ESTRO 2024 - Abstract Book

S881

Clinical - CNS

ESTRO 2024

treatment modalities and information on quality of life aspects were not an inclusion criterium for this review, but when available, this information was taken into account for analysis.

To rate the quality of the included papers, a risk of bias assessment, based on the Newcastle-Ottawa-Scale (NOS) for cohort studies, was performed. A maximum of 8 points was allocated if a study met all quality criteria.

Clinical and treatment variables like number of patients, age, tumor characteristics, follow-up time, radiation dose information and additional treatment modalities like surgery and/or chemotherapy were extracted. Prevalence per hormonal insufficiency was calculated using a random effects meta-regression with a random effect at the study level.

Results:

Results: The literature selection process resulted in a final total of 23 original papers suitable for full assessment (n = 1,442 patients). The identification and inclusion process is displayed in figure 1. In the risk of bias assessment, 2 papers were rated with 8 points, 6 papers with 7 points, 7 papers with 6 points, 3 papers with 5 points, 2 papers with 4 points and 3 papers with 3 points. Literature shows a wide variety in HPA insufficiency related to pituitary radiation dose and follow-up time, ranging from 22% at a median follow-up time of 76.8 months (19.2-133.2 months) and a mean pituitary dose of 29.9 Gy to 93.3% at a mean follow-up time of 24.4 months (9.8-133 months) at a mean pituitary dose of 46.2 Gy . The calculated prevalence for any insufficiency was 63%. Growth hormone has the highest prevalence for insufficiency(46%), followed by prolactin and gonadotrophic hormone (both 22%), adrenocorticotrophic hormone (18%) and thyroid stimulating hormone (17%). The prevalence for insufficiency on 2 axes was 22%, followed by insufficiency on 4 or more axes (17%), 1 axis (15%) and 3 axes (5%). The calculated prevalence is displayed in figure 2. There was considerable heterogeneity left in the meta-analysis estimates. Patients, irradiated for nasopharyngeal carcinoma seem to be most at risk for developing HPA insufficiency. Besides endocrine insufficiency, these patient groups show a higher prevalence on anxiety and distress, sleeping disorders and cognitive decline.