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Outcomes Associated With Stereotactic Radiosurgery After Multiple Resections of Nonfunctioning Pituitary Macroadenomas: An International, Multicenter Case Series
D. Grogan, C. Dumot, G. Mantziaris, SM. Tos, A. Tewari, S. Dayawansa, K. Sheehan, D. Sheehan, S. Peker, Y. Samanci, AM. Nabeel, WA. Reda, SR. Tawadros, K. AbdelKarim, AMN. El-Shehaby, RM. Emad, AR. Abdelsalam, R. Liscak, J. May, E. Mashiach, FN....
Jazyk angličtina
Typ dokumentu časopisecké články, multicentrická studie
- MeSH
- adenom * chirurgie radioterapie MeSH
- dospělí MeSH
- hypopituitarismus MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory hypofýzy * chirurgie radioterapie MeSH
- radiochirurgie * metody MeSH
- retrospektivní studie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
BACKGROUND AND OBJECTIVES: Stereotactic radiosurgery (SRS) represents an effective treatment for nonfunctioning pituitary adenomas (NFPAs). However, no data have yet been published regarding results of SRS on NFPAs after multiple previous resections. METHODS: Retrospective multicentric data of patients diagnosed with NFPA and who underwent multiple resections (≥2) before SRS were reviewed and analyzed. The treatment interval spanned the period of 1992 to 2022. Cox regression and Kaplan-Meier curves were used to assess predictive factors and the probability of tumor control and hypopituitarism. RESULTS: Among the 311 patients (median age: 50.2 [IQR: 18.0] years), 226 (72.7%) had undergone ≥2 previous resections. The median margin dose was 14 Gy (IQR: 4.0 Gy), and the median tumor volume 3.6 cm 3 (IQR: 4.8). Overall, the probability of tumor control after SRS was 93.3% (CI 95%: 89.9-96.9) and 86.7% (CI 95%: 81.1-92.6) at 5 and 10 years, respectively. A margin dose >14 Gy was associated with a decreased risk of tumor progression (hazard ratio = 0.33, CI 95% = 0.15-0.75, P = .008). At a last clinical follow-up of 4.1 (IQR 6.1) years, 10.1% (30/296) developed at least 1 new hormone deficiency after SRS. The cumulative probability of new hormone deficiency was 6.1% (95% CI: 3.0-9.1), 10.3% (95% CI: 5.8-14.6), and 18.9% (95% CI: 11.5-25.8) at 3, 5, and 10 years after SRS, respectively. The average latency between SRS and development of new hormone deficiencies was 3.3 years (IQR 4.1). A maximum point dose to the pituitary stalk >10 Gy was associated with a new deficiency (hazard ratio = 4.06, CI 95% = 1.57-10.5, P -value = .004). CONCLUSION: For patients with NFPA with multiple previous resections, SRS offers effective local tumor control and a low risk of delayed hypopituitarism for managing these challenging adenomas. SRS should be strongly considered in patients with NFPA with 2 previous resections compared with considering a third resection.
Allegheny Health Network Cancer Institute and Allegheny Health Network Pittsburgh Pennsylvania USA
Department of Clinical Oncology Ain Shams University Cairo Egypt
Department of Neurological Surgery Hospices civils de Lyon Lyon France
Department of Neurological Surgery University of Virginia Charlottesville Virginia USA
Department of Neurosurgery Ain Shams University Cairo Egypt
Department of Neurosurgery Allegheny Health Network Pittsburgh Pennsylvania USA
Department of Neurosurgery Koc University School of Medicine Istanbul Turkey
Department of Neurosurgery NYU Langone New York New York USA
Department of Neurosurgery University of Miami Miami Florida USA
Department of Neurosurgery University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA
Department of Radiation Oncology National Cancer Institute Cairo University Cairo Egypt
Department of Radiation Oncology NYU Langone New York New York USA
Department of Radiation Oncology University of Miami Miami Florida USA
Department of Stereotactic and Radiation Neurosurgery Na Homolce Hospital Prague Czech Republic
Dominican Gamma Knife Center and Radiology Department CEDIMAT Santo Domingo Dominican Republic
Drexel University College of Medicine Philadelphia Pennsylvania USA
Gamma Knife Center Cairo Nasser institute Hospital Cairo Egypt
Neurosurgery Department Faculty of Medicine Benha University Qalubya Egypt
Neurosurgery Department Military Medical Academy Cairo Egypt
University of Virginia School of Medicine Charlottesville Virginia USA
Citace poskytuje Crossref.org
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