Stereotactic radiosurgery for pituitary and cavernous sinus metastases

Lin, Yen‐Yu; Wu, Hsiu‐Mei; Yang, Huai‐Che; Chen, Ching-Jen; Hu, Yong-Sin; Cc, Lin; Guo, Wan‐Yuo; Pan, David Hung-Chi; Chung, Wen‐Yuh; Lee, Cheng‐Chia

doi:10.1007/s11060-023-04236-3

Cited by 3 publications

(3 citation statements)

References 20 publications

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“…SRS is a highly conformal technique, able to deliver a high dose of radiation in a single fraction to a well-defined target. This ablative and focal strategy mimics the effect of surgical resection through a less invasive approach, representing the ideal solution for small-sized BMs and a valid alternative when surgery is not feasible (generally for unresectable lesions critically located in deep or eloquent brain areas [ 10 , 11 , 12 ] or patients inoperable due to comorbidities).…”

Section: Stereotactic Radiosurgery (Srs)mentioning

confidence: 99%

Modern Stereotactic Radiotherapy for Brain Metastases from Lung Cancer: Current Trends and Future Perspectives Based on Integrated Translational Approaches

Levis,

Gastino,

De Giorgi

et al. 2023

Cancers

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Brain metastases (BMs) represent the most frequent metastatic event in the course of lung cancer patients, occurring in approximately 50% of patients with non-small-cell lung cancer (NSCLC) and in up to 70% in patients with small-cell lung cancer (SCLC). Thus far, many advances have been made in the diagnostic and therapeutic procedures, allowing improvements in the prognosis of these patients. The modern approach relies on the integration of several factors, such as accurate histological and molecular profiling, comprehensive assessment of clinical parameters and precise definition of the extent of intracranial and extracranial disease involvement. The combination of these factors is pivotal to guide the multidisciplinary discussion and to offer the most appropriate treatment to these patients based on a personalized approach. Focal radiotherapy (RT), in all its modalities (radiosurgery (SRS), fractionated stereotactic radiotherapy (SRT), adjuvant stereotactic radiotherapy (aSRT)), is the cornerstone of BM management, either alone or in combination with surgery and systemic therapies. We review the modern therapeutic strategies available to treat lung cancer patients with brain involvement. This includes an accurate review of the different technical solutions which can be exploited to provide a “state-of-art” focal RT and also a detailed description of the systemic agents available as effective alternatives to SRS/SRT when a targetable molecular driver is present. In addition to the validated treatment options, we also discuss the future perspective for focal RT, based on emerging clinical reports (e.g., SRS for patients with many BMs from NSCLC or SRS for BMs from SCLC), together with a presentation of innovative and promising findings in translational research and the combination of novel targeted agents with SRS/SRT.

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Section: Stereotactic Radiosurgery (Srs)mentioning

confidence: 99%

Modern Stereotactic Radiotherapy for Brain Metastases from Lung Cancer: Current Trends and Future Perspectives Based on Integrated Translational Approaches

Levis,

Gastino,

De Giorgi

et al. 2023

Cancers

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Several heterogeneous studies regarding metastasis to the pituitary gland (hereafter referred to as pituitary metastasis) have been published. [1][2][3][4][5][6][7][8] However, most studies' cohorts comprised patients whose diagnoses were made not only based on histology but also from radiological and clinical contexts. [1][2][3][5][6][7][8] Two studies on only histologically diagnosed pituitary metastasis exist, with cases occurring from 1992 to 2014.

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mentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] However, most studies' cohorts comprised patients whose diagnoses were made not only based on histology but also from radiological and clinical contexts. [1][2][3][5][6][7][8] Two studies on only histologically diagnosed pituitary metastasis exist, with cases occurring from 1992 to 2014. 4,6 Therefore, more contemporary studies may be relevant given the rapidly evolving field of oncology and patients surviving longer with disease-modifying agents.…”

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confidence: 99%

Treatment outcome of metastasis to the pituitary gland: a case series of 21 patients with pathological diagnosis

Hong,

Atkinson,

Erickson

et al. 2023

Neurosurgical Focus

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OBJECTIVE The aim of this study was to report the treatment course of histologically confirmed metastases to the pituitary gland (pituitary metastasis). METHODS The Mayo data explorer was used to find patients with pituitary metastasis. Twenty-one patients were identified between the years 2001 and 2021, and their data were retrospectively collected. RESULTS The most common primary cancer origin was lung in men (45%) and breast in women (33%). The median age was 66 years (IQR 56–68 years). Patients presented with headache (67% [14/21]), vision problems (86% [18/21]), anterior hypopituitarism (71% [15/21]), and arginine vasopressin deficiency (38% [8/21]). Pituitary metastases were found before the diagnosis of the primary cancer in 5 patients (24%). The mean ± SD tumor size was 2.0 ± 0.7 cm, and 90% (19/21) presented as a solitary pituitary mass with no other intracranial metastatic lesions. Common radiological features were pituitary stalk thickening (90% [19/21]), cavernous sinus involvement (71% [15/21]), and constriction at the diaphragma sellae (52% [11/21]). Transsphenoidal surgery was performed in 20 patients, and subtotal resection was most frequently attained (76% [16/21]). Fourteen patients (67%) had adjuvant radiation therapy, and 15 patients (71%) were treated with systemic therapy. The median time from surgery to the initiation of radiation therapy was 16 days (IQR 11–21 days), and that from surgery to the initiation of systemic therapy was 5.0 months (IQR 1.5–14 months). During management, headaches improved in 57% (8/14) and vision problems improved in 61% (11/18) of cases; new hypopituitarism occurred in 5 patients. Six patients developed recurrence, and the median progression-free survival was 24 months (95% CI 5.4–43 months). After recurrence, 1 patient with adenoid cystic carcinoma was treated with rescue radiotherapy twice, and 4 patients responded well to systemic therapy. The median overall survival (OS) was 25 months (95% CI 7.1–43 months). The mean OS was better in patients with neuroendocrine lung tumor (261 months) and papillary thyroid carcinoma (80 months) and worse in patients with small cell lung cancer (4 months) and unknown origin (5 months). CONCLUSIONS Surgery with or without adjuvant radiotherapy is effective for mass reduction, rapid symptomatic improvement of vision and headaches, and definitive diagnosis. Even after local tumor control failure, some patients still benefit from radiation and/or systemic therapy.

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Metastases to the pituitary gland: insights from the German pituitary tumor registry

Haberbosch,

Schmid,

Hubertus

et al. 2023

Pituitary

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Metastatic involvement of the pituitary gland is a rare but clinically significant phenomenon, that often poses diagnostic and therapeutic challenges. The aim of this study was to provide a comprehensive analysis of the origin of pituitary metastases using data from the German Pituitary Tumor Registry, one of the globally largest collections of pituitary pathology specimens. Here, we report data from a retrospective analysis of patients with metastases to the pituitary registered between 1990 and 2022. Out of 17,896 pituitary cases in the registry during this period, a total of 96 metastases to the pituitary gland were identified, accounting for 0.5% of all pituitary tumors in the registry. The mean age of the patients was 64 years. Breast cancer was identified as the primary tumor in 25% of total cases (n = 24/96) and in 50% of female patients. The second most prevalent primary tumor was lung cancer (18.75%, n = 18/96), followed by renal cell carcinoma (14.58%, n = 14/96). In comparison to current meta-analyses, this cohort shows a higher prevalence of metastases originating from the kidney. Furthermore, in contrast to the existing literature, no case of primary thyroid tumor was identified. Our study highlights the importance of pituitary metastases as a differential diagnosis in patients presenting with pituitary tumors.

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Stereotactic radiosurgery for pituitary and cavernous sinus metastases

Cited by 3 publications

References 20 publications

Modern Stereotactic Radiotherapy for Brain Metastases from Lung Cancer: Current Trends and Future Perspectives Based on Integrated Translational Approaches

Modern Stereotactic Radiotherapy for Brain Metastases from Lung Cancer: Current Trends and Future Perspectives Based on Integrated Translational Approaches

Treatment outcome of metastasis to the pituitary gland: a case series of 21 patients with pathological diagnosis

Metastases to the pituitary gland: insights from the German pituitary tumor registry

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