Deferred Radiotherapy After Debulking of Non-functioning Pituitary Macroadenomas: Clinical Outcomes

Abstract

Background: To describe the outcome for a cohort of patients with non-functioning pituitary macroadenomas (NFPMA), managed by debulking surgery with radiation therapy delayed until progression.Methods: Two hundred and sixty-seven patients were treated surgically for pituitary tumors at our institution between 1997 and 2005. One hundred and twenty-six patients met the inclusion criteria of NFPMA. They were followed for at least 2 years.Results: At presentation, 58% of patients had objectively decreased visual function, 66% had endocrine abnormalities, and 46% had headaches. Of the entire cohort, 75% of tumors abutted the optic chiasm and 87% had suprasellar extension. Over a median follow up of 112 months from surgery, 52% of patients had evidence of radiographic tumor progression, and 39% required additional treatment. There was a significant difference freedom from progression and in the number of patients receiving additional treatment with preoperative adenoma size of < 2 vs. ≥2 cm (p < 0.05).Conclusion: Close observation with radiation therapy delayed until the time of progression is an appropriate option for patients presenting with initial adenoma size < 2 cm, and can be considered for those with initial sizes up to 4 cm, as the majority of patients do not require further intervention for 10 or more years, thereby meaningfully postponing the risks of radiotherapy.

Post-operative volumes following endoscopic surgery for non-functioning pituitary macroadenomas are predictive of further intervention, but not endocrine outcomes

“…Postoperative residuum is not unique as a predictor of recurrence / progression, with a number of additional factors being important in this including age, invasiveness, proliferative character of the tumour, and duration of follow-up [ 35 ]. Preoperative size has also been observed to correlate with the need for further intervention [ 36 ], as evident in our study. Many of these variables are not mutually exclusive as larger tumours preoperatively are more likely to be invasive, and lead to a larger postoperative residuum.…”

Assessment of Computed Tomography (CT) And Magnetic Resonance Imaging (MRI) Based Radiosurgery Treatment Planning for Pituitary Adenomas

“…Nevertheless, excessive toxicity is an important concern for management of pituitary adenomas with radiosurgery a well as surgical resection and achieving an improved toxicity profile is a pertinent goal of irradiation as well to avoid adverse radiation effects [25,26]. In this context, several strategies have been implemented for avoiding excessive treatment toxicity such as deferral of irradiation, proton therapy, and combined modality management including surgery followed by SRS [27][28][29][30][31][32].…”

Pituitary Macroadenoma (Fungal Hyphae): A Case Report and Literature Review

“…The combine radiation treatment may be more beneficial for patients to treat from further visual injury. Furthermore, the effective treatment of fungal seller abscess is endoscopic trans-sphenoidal surgery [10].…”