Journal article
Outcomes Associated With Stereotactic Radiosurgery After Multiple Resections of Nonfunctioning Pituitary Macroadenomas: An International, Multicenter Case Series
Neurosurgery, v 97(1), pp 182-190
Jul 2025
PMID: 39508579
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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 cm3 (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.
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Details
- Title
- Outcomes Associated With Stereotactic Radiosurgery After Multiple Resections of Nonfunctioning Pituitary Macroadenomas: An International, Multicenter Case Series
- Creators
- Dayton Grogan - Neurological SurgeryChloe Dumot - Hospices Civils de LyonGeorgios Mantziaris - Neurological SurgerySalem M. Tos - University of VirginiaAnant Tewari - University of VirginiaSam Dayawansa - Neurological SurgeryKimball Sheehan - University of VirginiaDarrah Sheehan - Neurological SurgerySelcuk Peker - Koç UniversityYavuz Samanci - Koç UniversityAhmed M. Nabeel - Nasser Institute hospitalWael A. Reda - Ain Shams UniversitySameh R. Tawadros - Ain Shams UniversityKhaled Abdelkarim - Ain Shams UniversityAmr M. N. El-Shehaby - Ain Shams UniversityReem M. Emad - Cairo UniversityAhmed Ragab Abdelsalam - Military Medical AcademyRoman Liscak - Na Homolce HospitalJaromir May - Na Homolce HospitalElad Mashiach - NYU Langone HealthFernando De Nigris Vasconcellos - NYU Langone, Dept Neurosurg, New York, NY USAKenneth Bernstein - NYU Langone, Dept Radiat Oncol, New York, NY USADouglas Kondziolka - NYU Langone HealthHerwin Speckter - Instituto Tecnológico de Santo DomingoRuben Mota - Instituto Tecnológico de Santo DomingoAnderson Brito - Instituto Tecnológico de Santo DomingoShray Kumar Bindal - University of PittsburghAjay Niranjan - University of PittsburghL. Dade Lunsford - University of PittsburghCarolina Gesteira Benjamin - University of MiamiTimoteo Abrantes de Lacerda Almeida - University of MiamiDavid 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 Mao - University of MiamiJennifer 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 Sheehan - Neurological Surgery
- Publication Details
- Neurosurgery, v 97(1), pp 182-190
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 9
- Grant note
- Societe francaise of Neurochirurgie (SFNC), France Hospices civils de Lyon, France Institut Servier, France Phillip foundation Fondation Planiol, France
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Neurology; General Internal Medicine
- Web of Science ID
- WOS:001508964100001
- Scopus ID
- 2-s2.0-105008734813
- Other Identifier
- 991022154806804721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Clinical Neurology
- Surgery