the exact likelihood approach using a logistic regression with a random effects model at study level.

Results

18 studies were included, with a total of 873 patients. These included 608 patients treated for nasopharyngeal cancer and 265 for one or more cerebral tumours. The total radiation dose ranged from 14-83 Gy and 40–97 Gy for nasopharyngeal and cerebral tumours, respectively. The prevalence of any degree of hypopituitarism was 0.66 (95% CI: 0.48-0.76). The prevalence of growth hormone deficiency was 0.45 (95% CI: 0.27-0.55), of LH- FSH deficiency 0.3 (95% CI: 0.16-0.29), of TSH deficiency 0.25 (95% CI: 0.13-0.35), and of ACTH deficiency 0.22 (95% CI: 0.13-0.29), respectively. The prevalence of hyperprolactinaemia was 0.34 (95% CI: 0.11-0.38). There were no differences between the effects of radiotherapy between the two tumour groups. There was no difference in prevalence between studies with greater or lesser risk of bias.

Conclusion

Hypopituitarism is highly prevalent in adult patients following cranial radiotherapy for nasopharyngeal carcinoma and cerebral tumours. Therefore, all patients treated with cranial radiotherapy should have a long-term structured follow-up with regular assessment of pituitary function.

Conflict of interest: A.M. Pereira has received remuneration for consultation for Pfizer B.V. and for lectures for Novartis en Ipsen B.V. Financial support: none declared.