scholarly journals Factors Associated with and Temporal Trends in the Use of Radiation Therapy for the Treatment of Pituitary Adenoma in the National Cancer Database

2019 ◽  
Author(s):  
Ramie Fathy ◽  
Edward Kuan ◽  
John Y. K. Lee ◽  
M Sean Grady ◽  
Michelle Alonso-Basanta ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Pituitary Adenoma ◽  
Retrospective Analysis ◽  
Pituitary Adenomas ◽  
Temporal Trends ◽  
Benign Tumors ◽  
National Cancer Database ◽  
Cancer Program ◽  
To Receive ◽  
Over Time

Abstract 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.

Temporal Trends in the Use of Radiation Therapy for the Treatment of Pituitary Adenoma in the National Cancer Database

2019 ◽  
Author(s):  
Ramie Fathy ◽  
Edward Kuan ◽  
John Lee ◽  
M. Grady ◽  
Michelle Alonso-Basanta ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Pituitary Adenoma ◽  
Temporal Trends ◽  
National Cancer Database

Critical illness in patients with metastatic cancer: a population-based cohort study of epidemiology and outcomes

2021 ◽  
pp. jim-2021-002032
Author(s):  
Lavi Oud
Keyword(s):  
Mechanical Ventilation ◽  
Radiation Therapy ◽  
Metastatic Cancer ◽  
Temporal Trends ◽  
Population Based ◽  
Short Term ◽  
Icu Admission ◽  
Short Term Mortality ◽  
Organ Failures ◽  
Over Time

The appropriateness of intensive care unit (ICU) admission of patients with metastatic cancer remains debated. We aimed to examine the short-term outcomes and their temporal pattern in critically ill patients with metastatic disease. We used state-wide data to identify hospitalizations aged ≥18 years with metastatic cancer admitted to ICU in Texas during 2010–2014. Multivariable logistic regression modeling was used to examine the factors associated with short-term mortality and its temporal trends among all ICU admissions and those undergoing mechanical ventilation. Among 136,644 ICU admissions with metastatic cancer, 50.8% were aged ≥65 years, with one or more organ failures present in 53.3% and mechanical ventilation was used in 11.1%. The crude short-term mortality among all ICU admissions and those mechanically ventilated was 28.1% and 62.0%, respectively. Discharge to home occurred in 57.1% of all ICU admissions. On adjusted analyses, short-term mortality increased with rising number of organ failures (adjusted OR (aOR) 1.399, 95% CI 1.374 to 1.425), while being lower with chemotherapy (aOR 0.467, 95% CI 0.432 to 0.506) and radiation therapy (aOR 0.832, 95% CI 0.749 to 0.924), and decreased over time (aOR 0.934 per year, 95% CI 0.924 to 0.945). Predictors of short-term mortality were largely similar among those undergoing mechanical ventilation. Most ICU admissions with metastatic cancer survived hospitalization, although short-term mortality was very high among those undergoing mechanical ventilation. Short-term mortality decreased over time and was lower among those receiving chemotherapy and radiation therapy. These findings support consideration of critical care in patients with metastatic cancer, but underscore the need to address patient-centered goals of care ahead of ICU admission.

scholarly journals A Rare Case of a Plurihormonal Pituitary Adenoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A565-A565
Author(s):  
Alisha Hossain ◽  
Emily Skutnik ◽  
Arjan Ahluwalia ◽  
Lindor Gelin ◽  
Sonum Singh ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Thyroid Function ◽  
Pituitary Adenomas ◽  
Alpha Subunit ◽  
Histological Evaluation ◽  
Benign Tumors ◽  
Thyroid Function Tests ◽  
Free T4 ◽  
Function Tests ◽  
Suppression Test

Abstract Background: Pituitary adenomas are usually benign tumors that arise from adenophypophyseal cells and produce one or two types of hormones. Plurihormonal adenomas are a rare subtype that produce two or more hormones and represent less than 1% of all pituitary adenomas. Clinical Presentation: A 76-year-old female presented for evaluation of abnormal thyroid function test results. She was found to have an elevated free T4 of 1.92 ng/dL and total T4 of 14.4 ug/dL with an inappropriately normal TSH of 2.11 uIU/mL. Physical examination was significant for tachycardia, tremors, diaphoresis, coarse facial features, and enlarged hands. Further biochemical evaluation of her pituitary hormone levels demonstrated an elevated prolactin (PRL) of 237.2 ng/mL, elevated insulin-like growth factor 1 (IGF-1) of 787 ng/mL, normal morning ACTH of 47 pg/mL, normal morning cortisol of 17.0 ug/dL, an inappropriately suppressed FSH of &lt;5.0 mIU/mL, an elevated alpha subunit of pituitary glycoprotein hormones (PGH) of 6.9 ng/mL, and an elevated free T4 of 3.5 ng/dL by equilibrium dialysis. She underwent an MRI of the pituitary and brain which demonstrated a pituitary adenoma measuring 1.2 x 1.3 x 1.8 cm with a portion herniating into the sella turcica with no mass effect of the optic chiasm. A formal visual field examination was normal. The patient underwent workup for Cushing’s Disease with a low dose overnight dexamethasone suppression test, resulting in an appropriate response with an 8 AM cortisol of &lt;1.0 ug/dL. Glucose suppression test confirmed the diagnosis of acromegaly with growth hormone at 120 minutes of 19.90 ng/mL. Neurosurgery performed a trans-sphenoidal pituitary adenoma resection. Thyroid function tests on post-operative day 4 demonstrated a suppressed TSH of 0.01 uIU/mL and an elevated free T4 of 2.30 ng/dL. Histological evaluation revealed dual expression of transcription factors pituitary-specific positive transcription factor 1 (PIT1) and steroidogenic factor 1 (SF1) as well as PRL, GH, TSH and FSH expression. Immunostaining for LH and ACTH were negative. Post-operative IGF-1 and GH levels were 106 ng/mL and 0.51 ng/mL at 17 weeks, respectively. Post-operative TSH normalized to 0.82 uIU/mL, free T4 normalized to 1.04 ng/dL, and PRL normalized to 8.1 ng/mL at 12 weeks. The patient remained symptom free after successful surgical resection. Discussion: Our case demonstrates the clinical course of a unique patient with clinical and biochemical manifestations of thyroid dysfunction and acromegaly with a pituitary adenoma immunoreactive for GH, TSH, FSH, and PRL. The co-secretion of GH, TSH, PRL, and FSH as well as positivity for the alpha-subunit is extremely unusual. This case emphasizes the importance of considering pituitary abnormalities as a cause for abnormal thyroid function tests.

Association of cancer center type with treatment patterns and overall survival for patients with sacral and spinal chordomas: an analysis of the National Cancer Database from 2004 to 2015

2020 ◽  
Vol 32 (2) ◽  
pp. 311-320
Author(s):  
Christina Huang Wright ◽  
James Wright ◽  
Gino Cioffi ◽  
Alia Hdeib ◽  
Manish K. Kasliwal ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Clinical Care ◽  
Cancer Center ◽  
Primary Study ◽  
National Cancer Database ◽  
Risk Of Death ◽  
Increased Risk ◽  
Facility Type ◽  
To Receive

OBJECTIVEChordomas of the spine and sacrum are a rare but debilitating cancer and require complex multidisciplinary care. Studies of other such rare cancers have demonstrated an association of high-volume and/or multidisciplinary centers with improved outcomes and survival. Such an association has been proposed for chordomas, but evidence to support this claim is lacking. The authors performed a study to investigate if treatment facility type is associated with patterns of care and survival for patients with spinal and sacral chordomas by assessing records from a US-based cancer database.METHODSIn this observational retrospective cohort study, the authors identified 1266 patients from the National Cancer Database with vertebral column or sacral chordomas diagnosed between 2004 and 2015. The primary study outcome was overall survival, and secondary outcomes included odds of receiving treatment and time to treatment, defined as radiation therapy, surgery, and/or any treatment, including surgery, radiation therapy, chemotherapy, or participation in clinical trials. The results were adjusted for age, sex, race/ethnicity, level of education, income, and Charlson/Deyo score.RESULTSOf the 1266 patients identified, the mean age at diagnosis was 59.70 years (SD 16.2 years), and the patients were predominantly male (n = 791 [62.50%]). Patients treated at community cancer programs demonstrated an increased risk of death (HR 1.98, 95% CI 1.13–3.47, p = 0.018) when compared to patients treated at academic/research programs (ARPs). The median survival was longest for those treated at ARPs (131.45 months) compared to community cancer programs (79.34 months, 95% CI 48.99–123.17) and comprehensive community cancer programs (CCCPs) (109.34 months, 95% CI 84.76–131.45); 5-year survival rates were 76.08%, 52.71%, and 61.57%, respectively. Patients treated at community cancer programs and CCCPs were less likely to receive any treatment compared to those treated at ARPs (OR 6.05, 95% CI 2.62–13.95, p < 0.0001; OR 3.74, 95% CI 2.23–6.28, p < 0.0001, respectively). Patients treated at CCCPs and community cancer programs were less likely to receive surgery than those treated at ARPs (OR 2.69, 95% CI 1.82–3.97, p = 0.010; OR = 2.64, 95% CI 1.22–5.71, p = 0.014, respectively). Patients were more likely to receive any treatment (OR 0.59, 95% CI 0.40–0.87, p = 0.007) and surgery (OR 0.58, 95% CI 0.38–0.88, p < 0.0001) within 30 days at a CCCP compared to an ARP. There were no differences in odds of receiving radiation therapy or time to radiation by facility type.CONCLUSIONSClinical care at an ARP is associated with increased odds of receiving treatment that is associated with improved overall survival for patients with spinal and sacral chordomas, suggesting that ARPs provide the most comprehensive specialized care for patients with this rare and devastating oncological disease.

scholarly journals Post-Surgical Hormonal Complications in Pituitary Adenomas

2018 ◽  
Vol 27 (2) ◽  
pp. 105-110
Author(s):  
Leticia Marissol De Souza Francisco ◽  
Maick Willen Fernandes Neves ◽  
Telmo Augusto Barba Belsuzari ◽  
Paulo Henrique Pires De Aguiar ◽  
João Flavio De Araújo Mattos
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Diabetes Insipidus ◽  
Postoperative Period ◽  
Pituitary Adenomas ◽  
Surgical Complication ◽  
Hormone Deficiency ◽  
Benign Tumors ◽  
First Choice ◽  
Surgical Manipulation

Introduction: Pituitary adenomas are benign tumors that are classified into functioning and nonfunctioning adenomas. The diagnosis is based on the clinical picture and MRI. The first-choice treatment is usually surgery. Objective: We aimed to evaluate the hormonal complications in the postoperative period of pituitary adenomas resection. Methods: Using the databases PubMed, MedLine, and Scielo, the terms “pituitary adenoma” and “postoperative” were investigated and 11 publications were selected, written in English and Portuguese between 2007 and 2016 to evaluate hormonal complications in the postoperative period of pituitary adenomas resection. Results: Nonfunctioning tumors were more frequent and occurred along with hypopituitarism, mainly affecting the gonadotrophic axis. Among the functional adenomas, prolactinomas were more common. The rate of postoperative hypopituitarism varied from 1.29% to 21.2% and the diabetes insipidus rate was from 5.1% to 15.7%. Hypopituitarism or panhypopituitarism, adrenal insufficiency, growth hormone deficiency and diabetes insipidus occurred in the postoperative period. Conclusion: Nonfunctioning adenomas are more common and present hypopituitarism. Prolactinomas and somatotrophinomas are the most frequent tumors among functioning adenomas; hypopituitarism is a frequent complication due to the compression and destruction of the pituitary gland, which may be the result of the surgical manipulation itself. Diabetes insipidus is another common surgical complication.

Utilization of accelerated partial-breast irradiation (APBI) and guideline concordance: Analysis of the National Cancer Database.

2013 ◽  
Vol 31 (26_suppl) ◽  
pp. 54-54
Author(s):  
Simona Flora Shaitelman ◽  
Heather Lin ◽  
Yu Shen ◽  
Isabelle Bedrosian ◽  
Elizabeth S. Bloom ◽  
...  
Keyword(s):  
Consensus Statement ◽  
Ductal Carcinoma ◽  
Breast Conserving Surgery ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Breast Irradiation ◽  
National Cancer Database ◽  
Breast Irradiation ◽  
Cancer Program ◽  
Negative Tumor ◽  
To Receive

54 Background: ASTRO published a consensus statement on patient suitability for APBI treatment to guide physician practice. The purpose of this study was to examine utilization trends of APBI in the American College of Surgeons’ National Cancer Database and to assess changes in APBI use following publication of the ASTRO guidelines in 2009. Methods: A total of 337,910 women were identified who were diagnosed from 2004 to 2010 with non-metastatic invasive breast cancer or ductal carcinoma in situ who were treated with breast conserving surgery and radiation therapy (RT) to the breast. Patients were divided by the type of treatment received (whole breast irradiation (WBI) or APBI) and by suitability to receive APBI as defined by the ASTRO Consensus Statement. Logistic regression was applied to study APBI use overall and within consensus statement categorization. All p-values are two-sided. Results: For all patients, APBI usage increased as an alternative to WBI over time, from 3.8% in 2004 to 10.8% in 2008, with a subsequent decline to 9.9% in 2010, due to a decline in APBI use for “cautionary”/“unsuitable” patients (p<0.0001). Overall rates of APBI utilization were higher among “suitable” than “cautionary”/“unsuitable” patients (range 6.9% to 16.9% vs. 3.1% to 7.8%, p<0.0001). Among all patients, the most common modality of delivering APBI was brachytherapy (82%), followed by external beam RT (17%) and intraoperative RT (1.0%). For both “suitable” and “cautionary”/“unsuitable” patients, factors associated with treatment with APBI included treatment after 2004 (p<0.0001), well differentiated histology (p<.0001), and smaller tumor size (p<0.0001). For “cautionary”/“unsuitable” patients, those with grossly negative tumor margins were more likely to receive APBI, as were “suitable” patients treated at an academic or comprehensive community cancer program compared to a community cancer program (both p<0.0001). Conclusions: The highest absolute rate of use of APBI was seen in the group considered “suitable” by ASTRO guidelines. Although significant increases have also been seen among less suitable cohorts, these rates have declined since the publication of the ASTRO guidelines in 2009.

Receipt of inguinal lymph node dissection in patients with T2 penile cancer: Results from the National Cancer Database.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 383-383 ◽  
Author(s):  
Mohammed Haseebuddin ◽  
Elizabeth Handorf ◽  
Nikhil Waingankar ◽  
Yu-Ning Wong ◽  
Rosalia Viterbo ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Dissection ◽  
Penile Cancer ◽  
Inguinal Lymph Node ◽  
Temporal Trends ◽  
National Cancer Database ◽  
Node Dissection ◽  
Inguinal Lymph Node Dissection ◽  
Morbidity Score ◽  
To Receive

383 Background: Per the NCCN guidelines, inguinal lymph node dissection (ILND) is recommended for patients with intermediate (T1b) or high (Any T2 or Grade 3) risk disease even in the absence of palpable inguinal nodes. Our objective was to assess temporal trends in utilization of ILND and to determine factors associated with the receipt of ILND using National Cancer Database (NCDB). Methods: The NCDB was queried for all patients diagnosed with T2 penile cancer from 1998-2011. Temporal trends for receipt of ILND were assessed. Adjusting for patient, demographic, and clinicopathologic characteristics, multivariable logistic regression models were used to examine the association between available covariates and receipt of ILND. Results: Of 2019 patients identified over the study period, 693 (34.3%) underwent ILND. Rates of ILND did not significantly improve from 1998 to 2011 (34.2 to 40.0%; p = 0.09). Significant differences were observed in patients undergoing ILND with respect to age (p<0.001), Hispanic ethnicity (p=0.04), insurance status (p<0.001), and facility type (p<0.001), while no changes were seen with respect to race, income, education, urban/rural location, tumor grade, or Charlson co-morbidity score. Following adjustment, patients with high grade disease (OR 1.35 [CI 1.1-1.7]) and those treated at academic centers (OR 3.2 [CI 2.2-4.7]) were more likely to receive ILND, while patients >70 years of age (OR 0.41 [CI 0.28-0.60]) were less likely to receive ILND. Conclusions: In the NCDB, less then 35% of patients with T2 penile cancer receive ILND and the rates have not significantly changed over the last decade. Referral of patients with this uncommon, highly morbid lethal disease to experienced centers may increase adherence to guideline recommended care.

Pituitary Microadenoma Treated with Individualized Homeopathic Medicine: A Case Report

Homeopathy ◽  
2020 ◽  
Vol 109 (04) ◽  
pp. 243-247
Author(s):  
Mohit Mathur
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Tumor Regression ◽  
World Health ◽  
Benign Tumors ◽  
Hemorrhagic Complication ◽  
Repeat Magnetic Resonance Imaging ◽  
Homeopathic Medicine ◽  
Increased Risk

Abstract Background Pituitary adenomas are common benign tumors of the pituitary gland with an overall estimated prevalence of 16.7%. As per the revised World Health Organization (WHO) classification, these tumors are identified by their histological subtypes and are designated by their pituitary cell lineage instead of the hormone they produce. The lactotroph adenoma is the most common subtype of hormone-producing pituitary adenoma. Surgery is the mainstay of treatment, but complications are encountered. So far, there is no reported study evaluating individualized homeopathic intervention in pituitary adenoma in peer-reviewed journals. Methods This case study describes a case of functional lactotroph microadenoma with history of failed surgical treatment and heavy intrasellar hemorrhage occurring during the surgery. Phosphorus was prescribed as an individualized homeopathic medicine on the basis of symptoms—hemorrhagic complication during surgical procedure and aggravation of headache thereafter. Results There was a marked subjective improvement along with complete tumor regression, as evidenced by repeat magnetic resonance imaging scans. The Modified Naranjo Criteria total score was +10 out of a possible +13, providing some evidence to attribute the clinical outcome with the homeopathic intervention. Conclusion This case study reconfirms the association between increased frequency of headaches and pituitary hemorrhage among cases of lactotroph adenoma. It also suggests that individualized homeopathic treatment may be helpful in pituitary adenomas with increased risk of complications such as intrasellar hemorrhage.

Effects of adjuvant radiation therapy on survival for patients with resected primary tracheal carcinoma: an analysis of the National Cancer Database

2019 ◽  
Vol 49 (7) ◽  
pp. 628-638 ◽  
Author(s):  
Mehran Yusuf ◽  
Jeremy Gaskins ◽  
Emma Trawick ◽  
Paul Tennant ◽  
Jeffrey Bumpous ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Cox Regression ◽  
Surgical Margin ◽  
Surgical Margins ◽  
Adjuvant Radiation ◽  
National Cancer Database ◽  
Adjuvant Radiation Therapy ◽  
Immortal Time Bias ◽  
The Impact ◽  
To Receive

Abstract Objective(s) To identify predictors for receiving adjuvant radiation therapy (RT) and investigate the impact of adjuvant RT on survival for patients with resected primary tracheal carcinoma (PTC). Methods The National Cancer database was queried for patients with PTC diagnosed from 2004 to 2014 undergoing resection. Patients who died within 30 days of resection were excluded to minimize immortal time bias. Kaplan–Meier methods, Cox regression modeling and propensity score weighted (PSW) log-rank tests were considered to assess the relationship between adjuvant RT and overall survival (OS). Logistic regression was performed to identify predictors associated with receiving adjuvant RT. Results A total of 549 patients were identified with 300 patients (55%) receiving adjuvant RT. Squamous cell carcinoma (SCC) was the most common histology with 234 patients (43%). Adenoid cystic carcinoma (ACC) was second most frequent with 180 patients (33%). Adjuvant RT was not associated with OS by multivariable Cox analysis or PSW log-rank test (P values > 0.05). Patients with positive surgical margins (odds ratio (OR) 1.80, confidence interval (CI) 1.06–3.07) were more likely to receive adjuvant RT than those with negative surgical margins. Patients with ACC (OR 6.53, CI 3.57–11.95) were more likely to receive adjuvant RT compared with SCC. Conclusions Adjuvant RT was not significantly associated with OS for patients with resected PTC in this analysis. Surgical margin status and tumor histology were associated with receiving adjuvant RT. Further investigations including prospective registry studies capturing radiation technique and treatment volumes are needed to better define which patients with resected PTC may benefit from adjuvant RT.

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