Excess mortality in radiotherapy-treated pituitary adenoma patients: 50-year follow-up.
4 affiliations
- 1UCD School of Medicine, University College Dublin, Dublin D04 W6W8, Ireland.
- 2Neuro-oncology Unit, The Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK.
- 3The Institute of Cancer Research, London SW7 3RP, UK.
- 4Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool L69 7BE, UK.
Abstract
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.
Related
- Resistance to Thyroid Hormone Beta or Thyroid-Stimulating Hormone (TSH)-Secreting Pituitary Adenoma: A Diagnostic Dilemma With a THRB Variant of Uncertain Significance
- Predictive Factors for Diabetes Insipidus and Syndrome of Inappropriate Secretion of Antidiuretic Hormone After Transsphenoidal Surgery for Pituitary Adenoma
- Acute visual deterioration following endoscopic transsphenoidal resection of a pituitary adenoma secondary to a de novo cyst of normal pituitary origin: illustrative case
- Tumor-to-tumor metastasis of colorectal adenocarcinoma within a gonadotroph pituitary adenoma.
- Tirzepatide for pasireotide-induced hyperglycemia in a GH/TSH-producing pituitary adenoma/PitNET: a case report and literature review
BibTeX
@article{fitzgerald2026excess,
title = {{Excess mortality in radiotherapy-treated pituitary adenoma patients: 50-year follow-up.}},
author = {Anna Fitzgerald and James de Boisanger and Rosie Cooke and Daphne Traish and Anthony Swerdlow and Nicola Rosenfelder and Francesca Solda and Michael Brada},
journal = {Journal of the Endocrine Society},
year = {2026},
month = may,
doi = {10.1210/jendso/bvag115},
url = {https://europepmc.org/article/MED/42851721},
note = {CC BY},
}
RIS
TY - JOUR
TI - Excess mortality in radiotherapy-treated pituitary adenoma patients: 50-year follow-up.
AU - Anna Fitzgerald
AU - James de Boisanger
AU - Rosie Cooke
AU - Daphne Traish
AU - Anthony Swerdlow
AU - Nicola Rosenfelder
AU - Francesca Solda
AU - Michael Brada
PY - 2026
DA - 2026/05/14
JO - Journal of the Endocrine Society
DO - 10.1210/jendso/bvag115
UR - https://europepmc.org/article/MED/42851721
AB - 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.
SN - 2472-1972
ER -