Growth modelling of non-functioning pituitary adenomas in patients referred for surgery

Honegger, Juergen; Zimmermann, Sanna; Psaras, Tsambika; Petrick, Manfred; Mittelbronn, Michel; Ernemann, Ulrike; Reincke, Martín; Dietz, Klaus

doi:10.1530/eje-07-0502

Cited by 45 publications

(46 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The search identified 2,048 candidate references, of which 32 were studies deemed eligible [2,3,4,5,6,9,10,11,38,39,40,41,42,43,44,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66]. We excluded 9 studies [3,4,43,50,51,52,53,54,55] because the case identification was done using single older CT scan techniques that were not comparable with current MRI studies.…”

Section: Resultsmentioning

confidence: 99%

Natural History of Postoperative Nonfunctioning Pituitary Adenomas: A Systematic Review and Meta-Analysis

et al. 2012

View full text Add to dashboard Cite

Objective: Previous studies attempting to define the natural history of postoperative nonfunctioning pituitary adenomas (pNFPAs) were somewhat limited by selection bias and/or small numbers and/or lack of consistency among the study findings. The aim of this study was to scrutinize the literature in order to analyze the natural history of pNFPAs. Methods: Electronic database including MEDLINE, PubMed and Cochrane CENTRAL were searched. The literature relating to the patients with pNFPAs without postoperative radiotherapy and pharmacotherapy was collected. Eligible studies reported on the rate of tumor recurrence, the tumor growth-free survival rate (TGFSR) at 5 and 10 years, and/or the residual tumor volume doubling time (TVDT). Results: 19 studies met the criteria. The pNFPAs were divided into two groups: the pooled recurrence rate of group I without detectable residual tumor (371 patients) was 12% (95% CI 6–19%), the TGFSR at 5 and 10 years were 96% (95% CI 89–99%) and 82% (95% CI 65–94%), respectively. The pooled recurrence rate of group II with residual tumor (600 patients) was 46% (95% CI 36–56%), the TGFSR at 5 and 10 years were 56% (95% CI 41–71%) and 40% (95% CI 27–53%), respectively. The mean TVDT was 3.4 years (95% CI 2.4–4.5 years). Conclusions: pNFPAs, with or without detectable residual tumor, need stratification of treatment and radiological/endocrinological follow-up strategy. According to the TVDT, residual tumor regrowth is very slow, which permits an extensive and safe follow-up program for most patients.

show abstract

Section: Resultsmentioning

confidence: 99%

Natural History of Postoperative Nonfunctioning Pituitary Adenomas: A Systematic Review and Meta-Analysis

et al. 2012

View full text Add to dashboard Cite

show abstract

“…No predictive volumetric threshold was reported. According to Tanaka et al 49 and Honegger et al, 25 recurrent adenomas show mostly an exponential growth pattern. However, tumor volume doubling time (TVDT) can vary significantly between cases, with a younger age being a possibly relevant risk factor.…”

Section: Volumetric Quantification Of the Role Of 3t-imrimentioning

confidence: 94%

“…49 The MIB-1 index also seems to inversely correlate with TVDT. 25,49 Whether an increase in the EOR plays a clinically relevant role in subtotally resected adenomas has not been established, however. Specifically, it is not known if stepwise incremental EOR values for adenomas correlate with incremental progression-free survival or whether the absolute residual volume or the relative residual volume is the prognostic factor.…”

Section: Volumetric Quantification Of the Role Of 3t-imrimentioning

confidence: 99%

Pituitary surgery and volumetric assessment of extent of resection: a paradigm shift in the use of intraoperative magnetic resonance imaging

Serra¹,

Burkhardt²,

Esposito³

et al. 2016

FOC

View full text Add to dashboard Cite

A lthough pituitary adenomas (PAs) are commonly classified as benign lesions, their clinical course is not always benign, and studies have confirmed that patients harboring a secreting adenoma have a reduced life expectancy, particularly those affected by adrenocorticotropic hormone (ACTH)-or growth hormone (GH)-secreting adenoma. 15,24,29,38,46 For such patients, endocrinological remission through gross-total resection (GTR) is the goal. Similarly, GTR is recommended for nonfunctioning pituitary adenomas (NFAs) requiring surgery, since subtotal resection (STR) and adenoma remnants after surgery have been repeatedly shown to represent a risk factor AbbreviAtioNs ACTH = adrenocorticotropic hormone; EOR = extent of resection; GH = growth hormone; GTR = gross-total resection; iMRI = intraoperative MRI; NFA = nonfunctioning pituitary adenoma; PA = pituitary adenoma; STR = subtotal resection; t = targeted; TSS = transsphenoidal surgery; TVDT = tumor volume doubling time. obJective The aim of this study was to quantitatively assess the role of intraoperative high-field 3-T MRI (3T-iMRI) in improving the gross-total resection (GTR) rate and the extent of resection (EOR) in endoscopic transsphenoidal surgery (TSS) for pituitary adenomas. methods Radiological and clinical data from a prospective database were retrospectively analyzed. Volumetric measurements of adenoma volumes pre-, intraoperatively, and 3 months postoperatively were performed in a consecutive series of patients who had undergone endoscopic TSS. The quantitative contribution of 3T-iMRI was measured as a percentage of the additional rate of GTR and of the EOR achieved after 3T-iMRI. results The cohort consisted of 50 patients (51 operations) harboring 33 nonfunctioning and 18 functioning pituitary adenomas. Mean adenoma diameter and volume were 21.1 mm (range 5-47 mm) and 5.23 cm 3 (range 0.09-22.14 cm 3 ), respectively. According to Knosp's classification, 10 cases were Grade 0; 8, Grade 1; 17, Grade 2; 12, Grade 3; and 4, Grade 4. Gross-total resection was the surgical goal (targeted [t]GTR) in 34 of 51 operations and was initially achieved in 16 (47%) of 34 at 3T-iMRI and in 30 (88%) of 34 cases after further resection. In this subgroup, the EOR increased from 91% at 3T-iMRI to 99% at the 3-month MRI (p < 0.05). In the 17 cases in which subtotal resection (STR) had been planned (tSTR), the EOR increased from 79% to 86% (p < 0.05) and GTR could be achieved in 1 case. Intrasellar remnants were present in 20 of 51 procedures at 3T-iMRI and in only 5 (10%) of 51 procedures after further resection (median volume 0.15 cm 3 ). Overall, the use of 3T-iMRI led to further resection in 27 (53%) of 51 procedures and permitted GTR in 15 (56%) of these 27 procedures; thus, the GTR rate in the entire cohort increased from 31% (16 of 51) to 61% (31 of 51) and the EOR increased from 87% to 95% (p < 0.05). coNclusioNs The use of high-definition 3T-iMRI allowed precise visualization and quantification of adenoma remnant volume. It helped to increase GTR and EOR rates in ...

show abstract

“…With regard to surgical management, it is important to distinguish between recurrence following non-optimal surgery and recurrence after surgery performed by an expert. The growth rate of pituitary tumours is influenced by patient-and tumourspecific characteristics; this intrinsic tumour heterogeneity determines the risk of recurrence and resistance to treatment (6,19,20).…”

Section: Reasoningmentioning

confidence: 99%

European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas

Raverot

Burman

McCormack

et al. 2018

European Journal of Endocrinology

456

611

View full text Add to dashboard Cite

Background: Pituitary tumours are common and easily treated by surgery or medical treatment in most cases. However, a small subset of pituitary tumours does not respond to standard medical treatment and presents with multiple local recurrences (aggressive pituitary tumours) and in rare occasion with metastases (pituitary carcinoma). The present European Society of Endocrinology (ESE) guideline aims to provide clinical guidance on diagnosis, treatment and follow-up in aggressive pituitary tumours and carcinomas. Methods: We decided upfront, while acknowledging that literature on aggressive pituitary tumours and carcinomas is scarce, to systematically review the literature according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. The review focused primarily on first-and second-line treatment in aggressive pituitary tumours and carcinomas. We included 14 single-arm cohort studies (total number of patients = 116) most on temozolomide treatment (n = 11 studies, total number of patients = 106). A positive treatment effect was seen in 47% (95% CI: 36-58%) of temozolomide treated. Data from the recently performed ESE survey on aggressive pituitary tumours and carcinomas (165 patients) were also used as backbone for the guideline. In patients responding to first-line temozolomide, we suggest continuing treatment for at least 6 months in total. Furthermore, the guideline offers recommendations for patients who recurred after temozolomide treatment, for those who did not respond to temozolomide and for patients with systemic metastasis.

show abstract

Growth modelling of non-functioning pituitary adenomas in patients referred for surgery

Cited by 45 publications

References 24 publications

Natural History of Postoperative Nonfunctioning Pituitary Adenomas: A Systematic Review and Meta-Analysis

Natural History of Postoperative Nonfunctioning Pituitary Adenomas: A Systematic Review and Meta-Analysis

Pituitary surgery and volumetric assessment of extent of resection: a paradigm shift in the use of intraoperative magnetic resonance imaging

European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas

Contact Info

Product

Resources

About