Long-term radiographic and endocrinological outcomes of stereotactic radiosurgery for recurrent or residual nonfunctioning pituitary adenomas
Jazyk angličtina Země Spojené státy americké Médium electronic-print
Typ dokumentu časopisecké články, multicentrická studie
PubMed
38518285
DOI
10.3171/2024.1.jns232285
Knihovny.cz E-zdroje
- Klíčová slova
- endocrine outcome, nonfunctioning pituitary adenoma, pituitary surgery, stereotactic radiosurgery, tumor control,
- MeSH
- adenom * chirurgie radioterapie diagnostické zobrazování MeSH
- dospělí MeSH
- hypopituitarismus etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru * MeSH
- nádory hypofýzy * chirurgie radioterapie diagnostické zobrazování MeSH
- následné studie MeSH
- radiochirurgie * metody škodlivé účinky MeSH
- retrospektivní studie MeSH
- reziduální nádor MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
OBJECTIVE: Stereotactic radiosurgery (SRS) is used for the treatment of residual/recurrent nonfunctional pituitary adenoma (NFPA). The aim of this study was to evaluate the factors related to long-term tumor control and delayed endocrinopathies following SRS. METHODS: This retrospective, multicenter study included patients with recurrent/residual NFPA treated with single-fraction SRS; they were then divided into two arms. The first arm included patients with at least 5 years of radiographic follow-up and all patients with local tumor progression. The second arm included patients with at least 5 years of endocrinological follow-up and all patients who developed endocrinopathy. Study endpoints were tumor control and new or worsening hypopituitarism after SRS and were analyzed using Cox regression and Kaplan-Meier methodology. RESULTS: There were 360 patients in the tumor control arm (median age 52.7 [IQR 42.9-61] years, 193 [53.6%] males) and 351 patients in the hypopituitarism arm (median age 52.5 [IQR 43-61] years, 186 [53.0%] males). The median follow-up in the tumor control evaluation group was 7.95 (IQR 5.7-10.5) years. Tumor control rates at 5, 8, 10, and 15 years were 93% (95% CI 90%-95%), 87% (95% CI 83%-91%), 86% (95% CI 82%-90%), and 69% (95% CI 59%-81%), respectively. The median follow-up in the endocrinopathy evaluation group was 8 (IQR 5.9-10.7) years. Pituitary function preservation rates at 5, 8, 10, and 15 years were 83% (95% CI 80%-87%), 81% (95% CI 77%-85%), 78% (95% CI 74%-83%), and 71% (95% CI 63%-79%), respectively. A margin dose > 15 Gy (HR 0.8, 95% CI 0.7-0.9; p < 0.001) and a delay from last resection to SRS > 1 year (HR 0.9, 95% CI 0.7-0.9; p = 0.04) were significant factors related to tumor control in multivariable analysis. A maximum dose to the pituitary stalk ≤ 10 Gy (HR 1.1, 95% CI 1.09-1.2; p < 0.001) was associated with pituitary function preservation. New visual deficits after SRS occurred in 7 (1.94%) patients in the tumor control group and 8 (2.3%) patients in the endocrinopathy group. Other new cranial nerve deficits post-SRS occurred in 4 of 160 patients with data in the tumor control group and 3 of 140 patients with data in the endocrinopathy group. CONCLUSIONS: SRS affords favorable and durable tumor control for the vast majority of NFPAs. Post-SRS hypopituitarism occurs in a minority of patients, but this risk increases with time and warrants long-term follow-up.
Clinical Oncology Ain Shams University Cairo Egypt
Department of Neurological Surgery Hospices Civils de Lyon France
Department of Neurological Surgery University of Virginia Charlottesville Virginia
Department of Neurosurgery Koç University School of Medicine Istanbul Turkey
Department of Neurosurgery Postgraduate Institute of Medical Education and Research Chandigarh India
Department of Radiation Oncology National Cancer Institute Cairo University Cairo Egypt
Department of Stereotactic and Radiation Neurosurgery Na Homolce Hospital Prague Czech Republic
Departments of11Neurosurgery and
Departments of15Neurosurgery and
Departments of6Neurosurgery and
Dominican Gamma Knife Center and Radiology Department CEDIMAT Santo Domingo Dominican Republic
Drexel University College of Medicine Philadelphia Pennsylvania; and
Gamma Knife Center Cairo Nasser Institute Hospital Cairo Egypt
Neurosurgery Department Faculty of Medecine Benha University Qalubya Egypt
Neurosurgery Department Military Medical Academy Cairo Egypt; and
Radiation Oncology NYU Langone New York New York
Radiation Oncology University of Miami Florida
University of Pittsburgh School of Medicine Pittsburgh Pennsylvania
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