BACKGROUND: Pituitary metastases (PM) account for 0.4% of all intracranial metastases and typically present with visual and endocrinological deficits. Stereotactic radiosurgery (SRS) has shown excellent tumor control and safety profile in the management of intracranial metastases. However, its role and safety in managing metastases to the pituitary gland are not well-characterized. This study aims to evaluate SRS outcomes and safety profile in the management of PM in a multicenter international cohort. METHODS: The authors retrospectively analyzed data from 63 patients with PM treated with SRS across 12 institutions, assessing clinical and radiological outcomes, including survival rates, tumor control, visual and endocrinological outcomes, and post-treatment complications. RESULTS: Among 63 patients included in the study (median tumor volume: 1.5 cc), SRS demonstrated a local tumor control rate of 93.1% at 12 months. The median survival was 25.4 months and overall survival rates of 77.6%, 65.9%, and 55.1% at 6, 12, and 18 months, respectively. In multivariate analysis, a margin dose for PM > 10 Gy emerged as an independent predictor across progression-free survival (HR: 0.20, p < 0.01), distant metastasis-free survival (HR: 0.30, p = 0.01), and overall survival. (HR: 0.15, p < 0.01). Following SRS, most patients showed stable or improved visual function (n = 17/18). A small percentage of patients experienced complications: developed new visual deficits (n = 1/63), experienced new anterior pituitary hormone deficiency (n = 5/63), and developed arginine vasopressin (AVP)-deficiency post-treatment (n = 2/63). CONCLUSION: SRS is an important modality in the management of PM, offering excellent local tumor control and survival outcomes with minimal morbidity. These findings support the incorporation of SRS into the multidisciplinary management for treating patients with PM.

Clinical Oncology Department Ain shams University Cairo Egypt

Department of Neurological Surgery University of Pittsburgh Medical Center Pittsburgh PA USA

Department of Neurological Surgery University of Virginia Charlottesville VA USA

Department of Neurosurgery Allegheny Health Network Cancer Institute Pittsburgh PA USA

Department of Neurosurgery Koc University School of Medicine Istanbul Turkey

Department of Neurosurgery Neurological Institute Taipei Veterans General Hospital Taipei Taiwan

Department of Neurosurgery NYU Langone Medical Center New York University New York USA

Department of Neurosurgery PGIMER Chandigarh India

Department of Neurosurgery Sheba Medical Center Ramat Gan Israel

Department of Neurosurgery University of Miami Health System Miami FL USA

Department of Radiation Oncology Allegheny Health Network Cancer Institute Pittsburgh PA USA

Department of Radiation Oncology NYU Langone Medical Center New York University New York USA

Department of Stereotactic and Radiation Neurosurgery Na Homolce Hospital Prague Czechia Czechia

Division of Endocrinology Department of Medicine University of Pittsburgh Medical Center Pittsburgh PA USA

Gamma Knife Centre Nasser Institute Cairo Egypt

Neurosurgery Department Benha University Qualyobia Egypt

Radiation Oncology Department National Cancer Institute Cairo University Cairo Egypt

Radiation Oncology The James Cancer Center Ohio State University Columbus OH USA

Stereotactic and Functional Neurosurgery University of British Columbia Vancouver Canada

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