Introduction
Methods
Search strategy and paper selection
Data extraction
Quality assessment
Data analysis
Results
Authors | Publication year | Journal | Country | Study years | Type of radiotherapy (number of patients treated) | N of pts with Radiation | Median age (range) | % of male pts | N of pts with surgery prior to radiation (%) | Median Follow-up, months (range) | Adjusted NOS Score |
---|---|---|---|---|---|---|---|---|---|---|---|
Bir et al. [17] | 2015 | Journal of neurological surgery | United States | 2000–2013 | Gamma Knife Radiosurgery (53) | 53 | 56 (18–83) | 56.1 | 53 (100) | 45.57 (12–157) | 4/6 |
Diallo et al. [18] | 2015 | Endocrine | France | 1991–2011 | Fractionated stereotactic radiotherapy linac (34) | 34 | Mean 45 (5–65) | 52.9 | 30 (88.2) | Mean 152 (39–268) | 6/6 |
Elborsson et al. [19] | 2010 | Growth Hormone & IGF Research | Sweden | 1987–2006 | Two- or three-field technique radiotherapy | 36 | Mean 53 | 83.3 | 36 (100) | 120 | 9/9 |
Flickinger et al. [20] | 1989 | Pituitary irradiation and stroke | United States | 1964–1987 | Cesium teletherapy machine (25), cobalt-60 (30), 6, 8, or 18 mV linear accelerator (51), Ns (50) | 156 | Mean 47 | 72.0 | 118 (75.6) | Ns | 4/6 |
Hashimoto et al. [21] | 1986 | Surgical Neurology | Japan | 1965–1984 | Conventional radiotherapy, cobalt-60 (139) | 139 | Mean 41 (14–79) | 49.8 | 135 (100) | Ns | 4/6 |
Inoue et al. [22] | 1999 | Stereotactic and functional neurosurgery | Japan | 1991–1998 | Gamma Knife Radiosurgery (63) | 35* | Mean 47 (19–79) | 47,9 | Ns | >24* | 6/9 |
Olsson et al. [23] | 2016 | European Journal of Endocrinology | Sweden | 1997–2011 | Radiotherapy (104), unspecified | 104 | Mean 58.4 (1–97) | 53.7 | Ns | Ns | 5/7 |
Sattler et al. [5] | 2013 | International journal of radiation oncology, biology, physics | The Netherlands | 1959–2008 | Rotational (8), two fields (19), two fields and three fields (16), two fields and five fields (29), three fields(68), three fields and five fields (2), four fields (3), tetraedertechnique (47), five-fields technique (41), and Ns(3) | 462 | 46 (10–83) | 47.0 | 462 (100) | 14 (1–49) | 8/9 |
Schalin-Jantti et al. [24] | 2010 | Clinical endocrinology | Finland | 1998–2005 | Fractionated stereotactic radiotherapy (30) | 30 | 50 (24–71) | 70.0 | 25 (83.3) | 63 (20–125) | 5/6 |
van Varsseveld et al. [6] | 2015 | Journal of clinical endo-crinology and metabolism | The Netherlands | 1998–2009 | Conventional radiotherapy (429), stereotactic radiotherapy (27) | 456 | Mean 49 | 61.1 | 452 (99.1) | 120 (1.2–654) IRR: 152.4 | 9/9 |
Vargas et al. [25] | 2015 | International journal of endocrinology | Mexico | 2008–2013 | Three-dimensional, conformal, external beam radiotherapy (51) | 51 | Mean 53 | 54.0 | 51 | 78 (53–127) IRR: 60 | 7/9 |
Type of radiotherapy
Authors | N radiation as primary treatment (%) | N radiation at recurrence (%) | Median dose of radiotherapy, Gy (range) | Radiotherapy: median no of fractions (range) | EQD2, Gy (α/β = 2) | N of Ischemic stroke/total N of patients (%) |
---|---|---|---|---|---|---|
Bir et al. [17] | 38 (71.7) | 19 (35.8) | 15 (12–20) | 1 | 63.8 | 0/57 (0) |
Diallo et al. [18] | 4a (11.8) | 30 (88.2) | 50 | 27 | 50.0 | 0/34 (0) |
Elborsson et al. [19] | Ns | Ns | 40 | 20 | 40.0 | 1/18 (5.6) |
Flickinger et al. [20] | Ns | Ns | 4180 (35.72–62.32) | 22 (20–25) | 40.8 | 7/156 (4.5) |
Hashimoto et al. [21] | Ns | Ns | 40–60 | (20–25) | 40.0–66.0 | 10/139 (7.2) |
Inoue et al. [22] | Ns | Ns | Mean 20.2 (9–42) | 1 | 110.0 | 0/35 (0) |
Olsson et al. [23] | Ns | Ns | Ns | Ns | NA | 7/104 (6.7) |
Sattler et al. [5] | Ns | Ns | 45–49 | 25b
| 42.8 | 10/236 (4.2) |
Schalin-Jantti et al. [24] | 18 (60.0) | 12 (40.0) | 45 (45–54) | 25 (25–30) | 42.8 | 0/30 (0) |
van Varsseveld et al. [6] | Ns | Ns | Mean 45.6c
| 25–30 | 42.8 | 53/456 (11.6) |
Vargas et al. [25] | Ns | Ns | Mean 52 (50–57) | 25 | 53.8 | 0/51 (0) |
Timing of radiotherapy
Prior surgery
Ischemic stroke
Study quality according to Newcastle Ottawa scale and level of evidence
Authors | Selection | Comparabilitya
| Outcome | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Representativeness of the exposed cohort | Selection of the non exposed cohort | Ascertainment of exposure | Demonstration that outcome of interest was not present at start of study | Comparability of cohorts on the basis of the design or analysis | Assessment of outcome | Was follow-up long enough for outcomes to occur | Adequacy of follow up of cohorts | Total NOS score | CEBM level of evidence | |
Bir et al. [17] | + | = | + | + | = | + | − | − | 4/6 | 4 |
Diallo et al. [18] | + | = | + | + | = | + | + | + | 6/6 | 4 |
Elborsson et al. [19] | + | + | + | + | + | + | + | + | 9/9 | 3b |
Flickinger et al. [20] | + | = | + | + | = | + | − | − | 4/6 | 4 |
Hashimoto et al. [21] | + | = | + | + | = | + | − | − | 4/6 | 4 |
Inoue et al. [22] | + | + | + | + | + | + | − | − | 6/9 | 4 |
Olsson et al. [23] | + | + | + | + | = | + | − | − | 5/7 | 2b |
Sattler et al. [5] | + | + | + | + | + | + | + | − | 8/9 | 2b |
Schalin-Jantti et al. [24] | + | = | + | + | = | + | + | − | 5/6 | 4 |
van Varsseveld et al. [6] | + | + | + | + | + | + | + | + | 9/9 | 2b |
Vargas et al. [25] | + | + | + | + | + | + | + | − | 7/9 | 4 |