Management After Initial Surgery of Nonfunctioning Pituitary Adenoma: Surveillance, Radiotherapy or Surgery?

Overview

Journal Radiat Oncol

Publisher Biomed Central

Specialties Oncology
Radiology

Date 2022 Oct 13

PMID 36229880

Authors

Thomas Charleux

Veronique Vendrely

Aymeri Huchet

Renaud Trouette

Amandine Ferriere

Antoine Tabarin

Vincent Jecko

Hugues Loiseau

Charles Dupin

Affiliations

Soon will be listed here.

Abstract

Introduction: The first line of treatment for nonfunctioning pituitary adenoma (NFPA) is surgery. Adjuvant radiotherapy or surveillance and new treatment (second surgical operation or salvage radiotherapy) in case of recurrence are options discussed at the multidisciplinary tumor board. The purpose of this study was to evaluate the therapeutic outcome for each option.

Methods: The records of 256 patients followed with NFPA between 2007 and 2018 were retrospectively reviewed. Mean age at initial surgery was 55 years [18-86]. Post-operative MRI found a residual tumor in 87% of patients. Mean follow-up was 12.1 years [0.8-42.7].

Results: After initial surgery, 40 patients had adjuvant radiotherapy. At 5, 10 and 15 years progression-free survival (PFS) was significantly different after surgery alone (77%, 58% and 40%) compared to surgery and adjuvant radiotherapy (84%, 78% and 78%) (HR = 0.24 [0-0.53] p < 0.0005). Overall, after first, second or third surgical operation, 69 patients had adjuvant radiotherapy and 41 salvage radiotherapy. Five-year PFS was similar for adjuvant (90%) and salvage radiotherapy (97%) (p = 0.62). After a second surgical operation, 62% and 71% of patients were irradiated after 2 and 5 years respectively. The risk of corticotropic and thyrotropic deficiency rates were 38% and 59% after second or third surgical operation and 40% and 73% after radiotherapy. Brain tumors occurred in 4 patients: 1 meningioma present at initial surgery, and after radiotherapy, 1 neurinoma which appeared at 5 years, 1 glioblastoma at 13 years and 1 meningioma at 20 years.

Conclusion: Among patients treated by surgery for NFPA, a "wait-and-see" attitude should be an option since adjuvant radiotherapy is not superior to salvage radiotherapy. However, in case of recurrence or progression, the authors recommended delivery of salvage radiotherapy to avoid a second surgical operation.

Citing Articles

Brain radiotherapy and dorsal vagal complex irradiation: A new organ at risk to decrease radiation-induced nausea and vomiting?.

Caspar V, Giraud N, Charleux T, Beddok A, Bernard B, Martin M Clin Transl Radiat Oncol. 2025; 51():100902.

PMID: 39811541 PMC: 11729675. DOI: 10.1016/j.ctro.2024.100902.

Postsurgical outcomes of nonfunctioning pituitary adenomas: a patient-level meta-analysis.

Fong K, Lim M, Fu S, Low C, Chan Y, Deepak D Pituitary. 2023; 26(4):461-473.

PMID: 37389776 DOI: 10.1007/s11102-023-01335-2.

References

Woollons A, Hunn M, Rajapakse Y, Toomath R, Hamilton D, Conaglen J . Non-functioning pituitary adenomas: indications for postoperative radiotherapy. Clin Endocrinol (Oxf). 2001; 53(6):713-7. DOI: 10.1046/j.1365-2265.2000.01153.x. View

Burman P, van Beek A, Biller B, Camacho-Hubner C, Mattsson A . Radiotherapy, Especially at Young Age, Increases the Risk for De Novo Brain Tumors in Patients Treated for Pituitary/Sellar Lesions. J Clin Endocrinol Metab. 2017; 102(3):1051-1058. DOI: 10.1210/jc.2016-3402. View

Brada M, Burchell L, Ashley S, Traish D . The incidence of cerebrovascular accidents in patients with pituitary adenoma. Int J Radiat Oncol Biol Phys. 1999; 45(3):693-8. DOI: 10.1016/s0360-3016(99)00159-5. View

Magro E, Graillon T, Lassave J, Castinetti F, Boissonneau S, Tabouret E . Complications Related to the Endoscopic Endonasal Transsphenoidal Approach for Nonfunctioning Pituitary Macroadenomas in 300 Consecutive Patients. World Neurosurg. 2016; 89:442-53. DOI: 10.1016/j.wneu.2016.02.059. View

Sheehan J, Lee C, Bodach M, Tumialan L, Oyesiku N, Patil C . Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline for the Management of Patients With Residual or Recurrent Nonfunctioning Pituitary Adenomas. Neurosurgery. 2016; 79(4):E539-40. DOI: 10.1227/NEU.0000000000001385. View

Chanson P, Dormoy A, Dekkers O . Use of radiotherapy after pituitary surgery for non-functioning pituitary adenomas. Eur J Endocrinol. 2019; 181(1):D1-D13. DOI: 10.1530/EJE-19-0058. View

Raverot G, Burman P, McCormack A, Heaney A, Petersenn S, Popovic V . European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas. Eur J Endocrinol. 2017; 178(1):G1-G24. DOI: 10.1530/EJE-17-0796. View

Park K, Kano H, Parry P, Niranjan A, Flickinger J, Lunsford L . Long-term outcomes after gamma knife stereotactic radiosurgery for nonfunctional pituitary adenomas. Neurosurgery. 2011; 69(6):1188-99. DOI: 10.1227/NEU.0b013e318222afed. View

Uto M, Mizowaki T, Ogura K, Miyabe Y, Nakamura M, Mukumoto N . Volumetric modulated Dynamic WaveArc therapy reduces the dose to the hippocampus in patients with pituitary adenomas and craniopharyngiomas. Pract Radiat Oncol. 2017; 7(6):382-387. DOI: 10.1016/j.prro.2017.04.004. View

10.

Cifarelli C, Schlesinger D, Sheehan J . Cranial nerve dysfunction following Gamma Knife surgery for pituitary adenomas: long-term incidence and risk factors. J Neurosurg. 2012; 116(6):1304-10. DOI: 10.3171/2012.2.JNS111630. View

11.

Minniti G, Clarke E, Scaringi C, Maurizi Enrici R . Stereotactic radiotherapy and radiosurgery for non-functioning and secreting pituitary adenomas. Rep Pract Oncol Radiother. 2016; 21(4):370-8. PMC: 4899479. DOI: 10.1016/j.rpor.2014.09.004. View

12.

Pomeraniec I, Kano H, Xu Z, Nguyen B, Siddiqui Z, Silva D . Early versus late Gamma Knife radiosurgery following transsphenoidal surgery for nonfunctioning pituitary macroadenomas: a multicenter matched-cohort study. J Neurosurg. 2017; 129(3):648-657. PMC: 5924422. DOI: 10.3171/2017.5.JNS163069. View

13.

van den Bergh A, Schoorl M, Dullaart R, van der Vliet A, Szabo B, ter Weeme C . Lack of radiation optic neuropathy in 72 patients treated for pituitary adenoma. J Neuroophthalmol. 2004; 24(3):200-5. DOI: 10.1097/00041327-200409000-00003. View

14.

Erridge S, Conkey D, Stockton D, Strachan M, Statham P, Whittle I . Radiotherapy for pituitary adenomas: long-term efficacy and toxicity. Radiother Oncol. 2009; 93(3):597-601. DOI: 10.1016/j.radonc.2009.09.011. View

15.

Weber D, Momjian S, Pralong F, Meyer P, Villemure J, Pica A . Adjuvant or radical fractionated stereotactic radiotherapy for patients with pituitary functional and nonfunctional macroadenoma. Radiat Oncol. 2011; 6:169. PMC: 3248375. DOI: 10.1186/1748-717X-6-169. View

16.

Brada M, Ford D, Ashley S, Bliss J, Crowley S, Mason M . Risk of second brain tumour after conservative surgery and radiotherapy for pituitary adenoma. BMJ. 1992; 304(6838):1343-6. PMC: 1882057. DOI: 10.1136/bmj.304.6838.1343. View

17.

Lucas J, Bodach M, Tumialan L, Oyesiku N, Patil C, Litvack Z . Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Primary Management of Patients With Nonfunctioning Pituitary Adenomas. Neurosurgery. 2016; 79(4):E533-5. DOI: 10.1227/NEU.0000000000001389. View

18.

Grigsby P, Stokes S, Marks J, Simpson J . Prognostic factors and results of radiotherapy alone in the management of pituitary adenomas. Int J Radiat Oncol Biol Phys. 1988; 15(5):1103-10. DOI: 10.1016/0360-3016(88)90191-5. View

19.

Losa M, Mortini P, Barzaghi R, Ribotto P, Terreni M, Bianchi Marzoli S . Early results of surgery in patients with nonfunctioning pituitary adenoma and analysis of the risk of tumor recurrence. J Neurosurg. 2008; 108(3):525-32. DOI: 10.3171/JNS/2008/108/3/0525. View

20.

Trouillas J, Roy P, Sturm N, Dantony E, Cortet-Rudelli C, Viennet G . A new prognostic clinicopathological classification of pituitary adenomas: a multicentric case-control study of 410 patients with 8 years post-operative follow-up. Acta Neuropathol. 2013; 126(1):123-35. DOI: 10.1007/s00401-013-1084-y. View