Outcomes Associated With Stereotactic Radiosurgery After Multiple Resections of Nonfunctioning Pituitary Macroadenomas: An International, Multicenter Case Series

Dayton Grogan¹, Chloe Dumot^{1

2}, Georgios Mantziaris¹, Salem M Tos¹, Anant Tewari³, Sam Dayawansa¹, Kimball Sheehan¹, Darrah Sheehan¹, Selcuk Peker⁴, Yavuz Samanci⁴, Ahmed M Nabeel^{5

6}, Wael A Reda^{5

7}, Sameh R Tawadros^{5

7}, Khaled AbdelKarim^{5

8}, Amr M N El-Shehaby^{5

7}, Reem M Emad^{5

9}, Ahmed Ragab Abdelsalam¹⁰, Roman Liscak¹¹, Jaromir May¹¹, Elad Mashiach¹², Fernando De Nigris Vasconcellos¹², Kenneth Bernstein¹³, Douglas Kondziolka¹², Herwin Speckter¹⁴, Ruben Mota¹⁴, Anderson Brito¹⁴, Shray Kumar Bindal¹⁵, Ajay Niranjan¹⁵, L Dade Lunsford¹⁵, Carolina Gesteira Benjamin¹⁶, Timoteo Abrantes de Lacerda Almeida¹⁷, David Mathieu¹⁸, Jean-Nicolas Tourigny¹⁸, Manjul Tripathi¹⁹, Joshua David Palmer²⁰, Jennifer Mao¹⁶, Jennifer Matsui²⁰, Joseph Crooks²¹, Rodney E Wegner²², Matthew J Shepard²³, Jason Sheehan¹

Affiliations

¹ Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA.
² Department of Neurological Surgery, Hospices civils de Lyon, Lyon , France.
³ University of Virginia School of Medicine, Charlottesville , Virginia , USA.
⁴ Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey.
⁵ Gamma Knife Center Cairo, Nasser institute Hospital, Cairo , Egypt.
⁶ Neurosurgery Department, Faculty of Medicine, Benha University, Qalubya , Egypt.
⁷ Department of Neurosurgery, Ain Shams University, Cairo , Egypt.
⁸ Department of Clinical Oncology, Ain Shams University, Cairo , Egypt.
⁹ Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo , Egypt.
¹⁰ Neurosurgery Department, Military Medical Academy, Cairo , Egypt.
¹¹ Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague , Czech Republic.
¹² Department of Neurosurgery, NYU Langone, New York , New York , USA.
¹³ Department of Radiation Oncology, NYU Langone, New York , New York , USA.
¹⁴ Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo , Dominican Republic.
¹⁵ Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA.
¹⁶ Department of Neurosurgery, University of Miami, Miami , Florida , USA.
¹⁷ Department of Radiation Oncology, University of Miami, Miami , Florida , USA.
¹⁸ Division of Neurosurgery, Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke , Quebec , Canada.
¹⁹ Departments of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh , India.
²⁰ Department of Radiation Oncology, The James Cancer Hospital at The Ohio State University, Columbus , Ohio , USA.
²¹ Drexel University College of Medicine, Philadelphia , Pennsylvania , USA.
²² Allegheny Health Network Cancer Institute and Allegheny Health Network, Pittsburgh , Pennsylvania , USA.
²³ Department of Neurosurgery, Allegheny Health Network, Pittsburgh , Pennsylvania , USA.

PMID: 39508579
DOI: 10.1227/neu.0000000000003262

Multicenter Study

Outcomes Associated With Stereotactic Radiosurgery After Multiple Resections of Nonfunctioning Pituitary Macroadenomas: An International, Multicenter Case Series

Dayton Grogan et al. Neurosurgery. 2024.

. 2024 Nov 7;97(1):182-190.

doi: 10.1227/neu.0000000000003262.

Authors

Affiliations

¹ Department of Neurological Surgery, University of Virginia, Charlottesville , Virginia , USA.
² Department of Neurological Surgery, Hospices civils de Lyon, Lyon , France.
³ University of Virginia School of Medicine, Charlottesville , Virginia , USA.
⁴ Department of Neurosurgery, Koc University School of Medicine, Istanbul , Turkey.
⁵ Gamma Knife Center Cairo, Nasser institute Hospital, Cairo , Egypt.
⁶ Neurosurgery Department, Faculty of Medicine, Benha University, Qalubya , Egypt.
⁷ Department of Neurosurgery, Ain Shams University, Cairo , Egypt.
⁸ Department of Clinical Oncology, Ain Shams University, Cairo , Egypt.
⁹ Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo , Egypt.
¹⁰ Neurosurgery Department, Military Medical Academy, Cairo , Egypt.
¹¹ Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague , Czech Republic.
¹² Department of Neurosurgery, NYU Langone, New York , New York , USA.
¹³ Department of Radiation Oncology, NYU Langone, New York , New York , USA.
¹⁴ Dominican Gamma Knife Center and Radiology Department, CEDIMAT, Santo Domingo , Dominican Republic.
¹⁵ Department of Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA.
¹⁶ Department of Neurosurgery, University of Miami, Miami , Florida , USA.
¹⁷ Department of Radiation Oncology, University of Miami, Miami , Florida , USA.
¹⁸ Division of Neurosurgery, Centre de recherche du CHUS, Université de Sherbrooke, Sherbrooke , Quebec , Canada.
¹⁹ Departments of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh , India.
²⁰ Department of Radiation Oncology, The James Cancer Hospital at The Ohio State University, Columbus , Ohio , USA.
²¹ Drexel University College of Medicine, Philadelphia , Pennsylvania , USA.
²² Allegheny Health Network Cancer Institute and Allegheny Health Network, Pittsburgh , Pennsylvania , USA.
²³ Department of Neurosurgery, Allegheny Health Network, Pittsburgh , Pennsylvania , USA.

PMID: 39508579
DOI: 10.1227/neu.0000000000003262

Abstract

Background and objectives: Stereotactic radiosurgery (SRS) represents an effective treatment for nonfunctioning pituitary adenomas (NFPAs). However, no data have yet been published regarding results of SRS on NFPAs after multiple previous resections.

Methods: Retrospective multicentric data of patients diagnosed with NFPA and who underwent multiple resections (≥2) before SRS were reviewed and analyzed. The treatment interval spanned the period of 1992 to 2022. Cox regression and Kaplan-Meier curves were used to assess predictive factors and the probability of tumor control and hypopituitarism.

Results: Among the 311 patients (median age: 50.2 [IQR: 18.0] years), 226 (72.7%) had undergone ≥2 previous resections. The median margin dose was 14 Gy (IQR: 4.0 Gy), and the median tumor volume 3.6 cm 3 (IQR: 4.8). Overall, the probability of tumor control after SRS was 93.3% (CI 95%: 89.9-96.9) and 86.7% (CI 95%: 81.1-92.6) at 5 and 10 years, respectively. A margin dose >14 Gy was associated with a decreased risk of tumor progression (hazard ratio = 0.33, CI 95% = 0.15-0.75, P = .008). At a last clinical follow-up of 4.1 (IQR 6.1) years, 10.1% (30/296) developed at least 1 new hormone deficiency after SRS. The cumulative probability of new hormone deficiency was 6.1% (95% CI: 3.0-9.1), 10.3% (95% CI: 5.8-14.6), and 18.9% (95% CI: 11.5-25.8) at 3, 5, and 10 years after SRS, respectively. The average latency between SRS and development of new hormone deficiencies was 3.3 years (IQR 4.1). A maximum point dose to the pituitary stalk >10 Gy was associated with a new deficiency (hazard ratio = 4.06, CI 95% = 1.57-10.5, P -value = .004).

Conclusion: For patients with NFPA with multiple previous resections, SRS offers effective local tumor control and a low risk of delayed hypopituitarism for managing these challenging adenomas. SRS should be strongly considered in patients with NFPA with 2 previous resections compared with considering a third resection.

Keywords: Hypopituitarism; Nonfunctioning; Pituitary adenoma; Pituitary neuroendocrine tumors; Resection; Stereotactic radiosurgery.

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References

1. Pomeraniec IJ, Kano H, Xu Z, et al. Early versus late Gamma Knife radiosurgery following transsphenoidal surgery for nonfunctioning pituitary macroadenomas: a multicenter matched-cohort study. J Neurosurg. 2018;129(3):648-657.
1. Sheehan J, Lee C-C, Bodach ME, et al. 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-e540.
1. Bodhinayake I, Ottenhausen M, Mooney MA, et al. Results and risk factors for recurrence following endoscopic endonasal transsphenoidal surgery for pituitary adenoma. Clin Neurol Neurosurg. 2014;119:75-79.
1. Sheehan JP, Kondziolka D, Flickinger J, Lunsford LD. Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma. J Neurosurg. 2002;97(5 Suppl):408-414.
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Outcomes Associated With Stereotactic Radiosurgery After Multiple Resections of Nonfunctioning Pituitary Macroadenomas: An International, Multicenter Case Series

Affiliations

Outcomes Associated With Stereotactic Radiosurgery After Multiple Resections of Nonfunctioning Pituitary Macroadenomas: An International, Multicenter Case Series

Authors

Affiliations

Abstract

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical