Prognostic significance of corticotroph staining in radiosurgery for non-functioning pituitary adenomas: a multicenter study

Cohen-Inbar, Or; Xu, Zhiyuan; Lee, Cheng-chia; Wu, Chin-Chun; Chytka, Tomáš; Silva, Danilo; Sharma, Mayur; Radwan, Hesham; Grills, I.S.; Nguyen, Brandon; Siddiqui, Z.A.; Mathieu, David; Iorio-Morin, Christian; Wolf, Amparo; Cifarelli, Christopher P.; Cifarelli, Daniel T; Lunsford, L. Dade; Kondziolka, Douglas; Sheehan, Jason P.

doi:10.1007/s11060-017-2520-y

Cited by 42 publications

(32 citation statements)

References 32 publications

(44 reference statements)

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“…SCA comprise 5–19% of the NFPAs, depending on the cohort, and approximately 3% of all adenomas, whereas their functional counterpart, functioning corticotroph pituitary adenoma (FCA), represent only 2–6% [ 1 , 2 , 6 , 7 ]. SCA is categorized as a potentially more aggressive neuroendocrine tumor posing a high risk of increased invasiveness and parasellar growth, a tendency for multiple and earlier recurrences, and higher rates of hemorrhage and apoplexy [ 8 , 9 , 10 , 11 , 12 ]. Conversely, its clinically active counterpart rarely poses challenges due to tumor volume.…”

Section: Introductionmentioning

confidence: 99%

Distinct Pattern of Endoplasmic Reticulum Protein Processing and Extracellular Matrix Proteins in Functioning and Silent Corticotroph Pituitary Adenomas

Eieland

Normann

Sundaram

et al. 2020

Cancers

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Functioning (FCA) and silent corticotroph (SCA) pituitary adenomas act differently from a clinical perspective, despite both subtypes showing positive TBX19 (TPIT) and/or adrenocorticotropic hormone (ACTH) staining by immunohistochemistry. They are challenging to treat, the former due to functional ACTH production and consequently hypercortisolemia, and the latter due to invasive and recurrent behavior. Moreover, the molecular mechanisms behind their distinct behavior are not clear. We investigated global transcriptome and proteome changes in order to identify signaling pathways that can explain FCA and SCA differences (e.g., hormone production vs. aggressive growth). In the transcriptomic study, cluster analyses of differentially expressed genes revealed two distinct groups in accordance with clinical and histological classification. However, in the proteomic study, a greater degree of heterogeneity within the SCA group was found. Genes and proteins related to protein synthesis and vesicular transport were expressed by both adenoma groups, although different types and a distinct pattern of collagen/extracellular matrix proteins were presented by each group. Moreover, several genes related to endoplasmic reticulum protein processing were overexpressed in the FCA group. Together, our findings shed light on the different repertoires of activated signaling pathways in corticotroph adenomas, namely, the increased protein processing capacity of FCA and a specific pattern of adhesion molecules that may play a role in the aggressiveness of SCA.

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Section: Introductionmentioning

confidence: 99%

Distinct Pattern of Endoplasmic Reticulum Protein Processing and Extracellular Matrix Proteins in Functioning and Silent Corticotroph Pituitary Adenomas

Eieland

Normann

Sundaram

et al. 2020

Cancers

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“…Some pituitary adenomas spread locally to invade surrounding meninges (dura) and cavernous sinus, hampering a complete surgical resection. 5 , 16 , 17 Stereotactic radiosurgery is commonly utilized as an adjunct following incomplete surgical resection (as part of an AHS approach), tumor recurrence, or medical therapy failure. 7 Those with a residual functioning pituitary adenoma causing acromegaly or Cushing’s disease after resection require AHS as a routine approach in order to achieve durable tumor control rates.…”

Section: Additional Indications For Ahsmentioning

confidence: 99%

“… 16 Silent corticotroph-staining adenomas are a rare subset of non-functioning adenomas shown to be more locally aggressive, requiring AHS as a routine approach in order to achieve durable tumor control rates. 5 Prolactin-secreting adenomas are a common type of functioning adenomas, most effectively treated with dopamine agonists. A minority of patients do not respond to medications (dopamine agonist-resistant prolactinomas) or are intolerant to these owing to related side effects.…”

Section: Additional Indications For Ahsmentioning

confidence: 99%

“…Since its inception in the early 1950–1960s, stereotactic radiosurgery (SRS) has emerged as an increasingly accepted treatment option for patients with different intracranial pathologies. 1 , 5 – 17 This technology has evolved dramatically since then (both software- and hardware-related quantum leaps), but its core principles remain unchanged. Ionizing radiation utilized in SRS is commonly gamma radiation (emitted by the radioactive cobalt [Co] isotope 60) or X-rays from linear accelerators (LINAC, Cyber-Knife, etc.).…”

Section: Introductionmentioning

confidence: 99%

“…Several SRS reports of large series describing the treatment of small- to moderate-volume benign skull base lesions have reported more than adequate long-term tumor control rates coupled with impressively low related neurological morbidity and a good preservation of functions, compared with GTR. 1 , 5 , 7 – 10 , 15 – 22 …”

Section: Introductionmentioning

confidence: 99%

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Adaptive Hybrid Surgery: Paradigm Shift for Patient Centered Neurosurgery

Cohen-Inbar

Sviri

2018

Rambam Maimonides Med J

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The surgical management of cerebral and skull base lesions has evolved greatly in the last few decades. Still, a complete resection of lesions abutting critical neurovascular structures carries significant morbidity. Stereotactic radiosurgery (SRS) has emerged as an increasingly accepted treatment option. Minimally invasive, SRS results in excellent tumor control and low complication rates in patients with moderate-size tumors. The management of large cerebral and skull base tumors remains a formidable challenge. In such large tumors, radical surgical extirpation offers a significantly higher risk of neurological deficit, and SRS alone cannot be used because of the elevated incidence of radiation-induced complications known to be associated with large-volume tumors. With increasing treatment volumes, SRS-associated tumor control rates decrease and complication rates increase. Planned subtotal resection (STR) with adjuvant SRS (adaptive hybrid surgery [AHS]) has gained increasing interest in recent years as a multimodal approach. In AHS, a planned STR (aimed at decreasing surgical morbidity) followed by SRS to a preplanned residual tumor aids in harnessing advantages offered by both approaches. Although intuitive and reasonable, this paradigm shift from maximal resection at all cost has not been adopted widely. Combining open microsurgery with SRS requires a good understanding of both surgical and SRS modalities and their respective safety–efficacy features. We present a review and discussion on AHS as a modern, multidisciplinary treatment approach. Available data and views are discussed for vestibular schwannoma (VS) as a sample tumor. Other indications for AHS are mentioned in brief.

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