Journal article
Long-term radiographic and endocrinological outcomes of stereotactic radiosurgery for recurrent or residual nonfunctioning pituitary adenomas
Journal of neurosurgery, v 141(3), pp 773-780
01 Sep 2024
PMID: 38518285
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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.
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.
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.
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.
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Details
- Title
- Long-term radiographic and endocrinological outcomes of stereotactic radiosurgery for recurrent or residual nonfunctioning pituitary adenomas
- Creators
- Ahmed Shaaban - University of VirginiaChloé Dumot - Hospices Civils de LyonGeorgios Mantziaris - Neurological SurgerySam Dayawansa - Neurological SurgerySelcuk Peker - Koç UniversityYavuz Samanci - Koç UniversityAhmed M Nabeel - Nasser Institute hospitalWael A Reda - Nasser Institute hospitalSameh R Tawadros - Nasser Institute hospitalKhaled Abdel Karim - Ain Shams UniversityAmr M N El-Shehaby - Nasser Institute hospitalReem M Emad Eldin - Cairo UniversityAhmed Ragab AbdelsalamRoman Liscak - Na Homolce HospitalJaromir May - Na Homolce HospitalElad Mashiach - Departments of11Neurosurgery andFernando De Nigris Vasconcellos - Departments of11Neurosurgery andKenneth Bernstein - 12Radiation Oncology, NYU Langone, New York, New YorkDouglas Kondziolka - Departments of11Neurosurgery andHerwin Speckter - Instituto Tecnológico de Santo DomingoRuben Mota - Instituto Tecnológico de Santo DomingoAnderson Brito - Instituto Tecnológico de Santo DomingoShray K Bindal - University of PittsburghAjay Niranjan - University of PittsburghL Dade Lunsford - University of PittsburghCarolina Gesteira Benjamin - Departments of15Neurosurgery andTimoteo Almeida - University of MiamiJennifer Z Mao - Departments of15Neurosurgery andDavid Mathieu - Université de SherbrookeJean-Nicolas Tourigny - Université de SherbrookeManjul Tripathi - Post Graduate Institute of Medical Education and ResearchJoshua David Palmer - The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteJennifer Matsui - The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research InstituteJoseph Crooks - Drexel UniversityRodney E Wegner - Allegheny Health NetworkMatthew J Shepard - Allegheny Health NetworkJason P Sheehan - Neurological Surgery
- Publication Details
- Journal of neurosurgery, v 141(3), pp 773-780
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurology; General Internal Medicine
- Web of Science ID
- WOS:001309865000001
- Scopus ID
- 2-s2.0-85203028974
- Other Identifier
- 991022155290604721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Clinical Neurology
- Surgery